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Garber AM, Meliagros P, Diener-Brazelle J, Dow A. Using Virtual Reality to Teach Medical Students Cross-Coverage Skills. Am J Med 2024; 137:454-458. [PMID: 38364987 DOI: 10.1016/j.amjmed.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/29/2024] [Accepted: 02/03/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Recognizing and attempting management of patients with urgent or emergent conditions is one of the Association of American Medical Colleges Core Entrustable Professional Activities (#10) and a skill desired of new interns. However, given the acuity of these patient conditions, medical students often struggle to gain experience in these situations. Virtual reality could help fill this void while lowering costs and resources compared with high-fidelity simulation. METHODS We converted a high-fidelity chest pain simulation case to virtual reality format utilizing short video clips filmed with a 360-degree camera and superimposed menus of options at decision points. This virtual reality simulation was offered to fourth-year medical students during their transition to residency course in the spring of 2023. Students were offered a post-survey on the simulation. RESULTS There were 47 fourth-year students that completed the virtual reality simulation; 41 completed the post-survey (response rate 87.2%). Over 90% of the students agreed or strongly agreed with the following statements: the virtual reality simulation was a valuable part of the transition to residency course, the virtual reality case was similar to what they will face as an intern, and they would like to have more virtual reality simulations earlier in the fourth year; 85.4% agreed or strongly agreed that the virtual reality simulation helped prepare them for the first few days of intern year. CONCLUSIONS We demonstrated that virtual reality is an acceptable, cost-effective, and feasible modality to teach medical students how to recognize and attempt management of urgent clinical situations (Core Entrustable Professional Activity 10).
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Affiliation(s)
- Adam M Garber
- Departments of Medicine and Health Administration, Virginia Commonwealth University School of Medicine, Richmond.
| | - Pete Meliagros
- Departments of Medicine and Health Administration, Virginia Commonwealth University School of Medicine, Richmond
| | - Jayson Diener-Brazelle
- Virginia Commonwealth University School of Medicine Technology Services (VCU SOMTech), Richmond
| | - Alan Dow
- Departments of Medicine and Health Administration, Virginia Commonwealth University School of Medicine, Richmond
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Sendekie AK, Tesfaye AH, Tadesse YB, Dagnaw AD, Belachew EA. Actual practices of community pharmacists in the management of diabetes: a comparison of simulated patient-based study with perceived role of involvement. J Pharm Policy Pract 2024; 17:2326381. [PMID: 38562557 PMCID: PMC10984231 DOI: 10.1080/20523211.2024.2326381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Objectives This study evaluated the level of community pharmacy professionals' (CPPs) actual practices and contrasted it with their self-reported perceived involvement in diabetes management. Methods A self-reported cross-sectional and simulated patient (SP)-based study were employed at community drug retail outlets (CDROs) in Northwest Ethiopia. SP-case scenarios were used to examine the actual practices of CPPs in diabetes management and were compared with self-reported perceived involvement. The data were managed and analysed using SPSS version 26. Results About 184 participants in the self-reported and 100 CPPs' actual practices using three SP visits were included. The overall actual practice (17.8%) was found to be significantly different compared with the perceived level of involvement (73.5%) (p-value <0.05). About 94.3% of CPPs dispensed requested medications to the SP without a prescription. Despite most participants being perceived to be involved, more than 76% of CPPs did not counsel the SP for lifestyle modifications, avoiding risky behaviours, adherence to treatment, routine blood glucose checkups, diabetic foot care techniques, or consultation with physicians for further management. Conclusion A significant discrepancy between actual practices and perceived CPPs' involvement in the management of diabetes was observed. The findings may suggest that exploring possible gaps may be crucial.
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Affiliation(s)
- Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amensisa Hailu Tesfaye
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yabibal Berie Tadesse
- Department of Pharmaceutical Chemistry, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abera Dessie Dagnaw
- Department of Pharmaceutical Chemistry, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eyayaw Ashete Belachew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Mori A, Kato I, Narumi K, Takekuma Y, Kashiwagi H, Sato Y, Sugawara M, Kobayashi M. Quantitative analysis of communication changes in online medication counseling using the Roter Interaction System. Res Social Adm Pharm 2024; 20:36-42. [PMID: 37833103 DOI: 10.1016/j.sapharm.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/30/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Quantitative analysis and objective evaluation of communication play an important role in medical communication education. In the process of developing an online methodology for medication counseling practice, we felt the necessity of conducting a quantitative evaluation to enhance its effectiveness. OBJECTIVES This study aimed to quantitatively evaluate the communication in each scenario to comprehensively identify the differences between face-to-face and online communication in medication counseling practicum. In addition, we examined how patient satisfaction changes between face-to-face and online interactions. METHODS Face-to-face and online role-playing were conducted between simulated patients (SPs) and students acting as pharmacists, and their dialogues were videotaped. The utterances in each recorded dialogue were categorized and analyzed by the Roter interaction analysis system (RIAS). The Japanese version of the Medical Interview Satisfaction Scale (MISS-21J) responses of the SPs were analyzed for the patient satisfaction survey. RESULT The results of the RIAS analysis revealed that the socio-emotional category appeared significantly more frequently in face-to-face communication, with more utterances that were more attuned to the feelings of the other person and more considerate of his or her feelings. The ratio of the number of utterances between students and SPs suggested that the communication was more interactive. CONCLUSION Based on the respective communication tendencies may have led to higher satisfaction in face-to-face than in online patient satisfaction surveys, less anxiety about illness and medications, and easier trusting relationships. Since it is difficult to grasp the mood of the other party and to open up to them due to the lack of nonverbal information in online dialogue, it is necessary to be more conscious of conversations that capture the feelings of patients in online medication counseling.
