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Simulated Patients. Valuing the patient voice in medical education. Teaching, research and evaluation Interactive aspects of the consultations: - communication and interpersonal skills - diagnostic and management processes - physical examination
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Simulated Patients Valuing the patient voice in medical education
Teaching, research and evaluation • Interactive aspects of the consultations: - communication and interpersonal skills - diagnostic and management processes - physical examination • Feedback, formative and summative assessment by MEs +/- SPs
History and evolution • 1962 - neurological examination training – Howard Barrows. • Early 1970s –behavourally based rating scale of basic clinical skills – Paula Stillman. • 1970s – Patient instructors: real patients as teachers and formative assessors.
History and Evolution • 1980s – Summative assessment (performance based examinations). • 1980s / 1990s – research into SPs establishes reliability and validity. • By 1993 80% of U.S. medical schools use SPs in teaching and assessment.
Miller’s developmental stages Knows = Knowledge Knows how = Competence: knowing how to use knowledge Shows how = Performance: demonstrating how knowledge is used Does = Independent action
Terminology • Simulated patients
Terminology • Simulated patients • Standardized patients
Terminology • Simulated patients • Standardized patients • Surrogate / Substitute patients
Terminology • Simulated patients • Standardized patients • Surrogate / Substitute patients • Actors
Terminology • Simulated patients • Standardized patients • Surrogate / Substitute patients • Actors • Clinical Teaching Associates
Attributes of Effective SPs • Commitment to training Healthcare providers
Attributes of Effective SPs • Commitment to training Healthcare providers • Positive regard for Health care providers and students
Attributes of Effective SPs • Commitment to training Healthcare providers • Positive regard for Health care providers and students • Motivation and Enthusiasm
Attributes of Effective SPs • Commitment to training Healthcare providers • Positive regard for Health care providers and students • Motivation and Enthusiasm • Availability, reliability and punctuality
Attributes of Effective SPs • Commitment to training Healthcare providers • Positive regard for Health care providers and students • Motivation and Enthusiasm • Availability, reliability and punctuality • Good communication skills
Attributes of Effective SPs • Commitment to training Healthcare providers • Positive regard for Health care providers and students • Motivation and Enthusiasm • Availability, reliability and punctuality • Good communication skills • Acting skills
Attributes of Effective SPs • Commitment to training Healthcare providers • Positive regard for Health care providers and students • Motivation and Enthusiasm • Availability, reliability and punctuality • Good communication skills • Acting skills • Ability to “de-role”
Attributes of Effective SPs • Commitment to training Healthcare providers • Positive regard for Health care providers and students • Motivation and Enthusiasm • Availability, reliability and punctuality • Good communication skills • Acting skills • Ability to “de-role” • Ability to be trained
Advantages • Availability
Advantages • Availability • Custom-made cases
Advantages • Availability • Custom-made cases • Realism
Advantages • Availability • Custom-made cases • Realism • Standardization
Advantages • Availability • Custom-made cases • Realism • Standardization • Responsive consistency
Advantages • Availability • Custom-made cases • Realism • Standardization • Responsive consistency • Reducing risk to real patients
Advantages • Availability • Custom-made cases • Realism • Standardization • Responsive consistency • Reducing risk to real patients • Transition
Advantages • Availability • Custom-made cases • Realism • Standardization • Responsive consistency • Reducing risk to real patients • Transition • Relative safety for learners
Educational Opportunities • Exploration / observation of alternative approaches
Educational Opportunities • Exploration / observation of alternative approaches • Direct feedback - Immediate, descriptive, relevant, specific and constructive - From the patient’s perspective - As teachers
Educational Opportunities • Exploration / observation of alternative approaches • Direct feedback - Immediate, descriptive, relevant, specific and constructive - From the patient’s perspective - As teachers • Pause, rewind, fast forward, replay: analysis and rehearsal
Educational Opportunities • Exploration / observation of alternative approaches • Direct feedback - Immediate, descriptive, relevant, specific and constrictive - From the patient’s perspective - As teachers • Pause, rewind, fast forward, replay: analysis and rehearsal • Focus on process skills
Barriers • Scepticism re realism and student acceptance
Barriers • Scepticism re realism and student acceptance • Questions re reliability and validity
Barriers • Scepticism re realism and student acceptance • Questions re reliability and validity • Increased complexity, duration and cost of teaching sessions
Barriers • Scepticism re realism and student acceptance • Questions re reliability and validity • Increased complexity, duration and cost of teaching sessions • Power challenges
“If we could all just learn to listen, everything else would fall into place. Listening is the key to being patient centered.” Ian McWhinney (cited in Kelly 1998)