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Weller I, Spiegel M, de Carvalho Filho MA, Martin A. When Play Reveals the Ache: Introducing Co-constructive Patient Simulation for Narrative Practitioners in Medical Education. THE JOURNAL OF MEDICAL HUMANITIES 2024:10.1007/s10912-023-09837-7. [PMID: 38635152 DOI: 10.1007/s10912-023-09837-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 04/19/2024]
Abstract
Despite the ubiquity of healthcare simulation and the humanities in medical education, the two domains of learning remain unintegrated. The stories suffused within healthcare simulation have thus remained unshaped by the developments of narrative medicine and the health humanities. Healthcare simulation, in turn, has yet to utilize concepts like co-construction and narrative competence to enrich learners' understanding of patient experience alongside their clinical competencies. To create a conceptual bridge between these two fields (including narrative-based inquiry more broadly), we redescribe narrative competence via Ronald Heifetz's distinction of "technical" and "adaptive" challenges outlined in his adaptive leadership model. Heifetz, we argue, enriches learners' self-understanding of the unique demands of cultivating narrative competence, which can be both elucidated on the page and tested within the charged yet supportive simulation environment. We introduce Co-constructive Patient Simulation (CCPS) to demonstrate how working with simulated patients can support narrative work by drawing on the clinical vicissitudes of learners in the formulation and enactment of case studies. The three movements of CCPS-resensing, retelling, and retooling-told through learner experiences, describe the affinities and divergences between narrative medicine's sequence of attention, representation, and affiliation; Montello's three forms of narrative competence (departure, performance, change), and Heifetz's three steps (observe, interpret, and intervene) of adaptive leadership.
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Affiliation(s)
- Indigo Weller
- Yale School of Medicine, Child Study Center, New Haven, CT, USA.
| | - Maura Spiegel
- Columbia University, CUIMC Division of Narrative Medicine, New York City, NY, USA
| | - Marco Antonio de Carvalho Filho
- Wenckebach Institute, Research Program LEARN (Lifelong Learning, Assessment and Research Network), University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Andrés Martin
- Yale School of Medicine, Child Study Center, New Haven, CT, USA
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van Hoof MJ, Piot MA, Iozzia G, Mirsujan K, Hanson MD, Martin A. Co-constructive patient simulation at international conferences: strengthening interactions and deepening reflection. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02384-z. [PMID: 38386073 DOI: 10.1007/s00787-024-02384-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/20/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Marie-José van Hoof
- iMindU GGZ, Leiden, The Netherlands.
- Amsterdam UMC, Amsterdam, The Netherlands.
| | - Marie-Aude Piot
- Department of Child and Adolescent Psychiatry, Necker-Enfants Malades Hospital-APHP, Paris, France
- School of Medicine, Université de Paris-Cité - Health Faculty, Paris, France
| | | | | | - Mark D Hanson
- The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
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Danieli PP, Hanson MD, VanRiper L, van Hoof MJ, Thomas I, Sibeoni J, Raats P, Prins C, Porter S, Piot MA, Nair B, Mian I, Leung K, Hibbard K, Billon G, Benoit L, Baker JD, Alleyne S, de Carvalho-Filho MA, Amsalem D, Martin A. Psychiatric Clinical Training Across Borders: Developing Virtual Communities of Practice Through International Co-constructive Patient Simulation. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024; 48:71-76. [PMID: 37789233 DOI: 10.1007/s40596-023-01880-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/19/2023] [Indexed: 10/05/2023]
Affiliation(s)
- Polina Perlman Danieli
- SickKids, The Hospital for Sick Children and Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mark D Hanson
- SickKids, The Hospital for Sick Children and Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Marie-José van Hoof
- iMindU GGZ, Leiden, The Netherlands
- University of Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Isaiah Thomas
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Jordan Sibeoni
- Service Universitaire de Psychiatrie de L'adolescent, Centre Hospitalier d'ArgenteuilUniversité Paris Cité, Paris, France
| | | | | | - Sara Porter
- University of Mississippi Medical Center, Jackson, MS, USA
| | - Marie-Aude Piot
- Université de Paris-Cité, School of Medicine, Necker-Enfants Malades Academic Hospital - APHP, Paris, France
| | - Bina Nair
- University of Alberta, Edmonton, AB, Canada
| | - Irfan Mian
- SickKids, The Hospital for Sick Children and Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kitty Leung
- College of Medicine, University of Florida, Jacksonville, FL, USA
| | | | | | - Laelia Benoit
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | | | | | | | - Doron Amsalem
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, USA.
