The Simulated Patient Handbook

A Comprehensive Guide for Facilitators and Simulated Patients

Fiona Dudley

• Publisher: CRC Press
• Year: 2018
• Print ISBN:
  9781846194542
• eBook ISBN:
  9781315346434
• Topic: Medicine
• Subtopic: Evaluation & Assessment in Education

A simulated patient is an individual who, by pretending to be a patient in a consultation, offers health professionals an opportunity to learn, explore and develop their expertise. Simulated patients are also highly effective when used as an aid for consultation skills assessment. In recent years the rapid rise of simulated patients in healthcare training has led to many more people working as and with simulated patients. There is now a growing need for guidance on its benefits and also its potential complications. The Simulated Patient Handbook is full of practical, hands-on advice and procedures for simulated patients covering all aspects of their work. It includes comprehensive guidelines on the essential skills of characterisation and the giving of feedback. This is the only manual currently available for simulated patients to learn best practice. The wide-ranging, accessible reference also offers concise, realistic advice to facilitators about setting up, running and participating in sessions using simulated patients - using this extroadinary educational resource to its greatest advantage.

PART ONE

Background

I hear and I forget

I see and I remember.

I do and I understand.

Confucius (551–479 BC)

CHAPTER 1

So you want to join the world of the simulated patient?

There can be no such thing as ‘The Definitive Guide’ to working as or with a simulated patient. There are so many potential situations you may encounter, so many variations of ways in which you can work, that it would be impossible to cover every aspect of the work in one small tome. This handbook is intended to give you an insight into the world of consultation skills training using simulated patients, from all perspectives, and to give facilitators and simulators alike some guidelines and practical advice about how best to manage such opportunities. It provides useful information and ideas for further development of your own skills and it should inspire you to continue to explore the creative potential of working with simulated patients.

Assuming that you chose this book with a particular aim in mind, rather than just randomly selecting it from the bookshelf for a good bedtime read (it could be a bit thin on the plot line!), you probably have some idea of what simulated patients are and what they can do. However, opinions are usually formed from experience, and so if you have only encountered simulated patients in limited settings such as examination situations or undergraduate medical education sessions, you could be surprised at the versatility of simulated patients as a resource. Therefore, for the sake of clarity, I will attempt a brief definition that will be expanded throughout the book as we explore the different areas of potential work with simulated patients.

WHAT EXACTLY IS A SIMULATED PATIENT?

A simulated patient is a person who pretends to be a patient (or, indeed, as we shall see, a relative or even a health practitioner), simulating health problems in order to offer health professionals an opportunity to develop, practise and be assessed on their consultation skills and providing feedback.

A simulated patient is an ordinary person (the green antennae only develop with experience!). The simulated patient may be young or old, fat or thin, tall or short, black, white or grey. They may have no drama training whatsoever or they may be a trained actor. They may have some medical knowledge or none at all. They may have qualifications coming out of their ears or they may have left school after 11 years of playing hookey.

Potential simulated patients

Basically, whatever a persons physical or psychological attributes, whatever their educational or professional experience, they have the potential to work as a simulated patient. Because patients are drawn from a whole cross-section of society, this diversity needs to be reflected in the variety of people working as simulated patients.

To say that everybody has the potential to become a simulated patient is not, however, to say that everybody has the potential to be an effective simulated patient. There are certain personal attributes that are essential, and others that are highly desirable, for the people to have who wish to carry out this work. Some of these are innate personal qualities; others may be acquired and developed through training and experience.

Simulated patients are asked to do many different kinds of work, from examinations for medical students to interviews for practice managers in surgeries, from ‘mystery shopper’ customer service training for pharmacists to breaking bad news for people working in hospices. The ways in which simulated patients may be used are limited only by the imagination. Each different way of working requires certain particular qualities from the simulated patient, as we shall soon see.

AND WHAT DO YOU DO WITH ONE?

The use of simulated interactions as a method of teaching consultation skills has gained immensely in popularity over the last few years. As a consequence, it happens increasingly that people who have little or no experience of working with simulated patients in their teaching are finding themselves in the exciting, if somewhat daunting, position of facilitating a simulated patient session.

It may be that you are a clinician who has been asked to carry out some consultation skills training with your colleagues. Perhaps you work in higher education with healthcare students and need to facilitate one of the increasing number of communication sessions within the modern curriculum. It may be that you have worked as a simulated patient but never in the role of facilitator. Whatever the reason, you should realise that this is no ordinary teaching session and the effective facilitation of the simulated patient session requires no ordinary teaching skills!

Teaching using simulated patients is not so much an imparting of knowledge as an exploration, by a group of people, of a particular given situation, in the hope that the most effective strategies of dealing with the challenges presented will emerge. Therefore, teaching using simulated patients may require a different approach and attitude for those accustomed to a more didactic style of teaching. Generally speaking, as a teacher, you are usually able to thoroughly prepare the material you wish to present to the students - you can even practise the way in which you wish to present it. In the simulated patient session, you can prepare and practise your introduction, but beyond that you must be completely responsive to the situation and draw your teaching material from the interactions presented.

