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A needs analysis for a Standardised Patient programme at an African medical school

Authors

Cathi Draper
Lindsey Aubin
Gail Edelstein
Natalie Moller
Rachel Weiss

Theme

Simulation and Simulated Patients

INSTITUTION

University of Cape Town

Background

Many African medical schools rely on utilizing real patients for undergraduate clinical skills training due to cost. However, third year students in this tertiary hospital increasingly complain of struggling to find sufficient numbers of patients willing and well enough to handle multiple examinations by junior students. The study aims to investigate the validity of students’ complaints and to explore whether a formalized Standardized Patient (SP) Programme should be developed to provide additional clinical learning opportunities. Since the curriculum has a patient-centered Primary Health Care orientation, the SP is conceptualized as a knowledgeable ‘Patient Partner’ with the ability to teach.

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Summary of Work

Data is collected through quantitative tracking of patient-student encounters, through focus groups and questionnaires with students, and through interviews with patients.

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Summary of Results

The data confirms significant challenges in sourcing ward patients. However, most students report that the value of interviewing and examining real patients outweighs the challenges, and suggest that skills practice with Patient Partners should rather be included in the pre-clinical years. With regard to bed-side teaching, students prefer traditional doctor-led tutorials to teaching by experienced Patient Partners. The data also reveals tension between what the students believe about real patients’ health rights and students’ need for interviewing and examining the small cohort of available patients. While some patients may feel pressured, all prioritize students’ need to learn.

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Conclusion

In exploring students’ views on and needs for additional clinical learning opportunities, the study uncovers ambiguity and compromises regarding patients’ rights, and doctor-centered approaches to clinical learning. These findings challenge the Primary Health Care principles on which the curriculum is based. While the need for real patients remain, the challenge of transferring a patient-centered philosophy from classroom to ward practice is forgrounded.

Take-home Messages

A SP Programme may not be the best solution to address the need for providing additional clinical learning opportunities for 3^rd year students. However, developing a patient-centered ‘Patient Partner Programme’ for pre-clinical students may provide opportunities not only to practice clinical skills before they go to the wards, but also to explore human rights and relationships of power in the clinical context.

Acknowledgement

Thanks to the students and patients who partcicipated in this study, and to Callen Byrnes who created the illustrations

References

The full article will be published in the African Journal of Health Professions Education

Summary of Work

1. Qualitative tracking of student-patient encounters

Over a 6-week period, four groups of 3^rd year students (n=50) go to the wards one day a week. They are expected to interview and examine 15 patients during this time. Clinical nurse educators go to the wards every morning to identify suitable patients and ask the patient’s permission to be seen by junior students during the day. The names of patients who consented are given to the students.

Data that was collected after student-patient encounters:

· How many patients gave consent to Clinical Nurse Educators?

· How many refused to see students after initial consent?

· How many gave consent but were not available at the time of examination?

2. Focus group questions for 4^th year students

Three focus group discussions were done with 4^th year students. This cohort was chosen because they already had significant ward exposure to both real patients and Rheumatology SPs. Discussions were audio recorded, transcribed and a process of constant comparative analysis was used to identify themes.

The following questions were asked:

· What can you tell me about working with patients during your third year?

· Explain some of the challenges you experienced in finding patients to examine.

· Did you ever feel like you were putting patients under pressure?

· Do you ever feel that in the pursuit of finding patients to examine, that the rights of patients were not being upheld / their dignity was not retained?

· What roles do you think patients should play in an academic hospital?

· What advantages could there be to a standardised patient programme in the MBChB curriculum?

· Would there be any disadvantages to such a programme?

· What recommendations would you make for the development of such a programme?

3. Questionnaire for 3^rd year students

Based on themes identified in focus groups, a self-administered questionnaire was developed for 3^rd year students and analysed for frequencies. A total of 181 students completed the survey (97% response rate).

How would you describe your experience of interacting with the selected ward patients?	Never	Sometimes	Often
1. I felt like I was pressurising / harassing patients, because they were not willing to speak to me
2. Real ward patients made a big difference in improving my history taking and clinical examination skills
3. I felt like I wasted a lot of time looking for patients

What challenges did you experience while looking for and interacting with ward patients?	Never	Sometimes	Often
4. There weren’t enough patients for all the students to see
5. There wasn’t enough time to see all the patients
6. Patients were too sick or confused to speak to us
7. Patients were too tired to speak to us, or were sleeping
8. Patients were not there when we went to look for them
9. I couldn’t understand or speak the patients’ home language

Give your opinion on the following questions:	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
10. The benefit of interacting with real patients in the wards (rather than the ideal SP) is worth the frustration of and the time spent looking for suitable patients
11. Even though it is an unavoidable part of medical training, I feel that repeated examinations by students infringe on real patients’ human rights
12. A knowledgeable SP can replace a clinical tutor to teach a particular topic
13. Please write any comments: