Using actors to simulate doctors in the continuing professional development of GP trainers and appraisers

When Old Habits Train a New Generation: Findings From a National Survey of Internal Medicine Program Directors on Procedural Training

Resident physicians routinely perform bedside procedures that pose substantial risk to patients. However, no standard programmatic approach to supervision and procedural competency assessment among residents currently exists. The authors performed a national survey of internal medicine (IM) program directors to examine procedural assessment and supervision practices of IM residency programs. Procedures chosen were those commonly performed by medicine residents at the bedside. Of the 368 IM programs, 226 (61%) completed the survey. Programs reported the predominant method of training as 171 (74%) apprenticeship and 106 (46%) as module based. The majority of programs used direct observation to attest to competence, with 55% to 62% relying on credentialed residents. Most programs also relied on a minimum number of procedures to determine competence (64%-88%), 72% of which reported 5 procedures (a lapsed historical standard). This national survey demonstrates that procedural assessment practices for IM residents are insufficiently robust and may put patients at undue risk.

Using GP trainees as role players as a teaching/training tool for established GP trainers

This work aimed to evaluate the effectiveness of using GP trainees in place of professional actors, to role-play trainees with 'difficulties' or various challenging characteristics, as an educational tool for skills development of experienced GP trainers. The context was a residential experienced GP trainers' course and the role players were local ST3 GP trainees. Professional actors have been used for this purpose for many years in medical education at all levels, particularly in teaching communication and consultation skills in the Thames Valley area of the UK. We wanted to trial and evaluate whether using GP trainees themselves, with their own more authentic 'hinterland' of experience, (but no acting training) would be as, or more, effective than using actors. The exercise was successful and showed, through post-course feedback (immediate written feedback and later on-line questionnaire), that the use of trainees was considered by the delegates to be an effective, adaptable and realistic training tool, and more so than using professional actors. The trainees also reported educational benefit from the experience.