Simulated PatientsValuing 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

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.

History and Evolution

Knows = Knowledge

Knows how = Competence: knowing how to use knowledge

Shows how = Performance: demonstrating how knowledge is used

Does = Independent action

Miller’s developmental stages

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

Terminology

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

Attributes of Effective SPs

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

Advantages

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

Educational Opportunities

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

Barriers

“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)