Delirium is a serious condition that is under-recognised and undertreated in hospital inpatients. In order to redress this, enhancing the delivery of delirium education has been identified as a priority. Overcoming the practical challenges in developing suitable delirium specific educational resources may be achieved by using simulated patients (SPs) to emulate delirium. However, there is a paucity of understanding regarding the training of SPs for this specific role and, in particular, whether in the course of that training exposure to real patients with delirium is necessary. 

SPs were recruited from a well-established SP programme and a dedicated training programme was devised and delivered. This included exposing the SPs to real hospital inpatients with delirium, after which scenarios were rehearsed and filmed. All recruited SPs took part in a focus group discussion held prior to the real patient exposure and a further discussion subsequently followed. During these discussions, semi-structured interview questions were used to facilitate discussion about the training process. The recordings were transcribed verbatim and, using thematic analysis, the data was analysed.

Three main themes (being a simulated patient, preparedness for delirium role and effects of the role on the SP) were constructed into a conceptual framework that illustrates the relationships between those themes and their comprising subthemes. The significance of being a simulated patient with a life journey, past experiences and a sense of belonging influenced the readiness of the SPs for this unfamiliar role. Specifically impacting on their preparedness for enacting delirium was the acquisition of knowledge of the subject, scripting, and the significance they ascribed to their endeavours. The real patient exposure indirectly influenced this readiness by enhancing self-reported knowledge and understanding of delirium, and magnified the importance assigned by the SPs to their role. Additionally, seeing real patients also contributed to both the positive and negative effects of the role on the SPs themselves. 

When SPs are trained to emulate delirium there are many complex interacting factors that influence their training and perceptions of preparedness. Real patient exposure is a helpful adjunct but must be weighed against the potential negative impact on the SPs. Further work examining the authenticity of delirium portrayal is required. 

I would like to acknowledge Professor Alasdair MacLullich, Professor of Geriatric Medicine, The University of Edinburgh for his commitment to changing the delirium landscape that inspired this work.

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