Description

The Clinical Studies Unit has trained increasing numbers of 'actors' to be employed as simulated 'patients' for student training. While clinical staff of the hospitals were sceptical at first, there has been increasing acceptance that such surrogate patients can be remarkably good at presenting the symptoms and some of the physical signs of a range of diseases. Unlike true patients, trained surrogates are able to participate in the assessment of the students by providing feedback on interpersonal, English language and medical communication skills; and by providing the medical assessors with information on deficiencies in the range of questions considered as relevant to the simulated disease process, posed by students during history-taking with simulated patients.

Aims

• To standardise the 'patient' performance.
• To assist 'criterion' marking of students performance.
• To encourage self-directed learning.
• To enable student practice with feedback to be the norm.
  
  

Background

Because of the marked reduction in the average number of days spent in hospital by in-patients, it is rarely the case now that a patient spends the full period of an illness as an in-patient of a teaching hospital. Consequently, students have infrequent opportunities to follow the course of an illness in a single patient, and this makes it difficult for students in the earlier clinical years to gain the necessary matrix of clinical and pathological science, and for their knowledge level to be adequately assessed.

Process

The introduction of simulated patients for acquiring and assessing clinical skills has been a significant step forward in medical education at the University of Adelaide. This has been augmented by using the simulated patients for the preparation of demonstration videos for self-directed learning and assessment. These have been particularly valuable in demonstrating history-taking, the systematic examination of body systems, the undertaking of procedures (such as taking blood pressure), and in dealing with complex and sensitive issues such as the autopsy.

There are two main aspects of the Simulated Patients process:

• Standardising patients performance

  Following initial work on the scripts the simulated patients are video taped with a young physician posing as a good student. (Good students are often the ones that put surrogate patients on the spot.) This is followed by a debrief with all players and then everyone involved works on the scripts again in the light of the workshop experience.

• Enabling students to practice with patient feedback

  Students work in pairs with a surrogate patient. The encounter is videotaped. Immediate feedback is provided by the trained surrogate patient. Further feedback is provided from a tutor if the relevant video is provided and feedback requested.

Further Developments

Experience of the use of simulated patients for clinical teaching and assessment indicates that it is possible to advance beyond the subjective and qualitative assessments traditionally used to determine the clinical competence of medical students. Simulated patients are used in Objective Structured Clinical Examinations (OSCE), for standardised tests of clinical competence. Assessment of students for clinical competence increasingly uses the standardised approach.

Simulated patients are also used in Clinical Studies to provide additional training for students with a Language Background Other Than English (LABOTE).

Evaluation

The response of students in formal Student Evaluation of Teaching (SET) questionnaires has been very favourable. Evaluations of the benefits of surrogate patients have been extensively (and expensively!) undertaken overseas (see Barrows, 1993)

Reference

Barrows, H.S. (1993) An overview of standardised patients for teaching and evaluating clinical skills., Academic Medicine,Vol 68, No 6.

Research

for Simulated Patients: Training

for Simulated Patients: Research

last updated 2/8/01