Although each consultation will have its own learning objectives, which the scenarios will have been developed to present, it is a wholly interactive teaching method. Neither the facilitator nor the participants can ever know exactly what will arise during the course of the session. It is vital, therefore, that you are flexible and creative enough to react to any given situation and that you are able to draw the learning points from what does arise, in a spontaneous fashion. Now, before you panic and decide to apply for a job at your local supermarket instead, try to consider the opportunity to work in this way as a unique and exciting challenge! With a little preparation and careful thought, and a lot of enthusiasm, you should find working with simulated patients a most fulfilling and rewarding exercise.

In this handbook, I will endeavour to give you some guidelines and direction, some advice and some top tips, to help you feel confident in approaching this challenge and ensure you get the most benefit from the session, for your group of practitioners and for yourself. There are, as in all aspects of work with simulated patients, no hard and fast rules. As I have mentioned, there are so many different ways simulated patients can be used in the teaching and assessment of consultation skills, it is impossible to give definitive approaches to any of the work. However, in this handbook I have aimed to give you as comprehensive a guide as possible to various potential ways of working with simulated patients, focusing in detail on the most common techniques and approaches. It is important that as you read this, perhaps with a view to running a session, you bear in mind the learning outcomes you are hoping to achieve and the nature of the group of people with whom you are working. Ideas and guidance are offered here to help you decide what will work best for you and your group, and to help you develop your own style and techniques, according to your own personality and experience. Explore and create!

WHERE ARE YOU FROM?

The art of teaching is

the art of assisting discovery.

Mark Van Doren (1894–1972)

People from many different backgrounds can facilitate simulated patient sessions. Your own background and experience will make a difference to the type of sessions you can most effectively facilitate, as well as obviously making a difference to how you run those sessions. There are no absolute dictates about this, as each session will be a unique venture. However, it is important that you are able to reflect honestly on yourself and your skills, to ensure that you have the relevant qualifications, experience and even personality to be effective in this role, before embarking on this challenge.

If you are a simulated patient from a drama background, for example, you may be very good at facilitating a forum session on managing conflict between professionals. However, the clinical support you would need to enable you to facilitate a management planning session for complex medical consultations, for example, may make the situation too challenging and therefore ineffective as a learning medium for practitioners. Equally, a palliative care consultant may be very skilled at facilitating a session on breaking bad news for medical students, but may find a forum session for receptionists on dealing with angry patients rather more challenging.

Therefore, before accepting the challenge of facilitation, it is important that you are very clear about the learning objectives of the session and the experience level of the group you are working with. Make an honest appraisal of your own capabilities and, if possible, only agree to facilitate those sessions that you feel confident of managing effectively.

If you are used to more didactic teaching methods, working with simulated patients can be a precarious experience. As an experienced teacher, even though you may be very clear about how different the job of facilitating a simulated patient session is, you may find it all too easy to slip back into the ‘imparting of information model. It may be more comfortable for you to pass on your own knowledge and experience to a group, but it is essential that you are awake to this process throughout the session. Your job is to facilitate their learning experience, not to ‘teach’ them how to do it. You should be encouraging each practitioner to analyse his or her own strengths and weaknesses. They can do this with the help and support of their colleagues within the group, and their analysis should be backed up, or disputed, by the simulated patient. You, as facilitator, can then further reinforce aspects of the consultations and identify any learning points that might have been missed in discussion. By encouraging them to work together to explore different options and to find their own solutions, you will be a more effective educator than if you continually give them your own opinions. This is not to say that you should not share some of your own experience and knowledge with the group; however, the more involved they can be in their own learning process, the more robust the learning will be.

JARGON BUSTER AND GLOSSARY OF TERMS

Think like a wise man
but communicate in the
language of the people.

William Butler Yeats (1865–1939)

One aspect of consultation skills that is often highlighted during training sessions involving simulated patients is the use of jargon. For clarity’s sake I will define here the basic terms I have used in this book. A more comprehensive and alphabetised ‘jargon buster’ can be found in Appendix 1.

Simulated patient – I hope you will be aware of what a simulated patient is by the time you have read this handbook … but you should be aware that they may also be called an SP, a role player, a patient teacher, a simulator, an actor, a standardised patient, a character, a patient, a co-facilitator, a programmed patient, a clinical teaching associate, a co-teacher … and probably a host of other names we shan’t go into here! I have used the terms ‘simulated patient’ and ‘simulator’ when talking about teaching sessions and the term standardised patient’ when describing the simulated patient in an assessment situation.

Facilitator – the facilitator is the person who is coordinating the session. They are responsible for guiding the simulated patient and the group of learners in order to bring out learning points relevant to the aims of the session. The facilitator may have a completely different role outside the session (e.g. doctor, teacher, nurse, service user, or they may be from any number of other professions or have any number of other experiences). Although their role outside the session will obviously influence the way it is conducted, within the session they are there primarily to facilitate the learning of the group members.

Feedback – this is the means by which the simulated patient, the facil...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• About the author
• Acknowledgements
• Dedication Page
• Part One: Background
• Part Two: Preparation
• Part Three: Managing the session
• Part Four: Assessment and other uses of simulated patients
• Appendix 1: Consultation skills advanced jargon buster
• Appendix 2: Sample scenario briefs
• Appendix 3: Resources for role development
• Appendix 4: A list of mood indicators
• Appendix 5: Communication skills
• Appendix 6: Six Hats Exercise – Edward de Bono
• Appendix 7: Suggested further reading
• Index