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Simulated Patients

Simulated Patients

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Simulated Patients

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  1. Simulated Patients Valuing the patient voice in medical education

  2. Teaching, research and evaluation • Interactive aspects of the consultations: - communication and interpersonal skills - diagnostic and management processes - physical examination • Feedback, formative and summative assessment by MEs +/- SPs

  3. History and evolution • 1962 - neurological examination training – Howard Barrows. • Early 1970s –behavourally based rating scale of basic clinical skills – Paula Stillman. • 1970s – Patient instructors: real patients as teachers and formative assessors.

  4. History and Evolution • 1980s – Summative assessment (performance based examinations). • 1980s / 1990s – research into SPs establishes reliability and validity. • By 1993 80% of U.S. medical schools use SPs in teaching and assessment.

  5. Miller’s developmental stages Knows = Knowledge Knows how = Competence: knowing how to use knowledge Shows how = Performance: demonstrating how knowledge is used Does = Independent action

  6. Terminology • Simulated patients

  7. Terminology • Simulated patients • Standardized patients

  8. Terminology • Simulated patients • Standardized patients • Surrogate / Substitute patients

  9. Terminology • Simulated patients • Standardized patients • Surrogate / Substitute patients • Actors

  10. Terminology • Simulated patients • Standardized patients • Surrogate / Substitute patients • Actors • Clinical Teaching Associates

  11. Attributes of Effective SPs • Commitment to training Healthcare providers

  12. Attributes of Effective SPs • Commitment to training Healthcare providers • Positive regard for Health care providers and students

  13. Attributes of Effective SPs • Commitment to training Healthcare providers • Positive regard for Health care providers and students • Motivation and Enthusiasm

  14. Attributes of Effective SPs • Commitment to training Healthcare providers • Positive regard for Health care providers and students • Motivation and Enthusiasm • Availability, reliability and punctuality

  15. Attributes of Effective SPs • Commitment to training Healthcare providers • Positive regard for Health care providers and students • Motivation and Enthusiasm • Availability, reliability and punctuality • Good communication skills

  16. Attributes of Effective SPs • Commitment to training Healthcare providers • Positive regard for Health care providers and students • Motivation and Enthusiasm • Availability, reliability and punctuality • Good communication skills • Acting skills

  17. Attributes of Effective SPs • Commitment to training Healthcare providers • Positive regard for Health care providers and students • Motivation and Enthusiasm • Availability, reliability and punctuality • Good communication skills • Acting skills • Ability to “de-role”

  18. Attributes of Effective SPs • Commitment to training Healthcare providers • Positive regard for Health care providers and students • Motivation and Enthusiasm • Availability, reliability and punctuality • Good communication skills • Acting skills • Ability to “de-role” • Ability to be trained

  19. Advantages • Availability

  20. Advantages • Availability • Custom-made cases

  21. Advantages • Availability • Custom-made cases • Realism

  22. Advantages • Availability • Custom-made cases • Realism • Standardization

  23. Advantages • Availability • Custom-made cases • Realism • Standardization • Responsive consistency

  24. Advantages • Availability • Custom-made cases • Realism • Standardization • Responsive consistency • Reducing risk to real patients

  25. Advantages • Availability • Custom-made cases • Realism • Standardization • Responsive consistency • Reducing risk to real patients • Transition

  26. Advantages • Availability • Custom-made cases • Realism • Standardization • Responsive consistency • Reducing risk to real patients • Transition • Relative safety for learners

  27. Educational Opportunities • Exploration / observation of alternative approaches

  28. Educational Opportunities • Exploration / observation of alternative approaches • Direct feedback - Immediate, descriptive, relevant, specific and constructive - From the patient’s perspective - As teachers

  29. Educational Opportunities • Exploration / observation of alternative approaches • Direct feedback - Immediate, descriptive, relevant, specific and constructive - From the patient’s perspective - As teachers • Pause, rewind, fast forward, replay: analysis and rehearsal

  30. Educational Opportunities • Exploration / observation of alternative approaches • Direct feedback - Immediate, descriptive, relevant, specific and constrictive - From the patient’s perspective - As teachers • Pause, rewind, fast forward, replay: analysis and rehearsal • Focus on process skills

  31. Barriers • Scepticism re realism and student acceptance

  32. Barriers • Scepticism re realism and student acceptance • Questions re reliability and validity

  33. Barriers • Scepticism re realism and student acceptance • Questions re reliability and validity • Increased complexity, duration and cost of teaching sessions

  34. Barriers • Scepticism re realism and student acceptance • Questions re reliability and validity • Increased complexity, duration and cost of teaching sessions • Power challenges

  35. “If we could all just learn to listen, everything else would fall into place. Listening is the key to being patient centered.” Ian McWhinney (cited in Kelly 1998)