The role of actors in teaching communication

Acquisition of clinical skills

Clinical skills in psychiatry are not best acquired in unsupervised practice or in learning by apprenticeship. In the past, it was reported that during the course of their clinical training, students' interviewing skills actually deteriorated rather than improved (Helfer, 1970; Maguire & Rutter, 1976), although recent research suggests that improved training is now having an impact (Davis & Nicholaou, 1992). The methods described below may be employed at both undergraduate and postgraduate level. Traditionally, psychiatrists have been actively involved, along with general practitioners, in the provision of communication skills training to undergraduates. In the future, this training will become a continuous process carried out alongside and within other teaching in all specialities (Gushing, 1996). One of the biggest challenges facing medical schools is how to engage and train clinical teachers from a range of specialities in facilitating students in the acquisition of clinical interpersonal skills.

Effectiveness of a simulated patient training programme based on trainee response accuracy and appropriateness of feedback

INTRODUCTION

Simulated patients (SPs) need education and training in required skills to be effective resources in education. This study was conducted to examine the effectiveness of an SP training programme based on the accuracy of trainee responses and the appropriateness of their feedback.

METHODS

Thirty-two applicants to the training programme and 35 experienced SPs were included in this study. The experienced SPs served as a reference group. The rate of accurate responses and the rate of appropriate feedback were assessed with pre- and post-training tests, and these two outcome measures were compared with those of the experienced SPs.

RESULTS

No significant differences were found in trainee response accuracy or appropriateness of feedback between pre- and post-training tests. The response accuracy rate of the trainees on the pre-training test was significantly lower than that of SPs with 1-2 years of experience, whilst there was no significant difference between these SPs and the trainees on the post-training test.

CONCLUSIONS

Although our study suggests that more training is needed to improve the skills of SPs, the training programme may contribute to helping trainees reach a novice level in the skill of providing accurate responses. SP training should be encouraged to contribute to the effectiveness of such teaching and to establish the validity of the assessment.

Feedback by simulated patients in undergraduate medical education: a systematic review of the literature

OBJECTIVES

Although the importance of feedback by simulated patients (SPs) is generally recognised, knowledge is scarce about the most effective ways in which SPs can provide feedback. In addition, little is known about how SPs are trained to provide feedback. This study aimed to provide a systematic overview of the ways in which SPs provide feedback to undergraduate medical students, the domains in which SPs provide feedback and the ways in which SPs are trained to provide feedback.

METHODS

We performed a systematic search of the literature using PubMed, PsychINFO and ERIC and searched for additional papers cited in reference lists. Papers were selected on the basis of pre-established inclusion and exclusion criteria and were classified, using a pre-established form, according to three aspects of SP feedback: training in giving feedback; the process of delivering feedback, and the domain(s) in which feedback is given.

RESULTS

A total of 49 studies were included and described in detail on the basis of the three aspects of SP feedback described above. The ways in which SPs were trained to give feedback were largely heterogeneous, as were the processes by which feedback was provided by SPs. Only a few studies described feedback processes that were in accordance with general recommendations for the delivery of effective feedback. Although feedback from the patient's perspective is generally recommended, most SPs provided feedback on clinical skills and communication skills.

DISCUSSION

There appear to be no clear standards with regard to effective feedback training for SPs. Furthermore, the processes by which feedback is provided by SPs and the selection of domain(s) in which SPs give feedback often seem to lack a solid scientific basis. Suggestions for further research are provided.

Viewpoint: power and communication: why simulation training ought to be complemented by experiential and humanist learning

The authors present an analysis of communication training for medical students using simulation patients, and its possible influence on later doctor-patient relationships. Many empirical studies have shown the various benefits of using simulation patients to teach communication skills, but theoretical sociology and humanistic reflection shed light on some fundamental differences between the student-doctor/actor-patient interactions practiced in simulation encounters and real doctor-patient relationships. In contrast to the usual power dynamics of a doctor-patient relation, those of simulation encounters are inverted and overwritten by an entirely different set of power relations, namely, those of the evaluator-student relationship. Since the power dynamics of real doctor-patient relations are generally overlooked, the altered dynamics of the simulation encounter are not readily perceived, and simulation encounters are thus often mistaken as accurate representations of clinical reality. Exclusive reliance on this pedagogic approach of simulation training may be encouraging students to become "simulation doctors" who act out a good relationship to their patients but have no authentic connection with them. The authors propose that liberal-arts learning and encounters with real patients should be used to cultivate students' abilities to create good doctor-patient relationships, as a compliment to the pedagogic benefits of simulation encounters.

Cure-oriented versus care-oriented attitudes in medicine

This article focuses on the attitudinal component of patient-centredness. The literature reveals that the relationship between cure- and care-oriented attitudes remains to be clarified. The aim of this study is to gain further insight in the relationship between cure and care attitudes by questioning the bipolar unidimensional structure of the concept. By means of an empirical analysis among Belgian medical students, the cure versus care attitudes regarding the 'ideal physician' are investigated. Traits of the ideal physician are described in a bipolar rating scale reflecting cure-oriented versus care-oriented views of the medical profession. Subjects included 88 medical students of the Limburgs University Centre in Diepenbeek, Belgium. Results indicate that the Belgian sample is less care-oriented than the Dutch sample.Further, a factor-analysis reveals two components which correspond with the instrumental (cure) and the affective dimension (care) of the medical profession. The advantages of a two-dimensional framework as a basis for the development of courses aimed at attitude development in the curriculum of a medical school are discussed.

Problem-solving skills of senior student nurses: an exploratory study using simulation

The Stages Model of problem-solving as evidenced in the use of the nursing process is the key vehicle for the operationalisation of problem-solving in current nursing practice. An expanded variant of the model formed the theoretical framework for this study which aimed to explore and compare the problem-solving skills of senior student nurses (n=253) from three pre-registration nurse education programmes (RGN, diploma RN, integrated degree). Students' care planning skills were explored using a video-tape simulation exercise and data were subjected to statistical testing. Findings indicated a large range in the global care plan scores and while performance was similar in a number of areas independent of programme type, certain key differences also emerged. The findings are discussed in the wider context of professional education and practice and the potential for further development of problem-solving skills in pre-registration nurse education is explored.

Clinical problem-solving using video simulation: an investigation

This paper examines the use of videotape simulation as a research method for the exploration of clinical problem-solving. The challenges posed and the strategies employed to overcome the difficulties encountered are discussed. The simulation forms part of a larger comparative study of outcomes of pre-registration nurse education programmes, commissioned by the English National Board for Nursing, Midwifery and Health Visiting.

A dramatic experience in mental health nursing education

This paper examines aspects of a drama project in which a play Syncing Out Loud was produced for Mental Health Week. The project sought to raise community awareness about schizophrenia, as well as to provide an alternative educational experience for students enrolled in a preregistration nursing program. The programs conceptual approach is discussed. Particular referenced is made to the use of drama as a educational tool which can develop experiential sensitivity to the issues and concerns of health service consumers. The experiences of students involved in Syncing Out Loud are examined.

Measuring attitudes of doctors: the doctor-patient (DP) rating

An attitude scale was devised to discriminate between the extremes of doctor-centred, disease-oriented as opposed to patient-centred, problem-oriented (the DP scale). Four groups of subjects (214 in all) were tested with a Likert-type questionnaire based on this scale. Significant differences in attitude between the groups were found. Educational implications are discussed.