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Çamlı ŞE, Yavuz BE, Gök MF, Yazgan I, Yazgan Y, Brand-Gothelf A, Gothelf D, Amsalem D, Martin A. Embracing different languages and local differences: Co-constructive patient simulation strengthens host countries' clinical training in psychiatry. World J Psychiatry 2024; 14:111-118. [PMID: 38327898 PMCID: PMC10845220 DOI: 10.5498/wjp.v14.i1.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/30/2023] [Accepted: 12/22/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Global education in psychiatry is heavily influenced by knowledge from Western, high-income countries, which obscures local voices and expertise. AIM To adapt a human simulation model to psychiatric education in a context that is specific to local languages and cultures. METHODS We conducted an observational study consisting of six human simulation sessions with standardized patients from two host countries, speaking their native languages, and following an adaptation of the co-constructive patient simulation (CCPS) model. As local faculty became increasingly familiar with the CCPS approach, they took on the role of facilitators-in their country's native language. RESULTS Fifty-three learners participated: 19 child and adolescent psychiatry trainees and 3 faculty members in Türkiye (as a group that met online during 3 consecutive months); and 24 trainees and 7 faculty in Israel (divided into 3 groups, in parallel in-person sessions during a single training day). Each of the six cases reflected local realities and clinical challenges, and was associated with specific learning goals identified by each case-writing trainee. CONCLUSION Human simulation has not been fully incorporated into psychiatric education: The creation of immersive clinical experiences and the strengthening of reflective practice are two areas ripe for development. Our adaptations of CCPS can also strengthen local and regional networks and psychiatric communities of practice. Finally, the model can help question and press against hegemonies in psychiatric training that overshadow local expertise.
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Affiliation(s)
- Şafak Eray Çamlı
- Department of Child and Adolescent Psychiatry, Bursa Uludağ University Faculty of Medicine, Bursa 16059 Turkey
| | - Büşra Ece Yavuz
- Department of Child and Adolescent Psychiatry, Bursa Uludağ University Faculty of Medicine, Bursa 16059 Turkey
| | - Meliha Feyza Gök
- Department of Child and Adolescent Psychiatry, Bursa Uludağ University Faculty of Medicine, Bursa 16059 Turkey
| | - Idil Yazgan
- Yale University School of Medicine, New Haven, CT 06510, United States
| | - Yanki Yazgan
- Güzel Günler Clinic, Beşiktaş/İstanbul 34335 Turkey
- Child Study Center, Yale School of Medicine, New Haven, CT 06520, United States
| | - Ayelet Brand-Gothelf
- The Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Tel Aviv University, Petach Tikvah 4920235, Israel
| | - Doron Gothelf
- The Child Psychiatry Division, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan 52561, Israel
- Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Doron Amsalem
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, United States
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT 06520, United States
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Thomas I, Benoit L, Duvivier R, de Carvalho Filho MA, Martin A. Family dyads, emotional labor, and holding environments in the simulated encounter: co-constructive patient simulation as a reflective tool in child and adolescent psychiatry training. Child Adolesc Psychiatry Ment Health 2023; 17:114. [PMID: 37794397 PMCID: PMC10552304 DOI: 10.1186/s13034-023-00663-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Patient simulation has been used in medical education to provide a safe and supportive learning environment for learners to practice clinical and interpersonal skills. However, simulation involving pediatric populations, particularly in child and adolescent psychiatry, is rare and generally does not reflect the child-caregiver dyad or the longitudinal aspects of this care, nor does it provide learners with an opportunity to engage with and reflect on these dynamics. METHODS We organized as an educational opportunity a series of seven observed patient simulation sessions with a cohort of a dozen child and adolescent psychiatrists (eight fellows approaching graduation and four senior educators). In these sessions, we utilized the co-constructive patient simulation model to create the simulation cases. We included the use of at least two patient actors in most sessions, and two of the case narratives were longitudinally followed across multiple simulation sessions. We approached the data collected during the simulations and their respective debriefings by using thematic analysis informed by a symbolic interactionist approach. RESULTS Based on data from the debriefing sessions and longitudinal narratives, we identified four overarching themes: (1) Reflecting on dyadic challenges: role reversal and individuation; (2) Centering the child, allying with the parent, and treating the family system; (3) Ambivalence in and about the parent-child dyad; and (4) Longitudinal narratives and ambivalence over time. CONCLUSION The emotional experience of the simulations, for interviewers and observers alike, provided an opportunity to reflect on personal and professional experiences and triggered meaningful insights and connections between participants. These simulated cases called for emotional labor, particularly in the form of creating holding environments; in this way, the simulated encounters and the debriefing sessions became dialogic experiences, in which the patient and provider, parent and child, and learner and instructor could co-construct meaning and foster professional development as reflective practitioners.
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Affiliation(s)
| | | | | | | | - Andrés Martin
- Yale School of Medicine, New Haven, CT, USA.
- University Medical Center Groningen, Groningen, The Netherlands.
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Safranek CW, Sidamon-Eristoff AE, Gilson A, Chartash D. The Role of Large Language Models in Medical Education: Applications and Implications. JMIR MEDICAL EDUCATION 2023; 9:e50945. [PMID: 37578830 PMCID: PMC10463084 DOI: 10.2196/50945] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023]
Abstract
Large language models (LLMs) such as ChatGPT have sparked extensive discourse within the medical education community, spurring both excitement and apprehension. Written from the perspective of medical students, this editorial offers insights gleaned through immersive interactions with ChatGPT, contextualized by ongoing research into the imminent role of LLMs in health care. Three distinct positive use cases for ChatGPT were identified: facilitating differential diagnosis brainstorming, providing interactive practice cases, and aiding in multiple-choice question review. These use cases can effectively help students learn foundational medical knowledge during the preclinical curriculum while reinforcing the learning of core Entrustable Professional Activities. Simultaneously, we highlight key limitations of LLMs in medical education, including their insufficient ability to teach the integration of contextual and external information, comprehend sensory and nonverbal cues, cultivate rapport and interpersonal interaction, and align with overarching medical education and patient care goals. Through interacting with LLMs to augment learning during medical school, students can gain an understanding of their strengths and weaknesses. This understanding will be pivotal as we navigate a health care landscape increasingly intertwined with LLMs and artificial intelligence.
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Affiliation(s)
- Conrad W Safranek
- Section for Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, United States
| | | | - Aidan Gilson
- Section for Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, United States
| | - David Chartash
- Section for Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, CT, United States
- School of Medicine, University College Dublin, National University of Ireland, Dublin, Ireland
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Calhoun AJ, Martin A, Adigun A, Alleyne SD, Aneni K, Thompson-Felix T, Asnes A, de Carvalho-Filho MA, Benoit L, Genao I. Anti-Black racism in clinical supervision: asynchronous simulated encounters facilitate reflective practice. MEDEDPUBLISH 2023; 13:4. [PMID: 37123251 PMCID: PMC10140654 DOI: 10.12688/mep.19487.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 05/02/2023] Open
Abstract
Background Racist interactions in clinical practice remain a pervasive reality for Black healthcare providers. We sought to develop a framework to inform supervisors' actions when confronting racism in clinical practice and protecting trainees under their oversight. Methods We conducted a qualitative study in which experienced supervisors responded to seven short, videotaped interactions between: 1) Black trainees and a simulated patient (SP) in a racist role; 2) the trainees and their respective supervisors; and 3) the trainees and their supervisors together with the SP. The clinical exchanges exemplified different types of racist (entrenching) or antiracist (uprooting) behaviors by the supervisors. After viewing each clip, participants wrote their reflections confidentially; they later joined a structured debriefing together. We used thematic analysis to identify supervisors' behavioral patterns when confronting racist interactions. Results Based on the input of 52 participants recruited into five two-hour-long sessions, we categorized the behaviors of supervisors facing anti-Black racial injuries involving learners under their oversight. We organized supervisor behaviors into five interlocking domains, each with a range of possible themes: 1) Joining: from conciliatory to confrontational in communicating with the aggressor; 2) Explicitness: from avoiding to naming racism; 3) Ownership: from individual to shared responsibility of the event and the response to it; 4) Involving: from excusing to including the aggrieved party when confronting the aggressor; and 5) Stance: from protective to paternalistic in supporting the learner's autonomy. Conclusions Our qualitative findings can provide a framework for facilitated discussion toward reflective practice among healthcare providers who may have experienced, witnessed, or intervened in anti-Black racist interactions. They can also help medical educators to inform faculty development to fight anti-Black racism in clinical practice. The video materials we developed are available for viewing and download and can be used or adapted as springboards for reflective discussion or faculty development activities.
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Affiliation(s)
- Amanda J. Calhoun
- Child Study Center, Yale School of Medicine, New Haven, CT, 06520, USA
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, 06520, USA
| | - Ayodola Adigun
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Shirley D. Alleyne
- Division of Child Psychiatry, Lakeland Regional Health Medical Center, Lakeland, FL, 33805, USA
| | - Kammarauche Aneni
- Child Study Center, Yale School of Medicine, New Haven, CT, 06520, USA
| | | | - Andrea Asnes
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, 06520, USA
| | | | - Laelia Benoit
- Child Study Center, Yale School of Medicine, New Haven, CT, 06520, USA
| | - Inginia Genao
- Office of Equity, Inclusion and Belonging, Penn State College of Medicine, State College, PA, 17033, USA
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Spruijt A, Prins-Aardema CC, Antonio de Carvalho-Filho M, Jaarsma D, Martin A. Co-constructive Veterinary Simulation: A Novel Approach to Enhancing Clinical Communication and Reflection Skills. JOURNAL OF VETERINARY MEDICAL EDUCATION 2023; 50:134-139. [PMID: 35452374 DOI: 10.3138/jvme-2021-0160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Interpersonal communication is critical in training, licensing, and post-graduate maintenance of certification in veterinary medicine. Simulation has a vital role in advancing these skills, but even sophisticated simulation models have pedagogic limitations. Specifically, with learning goals and case scenarios designed by instructors, interaction with simulated participants (SPs) can become performative or circumscribed to evaluative assessments. This article describes co-constructive veterinary simulation (CCVS), an adaptation of a novel approach to participatory simulation that centers on learner-driven goals and individually tailored scenarios. CCVS involves a first phase of scriptwriting, in which a learner collaborates with a facilitator and a professional actor in developing a client-patient case scenario. In a second phase, fellow learners have a blinded interaction with the SP-in-role, unaware of the underlying clinical situation. In the final part, all learners come together for a debriefing session centered on reflective practice. The authors provide guidelines for learners to gain maximal benefit from their participation in CCVS sessions and describe thematic possibilities to incorporate into the model, with specific case examples drawn from routine veterinary practice. Finally, the authors outline challenges and future directions toward implementing CCVS in veterinary medical education toward the ultimate goal of professional growth and co-evolution as veterinary practitioners.
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Affiliation(s)
- Annemarie Spruijt
- Faculty of Veterinary Medicine, Utrecht University, Heidelberglaan 8, 3584 CS Utrecht, the Netherlands
| | - Cecil C Prins-Aardema
- GGZ Drenthe (Geestelijke Gezondheids Zorg: Mental Health Care), Beilen, the Netherlands
| | - Marco Antonio de Carvalho-Filho
- Faculty of Veterinary Medicine, Utrecht University, Heidelberglaan 8, 3584 CS Utrecht, the Netherlands, and Center for Educational Development and Research in Health Sciences (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Debbie Jaarsma
- Utrecht University, Heidelberglaan 8, 3584 CS Utrecht, the Netherlands, and Center for Educational Development and Research in Health Sciences (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Andrés Martin
- Yale School of Medicine; and Director, Simulated Participant Program, Teaching and Learning Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06510 USA. He is also a doctoral candidate at the Research Institute SHARE and the Center for Educational Development and Research in Health Sciences (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
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Calhoun AJ, Martin A, Adigun A, Alleyne SD, Aneni K, Thompson-Felix T, Asnes A, de Carvalho-Filho MA, Benoit L, Genao I. Anti-Black racism in clinical supervision: asynchronous simulated encounters facilitate reflective practice. MEDEDPUBLISH 2023. [DOI: 10.12688/mep.19487.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Racist interactions in clinical practice remain a pervasive reality for Black healthcare providers. We sought to develop a framework to inform supervisors’ actions when confronting racism in clinical practice and protecting trainees under their oversight. Methods We conducted a prospective study in which experienced supervisors responded to seven short, videotaped interactions between: 1) Black trainees and a simulated patient (SP) in a racist role; 2) the trainees and their respective supervisors; and 3) the trainees and their supervisors together with the SP. The clinical exchanges exemplified different types of racist (entrenching) or antiracist (uprooting) behaviors by the supervisors. After viewing each clip, participants wrote their reflections confidentially; they later joined a structured debriefing together. We used thematic analysis to identify supervisors’ behavioral patterns when confronting racist interactions. Results Based on the input of 52 participants recruited into five two-hour-long sessions, we categorized the behaviors of supervisors facing anti-Black racial injuries involving learners under their oversight. We organized supervisor behaviors into five interlocking domains, each with a range of possible themes: 1) Joining: from conciliatory to confrontational in communicating with the aggressor; 2) Explicitness: from avoiding to naming racism; 3) Ownership: from individual to shared responsibility of the event and the response to it; 4) Involving: from excusing to including the aggrieved party when confronting the aggressor; and 5) Stance: from protective to paternalistic in supporting the learner’s autonomy. Conclusions Our qualitative findings can provide a framework for facilitated discussion toward reflective practice among healthcare providers who may have experienced, witnessed, or intervened in anti-Black racist interactions. They can also help medical educators to inform faculty development to fight anti-Black racism in clinical practice. The video materials we developed are available for viewing and download and can be used or adapted as springboards for reflective discussion or faculty development activities.
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Martin A, de Carvalho Filho MA, Jaarsma D, Duvivier R. Making It Real: From Telling to Showing, Sharing, and Doing in Psychiatric Education. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:1379-1388. [PMID: 34876866 PMCID: PMC8643127 DOI: 10.2147/amep.s336779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/21/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Innovations in contemporary medical education could inform remedies to address enduring challenges such as the marginalization and stigmatization of psychiatry, of mental illnesses, and of those affected by them. METHODS In blending the works of Bleakley, Bligh, and Brown (2011) and of Kumagai and Naidu (2015), we developed an overarching heuristic with practical relevance and concrete applications to psychiatric education. RESULTS We identify three areas to enhance psychiatric education embedded into this blended framework: 1) Showing, or the more accurate depiction or imaging of mental illnesses and of psychiatric practice, as exemplified by the incorporation into didactic content of asynchronous video-based clinical materials produced with specific educational objectives in mind; 2) Sharing, or addressing the image problem of mental illnesses, of those living with or affected by them, and of psychiatry as a profession, as exemplified by psychiatrists embracing their role as experts by professional and personal experience when sharing their own journeys with mental illness, treatment, and recovery; and 3) Doing, or reimagining reflective psychiatric practice, as exemplified by the novel methodology of co-constructive patient simulation (CCPS), through which learners can engage in reflective practice and supervision in a participatory and democratic setting that does not privilege participants' hierarchical standing. CONCLUSION The blended model and the sample applications we describe offer a range of teaching, learning, and professional development opportunities, should psychiatric educators choose to pursue them and reap their promise.
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Affiliation(s)
- Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Simulated Participant Program, Teaching and Learning Center, Yale School of Medicine, New Haven, CT, USA
- Center for Educational Development and Research in Health Sciences (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, Groningen, the Netherlands
| | - Marco A de Carvalho Filho
- Center for Educational Development and Research in Health Sciences (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, Groningen, the Netherlands
- School of Medical Sciences, University of Minho, Braga, Portugal
| | - Debbie Jaarsma
- Center for Educational Development and Research in Health Sciences (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, Groningen, the Netherlands
- Faculty of Veterinary Medicine, University of Utrecht, Utrecht, the Netherlands
| | - Robbert Duvivier
- Center for Educational Development and Research in Health Sciences (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, Groningen, the Netherlands
- Parnassia Psychiatric Institute, The Hague, the Netherlands
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Piot MA, Attoe C, Billon G, Cross S, Rethans JJ, Falissard B. Simulation Training in Psychiatry for Medical Education: A Review. Front Psychiatry 2021; 12:658967. [PMID: 34093275 PMCID: PMC8175985 DOI: 10.3389/fpsyt.2021.658967] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/20/2021] [Indexed: 12/03/2022] Open
Abstract
Despite recognised benefits of Simulation-Based Education (SBE) in healthcare, specific adaptations required within psychiatry have slowed its adoption. This article aims to discuss conceptual and practical features of SBE in psychiatry that may support or limit its development, so as to encourage clinicians and educators to consider the implementation of SBE in their practice. SBE took off with the aviation industry and has been steadily adopted in clinical education, alongside role play and patient educators, across many medical specialities. Concurrently, healthcare has shifted towards patient-centred approaches and clinical education has recognised the importance of reflective learning and teaching centred on learners' experiences. SBE is particularly well-suited to promoting a holistic approach to care, reflective learning, emotional awareness in interactions and learning, cognitive reframing, and co-construction of knowledge. These features present an opportunity to enhance education throughout the healthcare workforce, and align particularly well to psychiatric education, where interpersonal and relational dimensions are at the core of clinical skills. Additionally, SBE provides a strategic opportunity for people with lived experience of mental disorders to be directly involved in clinical education. However, tenacious controversies have questioned the adequacy of SBE in the psychiatric field, possibly limiting its adoption. The ability of simulated patients (SPs) to portray complex and contradictory cognitive, psychological and emotional states has been questioned. The validity of SBE to develop a genuine empathetic understanding of patients, to facilitate a comprehensive multiaxial diagnostic formulation, or to develop flexible interpersonal skills has been criticised. Finally, SBE's relevance to developing complex psychotherapeutic skills is much debated, while issues such as symptom induction in SPs or patients involvement raise ethical dilemmas. These controversies can be addressed through adequate evidence, robust learning design, and high standards of practice. Well-designed simulated scenarios can promote a positive consideration of mental disorders and complex clinical skills. Shared guidelines and scenario libraries for simulation can be developed, with expert psychiatrists, patients and students involvement, to offer SPs and educators a solid foundation to develop training. Beyond scenario design, the nuances and complexities in mental healthcare are also duly acknowledged during the debriefing phases, providing a crucial opportunity to reflect on complex interpersonal skills or the role of emotions in clinicians' behaviour. Considered recruitment and support of SPs by clinical educators can help to maintain psychological safety and manage ethical issues. The holistic and reflexive nature of SBE aligns to the rich humanistic tradition nurtured within psychiatry and medicine, presenting the opportunity to expand the use of SBE to support a range of clinical skills and workforce competencies required in psychiatry.
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Affiliation(s)
- Marie-Aude Piot
- School of Medicine, Faculty of Health, University of Paris, Paris, France
- Department of Psychiatry, Institute Mutualiste Montsouris, Paris, France
- Epidemiological and Public Health Research Centre, Villejuif, France
| | - Chris Attoe
- Maudsley Simulation, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Gregoire Billon
- Maudsley Simulation, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Sean Cross
- Maudsley Simulation, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Jan-Joost Rethans
- Skillslab, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Bruno Falissard
- Epidemiological and Public Health Research Centre, Villejuif, France
- Department of Public Health, School of Medicine, University Paris Saclay, Villejuif, France
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Amsalem D, Martin A, Mosheva M, Soul O, Korotkin L, Ziv A, Gothelf D, Gross R. Delivering Difficult News: Simulation-Enhanced Training Improves Psychiatry Residents' Clinical Communication Skills. Front Psychiatry 2021; 12:649090. [PMID: 33746804 PMCID: PMC7973022 DOI: 10.3389/fpsyt.2021.649090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Delivering difficult news to individuals diagnosed with mental health disorders and their family members can be challenging. The use of simulated patients (SP) is an effective teaching method to enhance clinical skills, particularly those around communication. We developed, implemented, and evaluated the effectiveness of an SP-based training module to improve psychiatric residents' clinical communication skills in delivering difficult news. Methods: We conducted 5-h workshops consisting of 3 components: (1) a high-fidelity simulation session with a professional actor; (2) a 30-min lecture; and (3) role-playing of 3 short scenarios, during which residents rotated taking on different roles (as psychiatrist, patient, or family member). We observed through a 1-way mirror and videotaped each resident's simulation session and followed it with personalized debriefing. Following the workshop, each resident received the full-length video of their simulated interview, together with a list of questions as a take-home assignment. Two months after the workshop, the residents were invited to a second SP-based session, during which 2 independent evaluators, each a board-certified psychiatrist with expertise in medical simulation, evaluated the participants' communication skills using a previously validated instrument. To avoid observation bias, the 2 evaluators rated the videotapes blind to the timing of the simulation (pre- vs. post-training). Participants completed self-report questionnaires on satisfaction and self-confidence, before, after, and 2 months following the workshop. Findings: Of the 28 psychiatric residents who participated in the training day, 24 (86%) completed the post-workshop evaluation. Mean communication score increased from 24.9 to 27.8 (paired t-test: 5.6, p < 0.001). The mean score for the self-confidence questionnaire, calculated on a 1 to 5 Likert scale, increased from 3.4 to 4.0 after the training day, and remained unchanged (4.2) 2 months later (p < 0.001). Conclusions: An SP-based training module proved useful in improving the objectively measured communication skills of psychiatric residents delivering difficult news. The training further enhanced participants' subjective sense of confidence in those clinical skills.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mariela Mosheva
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Child & Adolescent Psychiatry, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Omer Soul
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Child & Adolescent Psychiatry, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Liran Korotkin
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amitai Ziv
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sheba Medical Center, Integrated Rehabilitation Hospital, Ramat Gan, Israel
| | - Doron Gothelf
- Division of Child & Adolescent Psychiatry, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
- Faculty of Medicine, Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Raz Gross
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel
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Martin A, Weller I, Amsalem D, Adigun A, Jaarsma D, Duvivier R, de Carvalho-Filho MA. From Learning Psychiatry to Becoming Psychiatrists: A Qualitative Study of Co-constructive Patient Simulation. Front Psychiatry 2020; 11:616239. [PMID: 33488433 PMCID: PMC7820173 DOI: 10.3389/fpsyt.2020.616239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/10/2020] [Indexed: 01/08/2023] Open
Abstract
Objectives: Co-constructive patient simulation (CCPS) is a novel medical education approach that provides a participatory and emotionally supportive alternative to traditional supervision and training. CCPS can adapt iteratively and in real time to emergent vicissitudes and challenges faced by clinicians. We describe the first implementation of CCPS in psychiatry. Methods: We co-developed clinical scripts together with child and adolescent psychiatry senior fellows and professional actors with experience performing as simulated patients (SPs). We conducted the simulation sessions with interviewers blind to the content of case scenarios enacted by the SPs. Each hour-long simulation was followed by an hour-long debriefing session with all participants. We recorded and transcribed case preparation, simulation interactions, and debriefing sessions, and analyzed anonymized transcripts through qualitative analysis within a constructivist framework, aided by NVivo software. Results: Each of six CCPS sessions was attended by a median of 13 participants (range, 11-14). The first three sessions were conducted in person; the last three, which took place during the COVID-19 pandemic, via synchronized videoconferencing. Each of the sessions centered on clinically challenging and affectively charged situations informed by trainees' prior experiences. Through iterative thematic analysis we derived an alliterating "9R" model centered on three types of Reflection: (a) in action/"while doing" (Regulate, Relate, and Reason); (b) on action/"having done" (Realities, Restraints, and Relationships); and (c) for action/"will be doing" (with opportunities for Repair and Reaffirmation). Conclusions: CCPS is an experiential approach that fosters autonomous, meaningful, and individually tailored learning opportunities. CCPS and the 9R model for reflective practice can be effectively applied to psychiatry and have the potential to contribute uniquely to the educational needs of its trainees and practitioners.
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Affiliation(s)
- Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
- Standardized Patient Program, Teaching and Learning Center, Yale School of Medicine, New Haven, CT, United States
- Center for Educational Development and Research in Health Sciences (CEDAR), LEARN, University Medical Center Groningen, Groningen, Netherlands
- *Correspondence: Andrés Martin
| | - Indigo Weller
- Bioethics Program, Harvard University, Cambridge, MA, United States
| | - Doron Amsalem
- Tel-Aviv University Faculty of Medicine, Ramat-Aviv, Israel
- Mental Health Services, Columbia University Irving Medical Center, New York, NY, United States
| | - Ayodola Adigun
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
- Mental Health Services, Columbia University Irving Medical Center, New York, NY, United States
| | - Debbie Jaarsma
- Center for Educational Development and Research in Health Sciences (CEDAR), LEARN, University Medical Center Groningen, Groningen, Netherlands
| | - Robbert Duvivier
- Center for Educational Development and Research in Health Sciences (CEDAR), LEARN, University Medical Center Groningen, Groningen, Netherlands
- Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Marco Antonio de Carvalho-Filho
- Center for Educational Development and Research in Health Sciences (CEDAR), LEARN, University Medical Center Groningen, Groningen, Netherlands
- School of Medical Sciences, University of Minho, Braga, Portugal
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