Standardized patients in psychotherapy training and clinical supervision: study protocol for a randomized controlled trial

Development and initial evaluation of a treatment integrity measure for low-intensity group psychoeducational interventions

BACKGROUND

Despite the importance of assessing the quality with which low-intensity (LI) group psychoeducational interventions are delivered, no measure of treatment integrity (TI) has been developed.

AIMS

To develop a psychometrically robust TI measure for LI psychoeducational group interventions.

METHOD

This study had two phases. Firstly, the group psychoeducation treatment integrity measure-expert rater (GPTIM-ER) and a detailed scoring manual were developed. This was piloted by n=5 expert raters rating the same LI group session; n=6 expert raters then assessed content validity. Secondly, 10 group psychoeducational sessions drawn from routine practice were then rated by n=8 expert raters using the GPTIM-ER; n=9 patients also rated the quality of the group sessions using a sister version (i.e. GPTIM-P) and clinical and service outcome data were drawn from the LI groups assessed.

RESULTS

The GPTIM-ER had excellent internal reliability, good test-retest reliability, but poor inter-rater reliability. The GPTIM-ER had excellent content validity, construct validity, formed a single factor scale and had reasonable predictive validity.

CONCLUSIONS

The GPTIM-ER has promising, but not complete, psychometric properties. The low inter-rater reliability scores between expert raters are the main ongoing concern and so further development and testing is required in future well-constructed studies.

Where it all begins: Predicting initial therapeutic skills before clinical training in cognitive behavior therapy

To train novice students adequately, it is crucial to understand where they start and how they develop their skills. This study examined the impact of novice students' characteristics on their initial clinical micro-skills when treating simulated patients with cognitive behavior therapy. The sample consisted of 44 graduate psychology students treating seven simulated patients. Clinical micro-skills were measured both using video-based ratings in reaction to short video clips of simulated patients (via the Facilitative Interpersonal Skills (FIS) performance task) and by using video-based ratings within a session with a simulated patient (using the Inventory of Therapeutic Interventions and Skills; ITIS). Two separate LASSO regressions were performed using machine learning to select potential predictors for both skills assessments. Subsequently, a bootstrapping algorithm with 10,000 iterations was used to examine the variability of regression coefficients. Using LASSO regression, we identified two predictors for clinical micro-skills in standardized scenarios: extraversion (b = 0.10) and resilience (b = 0.09), both were not significantly associated with clinical micro-skills. Together, they explained 15% of the skill variation. Bootstrapping confirmed the stability of these predictors. For clinical micro-skills in sessions, only competitiveness was excluded by LASSO regression, and all predictors showed significant instability. The results provide initial evidence that trainees' resilience and extraversion should be promoted in the clinical training of cognitive behavior therapy. More studies on clinical micro-skills and training with larger sample sizes are needed to fully understand clinical development.

The concise measurement of clinical communication skills: Validation of a short scale

OBJECTIVE

There is a lack of brief rating scales for the reliable assessment of psychotherapeutic skills, which do not require intensive rater training and/or a high level of expertise. Thus, the objective is to validate a 14-item version of the Clinical Communication Skills Scale (CCSS-S).

METHODS

Using a sample of N = 690 video-based ratings of role-plays with simulated patients, we calculated a confirmatory factor analysis and an exploratory structural equation modeling (ESEM), assessed convergent validities, determined inter-rater reliabilities and compared these with those who were either psychology students, advanced psychotherapy trainees, or experts.

RESULTS

Correlations with other competence rating scales were high (rs > 0.86-0.89). The intraclass correlations ranged between moderate and good [ICC_(2,2) = 0.65-0.80], with student raters yielding the lowest scores. The one-factor model only marginally replicated the data, but the internal consistencies were excellent (α = 0.91-95). The ESEM yielded a two-factor solution (Collaboration and Structuring and Exploration Skills).

CONCLUSION

The CCSS-S is a brief and valid rating scale that reliably assesses basic communication skills, which is particularly useful for psychotherapy training using standardized role-plays. To ensure good inter-rater reliabilities, it is still advisable to employ raters with at least some clinical experience. Future studies should further investigate the one- or two-factor structure of the instrument.

Fifteen simulated patient working formats to use in communication skills training: Report of a survey

OBJECTIVE

Simulated and standardized patients (SPs) are increasingly being used in communication skills training for healthcare professionals' education. Despite this broad use of SPs, there is no recent literature with an overview on SP working formats being used. We ran a study to fill this gap.

METHODS

First, a survey on formats on the use of SPs in various curricula for education of healthcare professionals in Belgium and The Netherlands was run by members of the Dutch Association of Medical Education Special Interest Group on Simulated and Standardized patients (SIG-NL/B). Then the SIG-NL/B organized a national workshop where professionals working with or interested in SPs were invited to come forward with SP working formats they used. They were also asked to provide relevant details about the use. Finally, the outcomes of these two phases were combined.

RESULTS

Fifteen SP working formats were found. Six of them were described before. The details of all formats are listed and discussed.

CONCLUSION

We categorised 15 SP working formats. The choice to use a particular format is mainly based on the learning objectives of the session involved and the expertise at hand.

