'I wouldn't get that feedback from anywhere else': learning partnerships and the use of high school students as simulated patients to enhance medical students' communication skills

Educational programmes for paediatric healthcare professionals in patient- and family-centred care. A scoping review

To identify and describe educational programmes in patient- and family-centred care for paediatric healthcare professionals. This scoping review was conducted and reported according to the JBI Manual for Evidence Synthesis and the PRISMA guideline. The databases searched included MEDLINE (PubMed), PsycINFO, CINAHL, Scopus, Cochrane, and Embase. Inclusion criteria were experimental, observational and qualitative studies about educational programmes on patient- and family-centred care for paediatric healthcare professionals. Exclusion criteria were reviews and non-peer-reviewed literature. Two reviewers independently screened and extracted the data using Covidence. Of the 13922 records identified, 49 articles met the inclusion criteria. There was a large variety of educational programmes, half of which were interdisciplinary, that mainly targeted nurses and doctors. The median number of participants was 51 (range 7 to 1411). The predominant target population was children with chronic disabilities and neonatal intensive care units, and only one programme specifically targeted adolescents. The median duration was one day (range 5 min to 3.5 years). Development of competencies was the most common objective. We identified 12 different educational content areas. Content mainly focused on communication and relational competencies, including partnership, which involved shared decision-making, mutual agenda setting, and negotiation of a plan. Many kinds of educational strategies were found but experiential learning through simulation and roleplay was used most.   Conclusion: A large variety of educational programmes in paediatric patient- and family-centred care exist. Educational content mainly focused on communication and relational competencies. Experiential learning including roleplay and simulation was the most used educational strategy. What is Known: • Delivery of patient- and family-centred care improves parental satisfaction of care but requires clinicians have a certain attitude towards involving the child and parents in a healthcare partnership as well as advanced triadic communication skills. Little is known about how this attitude, and more broadly, patient- and family-centred care, can be facilitated through education and training. What is New: • This scoping review found a wide array of programmes.. Workshops with simulation or roleplay was the most frequent educational strategy. The programmes, which typically targeted nurses and doctors, chiefly focused on basic and advanced communication and relational competencies, including partnership, which involved shared decision-making and negotiation of plans.

Children and young people as simulated patients: recommendations for safe engagement

Adult simulated patients (SPs) are now embedded in health professions education, prompting the development of practice standards. The comparatively sparse involvement of children and young people as simulated participants in education may account for the absence of standards to underpin their safe practice. Research suggests that children and young people who fulfil simulated participant roles have specific requirements not covered by existing standards. This paper offers recommendations specific to the safe engagement of simulated participants in health professions education that align with published guidelines for working with adult simulated patients. These recommendations include: Practical considerations, safe work environment, scenario development, training for role portrayal, feedback & completion of assessment instruments, parental responsibility and ethical considerations. We hope these recommendations are valuable for anyone working with children or young people in simulated participant roles.

A systematic scoping review of communication skills training in medical schools between 2000 and 2020

BACKGROUND

Communication skills training (CST) remains poorly represented and prioritised in medical schools despite its importance. A systematic scoping review (SSR) of CST is proposed to better appreciate current variability in their structure, content, and assessment. This is to guide their future design in medical school curricula.

METHODS

The Systematic Evidence-Based Approach (SEBA) was used to guide concurrent SSRs of teaching and assessment in CST. After independent database searches, concurrent thematic and content analysis of included articles were conducted separately. Resultant themes/categories were combined via the jigsaw perspective to provide a more holistic view of the data. These were then compared to tabulated summaries of the included articles to create funnelled domains.

RESULTS

52,300 papers were identified, 150 full-text articles included, and four funnelled domains were identified: Indications, Design, Assessment, and Barriers and Enablers of CST. CSTs confer numerous benefits to physicians and patients. It saw increased confidence, improved diagnostic capabilities and better clinical management, as well as greater patient satisfaction and treatment compliance. Skills may be divided into core, prerequisite competencies, and advanced skills pertinent to more challenging and nuanced scenarios - such as population or setting-specific situations. CST teaching and assessment modalities were found to align with Miller's Pyramid, with didactic teaching gradually infused with experiential approaches to enhance their understanding and integration. A plethora of CST frameworks, teaching and assessment methods were identified and are presented together.

CONCLUSION

While variable in approach, content and assessment, CST in medical schools often employ stage-based curricula to instil competency-based topics of increasing complexity throughout medical school education. This process builds on the application of prior knowledge and skills, influencing practice and, potentially, the students' professional identity formation. In addition, the institution plays a critical role in overseeing training, ensuring longitudinal guidance and holistic assessments of the students' progress.

4 Departmental Paediatric Simulation Teaching: How Can we Best Involve Adolescents as Simulated Patients?

Paediatrics requires diverse, adaptable, age and developmentally appropriate communication and clinical skills which HCPs can find challenging, negatively impacting paediatric care. The involvement of simulated patients (SPs) could be used to bridge this gap and bring patient perspectives. To create authentic, high-fidelity paediatric simulations it makes sense that young people should have a role. As a paediatric registrar in a district general hospital, I considered how to involve adolescent SPs in teaching by performing a literature review.

On 2 February 2021, an advanced title and abstract search on PubMed: ‘paediatric’/’children’/’adolescent’ AND ‘simulated patient’/’simulated patients’/’standardized patient’/’standardized patients’. In total, 196 results returned which I filtered as per the inclusion and exclusion criteria (Table 1) leaving five articles.

Inclusion/exclusion criteria

Findings

Recruitment: SPs were recruited from theatre groups

Training: some authors ran didactic teaching about conditions, rehearsals or video training

Scenarios: standards of best practice state that simulated patients should be involved in resource writing and evaluation. However, while one group personalized scenarios

Feedback: honest feedback from SPs is central to optimizing learning which SPs found challenging. Training to feedback with ‘I’ statements or using ‘the character’ to feedback was useful

Positive impact: SPs felt the experience was positive and would be involved again. Positive impacts include: increased trust in HCPs

Negative impact: exhaustion, boredom and potential for exploitation (missed schooling)

Student learning: real children challenged students’ interpersonal skills and rendered encounters realistic.

Implications for practice

‘Do no harm’ remains paramount in medical education. The benefit to society must be weighed against the risks to the child and their best interests must be kept central in educational processes.

When planning teaching I will:

Run monthly simulation sessions consolidating weekly didactic teaching

Limit sessions to 1 hour

Recruit young people within the hospital to minimize school absence

Invite collaboration between SPs and students to create scenarios around self-identified learning needs while maintaining psychological safety, allowing for complexity and fidelity that would be impossible if written by faculty

Train SPs to feedback using ‘I’ statements

Collaborate with the Child and Adolescent Mental Health Team prior to mental health scenarios to consider training and debriefing

Keep the SPs voice central to the debrief and feedback

Engaging young people as simulated patients: a qualitative description of health professional educators’ perspectives

Background

Real patients in clinical placements are important for learning and may well be the ‘gold standard’. However, simulated patients (SPs) are a viable alternative in the absence of this opportunity. While adult SPs contribute to health professions education, child and adolescent simulated patients (CASPs) are less common. This research aims to explore the perspectives of healthcare educators regarding the engagement of young SPs, specifically the identification of barriers and enablers to involving CASPs.

Methods

We used an interpretive paradigm of qualitative description. Thirteen interviewees, all educators involved in SP programmes, participated in semistructured interviews. Data were transcribed verbatim and analysed using an inductive thematic approach.

Findings

Not all participants saw value in engaging CASPs. A number of barriers and enablers to involving them were acknowledged in six themes: challenges and concerns; logistical barriers; benefits of CASPs; overcoming challenges; an ethical minefield; and child safety. Opinions differed with respect to feasibility and necessity for involving CASPs, particularly in the hospital setting where real patients are accessible. All participants articulated the critical importance of ensuring adequate support and adherence to ethical principles if CASPs were involved.

Conclusions

The involvement of CASPs in health professions education is a divisive issue. CASPs’ ability to provide a realistic option for supporting learning is recognised yet perhaps not wholly perceived as a feasible alternative to real patients. Their engagement raises critical ethical, practical, logistical and financial challenges.

Improving the provision of clinical skills teaching for undergraduate medical students during their psychiatry placement: a trainee-led quality improvement project

OBJECTIVE

To increase the provision of clinical skills training during their psychiatry placement by providing a new teaching course to enhance both their clinical knowledge and communication skills.

METHOD

We delivered a pilot teaching course consisting of five workshops (incorporating facilitated, 'near peer' role-play) during the students' psychiatry placement. Qualitative and quantitative feedback was collected pre- and post-course to allow for development of the course.

RESULTS

Data collected indicated that all students found the course a valuable addition to their usual teaching. They indicated that their confidence in their ability to assess patients with common clinical problems improved.

CONCLUSIONS

This trainee-led course was easily integrated into the curriculum and received positive feedback from students. It may have enhanced students' confidence and readiness for exams but this will require further examination of objective assessments and ongoing research to establish this.

Patient/service user involvement in medical education: A best evidence medical education (BEME) systematic review: BEME Guide No. 58

Background: The extent to which patients and service users are involved in medical education varies widely. There is a need for an up to date systematic review of the literature that examines what involvement (description), the potential outcome of such involvement (justification) and 'why' such involvement impacts students (clarification).Methods: Systematic searches of four databases were undertaken. Citations were screened and consensus reached for inclusion/exclusion of studies. Quality of study design and interventional presentation were assessed.Results: Of the 39 studies included in the review, 4 studies were encounter based, 17 sharing experiences, 16 with patients involved in teaching, 2 studies describing consumers as tutors, and none with involvement at the institutional level. Outcomes in terms of benefits to learners included increased empathy and understanding of illness as experienced by patients, improved communication with patients and a greater understanding of patient-center care. Educational quality assessment showed specific weaknesses in theoretical underpinning, curriculum outcomes, content or pedagogy.Conclusions: Patients can enrich medical education by allowing learners to explore patient-centered perspectives in holistic care. For educators this review highlights the lack of an underpinning conceptual basis for which to translate theory into practice.

Educating and Training the Future Adolescent Health Workforce

Unprecedented attention is now focused on adolescents with growing appreciation of their disease burden and of the opportunities of investing in adolescent health. New investments are required to build the technical capacity for policy, programming, research, and clinical care across the world, especially in resource-poor settings where most adolescents live. Strategies to educate and train the future workforce are needed. Competency-based education and training is the standard of education in preservice (undergraduate and postgraduate) health education and medical specialty training. Yet competency is difficult to quantify and standardize, as are the processes that underpin competency-based education and training. The primary objective of this review was to identify how quality education in adolescent health and medicine is determined. This information was used to inform the development of a conceptual framework for institutions teaching adolescent health, which can be used to assess the quality of teaching and learning and to monitor the implementation of these adolescent health competencies. Specific teaching modalities and assessment tools that have been used to teach adolescent health are described to exemplify how an educational program can be delivered and assessed. This framework is a step toward the development of a more adolescent-competent health workforce.