ePoster
Abstract Title | Is it better to use teachers or patient support group volunteers as surrogate patients to train students in clinical problem solving?

Authors

  1. Weng-Yee Chin
  2. Julie Chen
  3. Amber Yip
  4. Vivian Chau

Theme

7II Simulation and Simulated Patients

INSTITUTION

The University of Hong Kong - Department of Family Medicine & Primary Care
The University of Hong Kong - Institute for Medical and Health Sciences Education

Background

Medical training has traditionally relied heavily on direct patient contact, usually in the context of bed-side or clinical teaching. Early introduction of patient contact can increase student motivation and student confidence to interview patients, and can help ease the transition from preclinical to clinical training 1,2. There is evidence that patient interaction helps students build integrated skills for clinical reasoning, communication, history taking and physical examination 1,3,4. Unfortunately in recent years, several factors have resulted in a reduction in the availability of real patients for the teaching and learning of medicine5. Furthermore, the need to protect patients from unnecessary harm 6,7, has further limited the nature and types of patient-student interactions, particularly for relatively inexperienced learners. On top of all this, increasing class sizes have raised issues regarding "patient fatigue" which may result from limited patients being inundated by large numbers of students. One strategy to help overcome these problems has been the introduction of ‘simulated’ patients for the training of health professionals 8.

Simulated patients are individuals trained to present as patients. There are many well documented benefits for using simulated patients in health professions training as it allows teachers to manage and control many aspects of the clinical learning environment, including programming, level of content, environment, ethics and safety, economy and reproducibility 9.

Although simulated patients are widely used in medical education 3, details on the recruitment of volunteers for simulated patient teaching programs is limited. Examples in the literature have included recruitment through acting schools, local newspapers, retirement, community organizations, disease-focused foundations, theatre groups, outpatient settings and general practice 10-13. There is very little information on whether patient support groups (PSGs) may be a useful source of volunteers for simulated patient programs.

A patient support group is an association of people sharing common interests and experiences, and may include individuals with common disease conditions (‘patients’), as well as their carers or families. These groups may be independently run, or in affiliation with another organization such as healthcare or charitable organizations. PSGs provide an environment to share information and discuss ways to cope with the challenges of living with disease and usually offer a variety of activities or services. We believe that patient support group members are a potentially valuable source of volunteers for medical student training, as these individuals are real patients with a wealth of experience in dealing with healthcare workers.

As there is very little information available regarding the use of PSGs as resources for medical student training, and in particular as a potential source of volunteers for a simulated patient program, it is the aim of this study to explore the willingness and ways PSGs can assist in recruitment of volunteers (real patients and their family members) for a simulated patient medical education program.

Summary of Work

This was a mixed method study using a two-armed quasi-experimental study design to evaluate the effectiveness of the workshop, and qualitative methods to examine the student’s and patient volunteers’ perceptions of the learning activity.

From 2012-2013, all Year 3 medical students at the University of Hong Kong who participated in the Problem Solving Workshop during the Family Medicine rotation were invited to take part in the study. The study design is shown in Figure 1.

Figure 1. Research design

Four case scenarios were drafted; one for each volunteer based a previous medical encounter. Half the students were randomly allocated into the intervention group where patient volunteers role-played themselves. The other half were allocated to be in the control group where workshop facilitators role-played the same four case scenarios.

Our volunteers were recruited from various patient support groups. These volunteers were individuals with rich illness experiences and who had already been active in patient advocacy as part of their involvement in patient support group activities. The volunteers were screened by phone then interviewed in person to assess for suitability and for development of case scenarios. The volunteers were trained by practising mock interviews with a teaching assistant.

An outline of the workshop is shown in Figure 2. Students in all workshops underwent pre-post assessments by completing a Medical Record Form (Figure 3) based on a two video-taped consultations. Students were also evaluated in an end-of-rotation Objective Structured Clinical Examination (OSCE).

Figure 2. Outline of the workshops

Figure 3. Medical record form

Following with workshop, all students provided written feedback by completing a workshop evaluation form. Students participating in the intervention group were asked to provide specific feedback regarding their learning experiences during a small-group debriefing session.

Volunteers were interviewed one-on-one briefly after each workshop.

Summary of Results

Six groups of 26-28 students participated (response rate 100%). Students’ ability to complete the Medical Record Form improved after the workshop in both groups, although the intervention group had a higher mean improvement (Table 1). There was no difference in OSCE scores between groups.

Table 1. Descriptive statistics of pre-test and post-test scores

Descriptive statistics of pre-test and post-test scores

Paired samples t-test was performed to test whether there was a difference of pre-test and post-test score on Medical Record Form before and after the workshop.

Feedback from the volunteers who participated was positive. They appreciated sharing the story of their own lives and conditions. Contributing to the training of future doctors also gave them a sense of empowerment14,15. They were willing to continue participating in workshops so long as they did not have other conflicting commitments such as medical appointments to attend. The greatest barrier for them was the looming threat of future deteriorations to their health which may necessitate hospitalization.

Feedback from students was also predominantly positive with many reporting increased confidence and reduced anxiety in asking patients about their ideas and concerns about their symptoms, as well as what the patients expected from the medical consultation. Students enjoyed the ‘real patient’ interaction, especially the constructive feedback on communication skills and their sharing of illness experiences. Students also valued the direct feedback on their own performances as it helped them to identify their strength and weakness, and gave them better insight about how they appeared to patients.

“Having real patients for interview, this gives us a very good opportunity to practice and reflect on how we are doing. This helps us gain confidence and improve our skills.”

“A very good opportunity for us to have adequate practice. Feedback session was particularly useful, reminds me to have more eye contact, and now I understand more of patient's feelings”

Conclusion

Role playing is an effective approach for problem-solving training. Use of patient-educators enhances the student learning experience. It fosters better student confidence and skill, and enhances awareness of interpersonal behaviours such as eye contact and empathy. Patient volunteers appreciate the opportunity to contribute to training future doctors.

Take-home Messages

Structured learning opportunities with patient educators can benefit both students and patients.

References
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  2. Littlewood S, Ypinazar V, Margolis SA, Scherpbier A, Spencer J, Dornan T. Early practical experience and the social responsiveness of clinical education: systematic review. BMJ. 2005;331(7513):387.
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  10. Cleland JA, Abe K, Rethans JJ. The use of simulated patients in medical education: AMEE Guide No 42 1. Medical Teacher. 2009;31(6):477-486.
  11. Everett MR, May W, Nowels CT, Main DS. Recruitment, Retention, and Training of African American and Latino Standardized Patients: A Collaborative Study. JIAMSE. 2005;15:74-80.
  12. Ker JS, Dowie A, Dowell J, et al. Twelve tips for developing and maintaining a simulated patient bank. Medical Teacher. 2005;27(1):4-9.
  13. King AM, Perkowski-Rogers LC, Pohl HS. Planning standardized patient programs: case development, patient training, and costs. Teaching and learning in medicine. 1994;6(1):6-14.
  14. Stacy R, Spencer J. Patients as teachers: a qualitative study of patients' views on their role in a community-based undergraduate project. Medical Education. 1999;33(9):688-694.
  15. Wykurz G, Kelly D. Developing the role of patients as teachers: literature review. BMJ. 2002;325(7368):818.
Acknowledgement

This study was funded by the Faculty Development Fund, Li Ka Shing Faculty of Medicine, the University of Hong Kong.

Background
Summary of Work
Summary of Results
Conclusion
Take-home Messages
References
Acknowledgement
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