Vermittlung psychotherapeutischer Fertigkeiten durch die Arbeit mit Simulationspatientinnen

Zusammenfassung. Theoretischer Hintergrund: In der Ausbildung von Psychotherapeutinnen konnte bereits ein subjektiver Kompetenzgewinn durch die Arbeit mit Simulationspatientinnen (SP) belegt werden. Fragestellung: Neben der Replikation dieser Befunde, welche auf Selbstberichten basieren, untersuchte vorliegende Studie die objektive Behandlungsintegrität von Studierenden anhand von Beobachterratings. Methode: Die Stichprobe setzte sich aus 39 Studierenden aus 4 Fallseminaren zusammen. Zur Validierung der objektiven Behandlungsintegrität wurde eine Vergleichsstichprobe von Psychologischen Psychotherapeutinnen in Ausbildung (PPiA) herangezogen (Videos N = 763). Zusätzlich wurden Charakteristika der Studierenden hinsichtlich ihrer prädiktiven Fähigkeiten untersucht. Ergebnisse: Die Ergebnisse belegten neben einem selbstberichteten Kompetenzzuwachs auch eine zufriedenstellende objektive Behandlungsintegrität, die signifikant niedriger ausfiel als die der PPiA. Zusätzlich konnten Prädiktoren für die Behandlungsintegrität identifiziert werden. Schlussfolgerungen: Die Ergebnisse zeigen, dass Studierende Therapiesituationen, die ihrem Novizen-Status entsprechen, in zufriedenstellendem Maße ausgestalten können.

Konzeption des longitudinalen DYNAMIK-Curriculums

Hintergrund

Durch die Einführung des neuen „Psychotherapiestudiums“ zum Herbst 2020 und die Wünsche bisheriger Ausbildungsteilnehmer an psychotherapeutischen Ausbildungsinstituten ist die Notwendigkeit gegeben, erfahrungsbasierte und kompetenzorientierte Lehre in das zukünftige Studium und die nachfolgende Weiterbildung werdender Psychotherapeuten zu integrieren.

Material und Methode

Orientiert am Kern-Zyklus, einem bedeutenden Modell zur Curriculumsentwicklung, werden die Entwicklung, Konzeptionalisierung und Implementierung eines longitudinalen Curriculums zur Vermittlung psychodynamischer Interventionskompetenzen (DYNAMIK-Curriculum) in die derzeitige Ausbildung zum psychologischen Psychotherapeuten vorgestellt.

Ergebnisse

Es wurde ein longitudinales Curriculum mit 8 Modulen zur Vermittlung allgemeiner und spezifischer psychodynamischer Interventionskompetenzen mithilfe von Peer-Rollenspielen und standardisierten Patienten entwickelt. Dieses stellt seit Mitte 2019 einen integralen Bestandteil der Ausbildung zum tiefenpsychologisch fundierten Psychotherapeuten am Heidelberger Institut für Psychotherapie (HIP) dar.

Schlussfolgerung

Das DYNAMIK-Curriculum ist der erste wichtige Schritt in Richtung der longitudinalen erfahrungsorientieren, praxisnahen Kompetenzorientierung in der derzeitigen Ausbildung und dem zukünftigen Studium mit nachfolgender Weiterbildung von psychologischen Psychotherapeuten. Es resultiert die Notwendigkeit zur Wirksamkeitsüberprüfung solcher Curricula und zur praktischen Prüfung von Interventionskompetenzen.

Standardized Patients in Clinical Psychology: From Research to Practice

Background: Within the pending reform of the German law of psychotherapy training, education in clinical psychology and the examination of psychotherapeutic competencies are established as more practice oriented. Students will acquire and demonstrate therapeutic skills through interactions with standardized patients (SPs). The aim of the current paper is to enhance evidence-based implementation of these new methods of education and examination by presenting the current evidence regarding the use of SPs and by pointing out areas for further research. Results: Results of recent studies demonstrate that SPs are able to present mental disorders authentically. Prerequisites are, among others, the selection of suitable SPs, detailed role scripts, specific training, feedback, and corrective training. Although some research questions, including the comparative effectiveness of SPs, remain unanswered, practice implications for using SPs in education, examination, and research can be drawn. These implications are illustrated schematically. Conclusions: The use of SPs has large potential for education in clinical psychology and for research on psychotherapy training. With a view to encouraging the widespread use of SPs, we provide exemplary materials (e.g., role script) within the online supplements (for all online suppl. material, see www.karger.com/doi/10.1159/000510049).

Einsatz standardisierter Patienten im Psychologiestudium: Von der Forschung in die Praxis

<b><i>Hintergrund:</i></b> Im Rahmen des reformierten Psychotherapeutengesetzes wird eine stärkere Praxisorientierung in der klinisch-psychologischen Lehre und in der Prüfung psychotherapeutischer Kompetenzen verankert. Hierbei sollen Studierende durch die Interaktion mit standardisierten Patient*innen (SP) therapeutische Kompetenzen erwerben und demonstrieren. <b><i>Fragestellung:</i></b> Das Ziel des vorliegenden Beitrags ist es, eine evidenzbasierte Umsetzung dieser neuen Lehr- und Prüfungsformate zu unterstützen, indem bisherige Forschungsbefunde zum Einsatz von SP dargestellt und Bereiche, in denen weitere Forschung notwendig ist, aufgezeigt werden. <b><i>Ergebnisse:</i></b> Empirische Befunde zeigen, dass SP psychische Störungen authentisch darstellen können. Voraussetzung dafür sind beispielsweise die Auswahl geeigneter SP, detaillierte Rollenanleitungen, spezifisches Training, Feedback und Nachschulungen. Auch wenn einige Forschungsfragen, wie zur vergleichenden Wirksamkeit des Einsatzes von SP, noch unbeantwortet sind, lassen sich praktische Implikationen für SP-Programme in Lehre, Prüfung und Forschung ableiten, die in einem Ablaufschema dargestellt werden. <b><i>Schlussfolgerungen:</i></b> Der Einsatz von SP bietet großes Potenzial für die klinisch-psychologische Lehre und Ausbildungsforschung. Um den Einsatz von SP an anderen Standorten zu unterstützen, werden Beispielmaterialien (z.B. Rollenanleitung) in den elektronischen Supplementen (siehe www.karger.com/doi/10.1159/000509249 für alle Supplemente) zum Artikel zur Verfügung gestellt.