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Affiliation(s)
- Ayako Mori
- Education Research Center for Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-12-jo, Nishi-6-chome, Kita-ku, Sapporo, 060-0812, Japan
| | - Izumi Kato
- Education Research Center for Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-12-jo, Nishi-6-chome, Kita-ku, Sapporo, 060-0812, Japan
| | - Katsuya Narumi
- Education Research Center for Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-12-jo, Nishi-6-chome, Kita-ku, Sapporo, 060-0812, Japan; Laboratory of Clinical Pharmaceutics & Therapeutics, Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-12-jo, Nishi-6-chome, Kita-ku, Sapporo, 060-0812, Japan
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital, Kita-14-jo, Nishi-5-chome, Kita-ku, Sapporo, 060-8648, Japan
| | - Hitoshi Kashiwagi
- Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-12-jo, Nishi-6-chome, Kita-ku, Sapporo, 060-0812, Japan
| | - Yuki Sato
- Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-12-jo, Nishi-6-chome, Kita-ku, Sapporo, 060-0812, Japan
| | - Mitsuru Sugawara
- Department of Pharmacy, Hokkaido University Hospital, Kita-14-jo, Nishi-5-chome, Kita-ku, Sapporo, 060-8648, Japan; Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-12-jo, Nishi-6-chome, Kita-ku, Sapporo, 060-0812, Japan
| | - Masaki Kobayashi
- Education Research Center for Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-12-jo, Nishi-6-chome, Kita-ku, Sapporo, 060-0812, Japan; Laboratory of Clinical Pharmaceutics & Therapeutics, Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-12-jo, Nishi-6-chome, Kita-ku, Sapporo, 060-0812, Japan.
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Gagnerie P, Sanges S, Guerreschi P, Wiel E, Lebuffe G, Sanctorum T, Jourdain M, Morell-Dubois S, Zéphir H. Training first-year medical residents to break bad news using healthcare role-play and trainees as simulated patients: Experience of the "ADIAMED" program from Lille University School of Medicine. Rev Med Interne 2023; 44:632-640. [PMID: 37923588 DOI: 10.1016/j.revmed.2023.10.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Several studies suggest the relevance of healthcare simulation to prepare future doctors to deliver bad news. A such, we designed a role-play workshop to train first-year residents enrolled in Lille University School of Medicine to break bad news. The objective of this work is to report on our experience of this training and to assess its educational value through its capacity to satisfy residents' expectations, to induce a feeling of ease towards bad news disclosure, and to change trainees' preconceptions regarding these situations. METHODS The training consisted of a 45-minute heuristic reflective activity, aimed at identifying residents' preconceptions regarding bad news disclosure, followed by 4 30-min role-plays in which they played the parts of the physician, the patient and/or their relatives. Trainees were asked to answer 2 questionnaires (pre- and post-training), exploring previous experiences, preconceived ideas regarding bad news disclosure and workshop satisfaction. RESULTS Almost all residents felt very satisfied with the workshop, which they regarded as formative (91%) and not too stressful (89%). The majority felt "more capable" (53% vs. 83%) and "more comfortable" (27% vs. 62%) to deliver bad news, especially regarding "finding the right words" (12% vs. 22%). Trainees tended to overestimate their skills before the workshop and lowered their assessment of their performance after attending the training, especially when they played the role of a patient in the simulation. CONCLUSION Healthcare role-play seems an interesting technique for training to breaking bad news. Placing residents in the role of patients or relatives is an active approach that encourages reflexivity.
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Affiliation(s)
- P Gagnerie
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Centre de Simulation PRESAGE, Université de Lille, 59000 Lille, France
| | - S Sanges
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Centre de Simulation PRESAGE, Université de Lille, 59000 Lille, France; Université de Lille, Inserm, CHU de Lille, Département de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France.
| | - P Guerreschi
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Département de Chirurgie Plastique, Inserm, CHU de Lille, 59000 Lille, France
| | - E Wiel
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Université de Lille, CHU de Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, 59000 Lille, France; Pôle de l'Urgence, CHU de Lille, 59000 Lille, France
| | - G Lebuffe
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Centre de Simulation PRESAGE, Université de Lille, 59000 Lille, France; Pôle d'anesthésie réanimation - ULR 7365-GRITA - groupe de recherche sur les formes injectables et les techniques associées, Université de Lille, CHU de Lille, 59000 Lille, France
| | - T Sanctorum
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Centre de Simulation PRESAGE, Université de Lille, 59000 Lille, France
| | - M Jourdain
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Centre de Simulation PRESAGE, Université de Lille, 59000 Lille, France; Université de Lille, Inserm, CHU de Lille, U1190, Department of Intensive Care Medicine, 59000 Lille, France
| | - S Morell-Dubois
- Université de Lille, Inserm, CHU de Lille, Département de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France
| | - H Zéphir
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Département de Neurologie, CHU de Lille, 59000 Lille, France; Université de Lille, Inserm U 1172, CHU de Lille, 59000 Lille, France
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Ruba E, Reeves C, Khan A, Pelaez EC, Heaberlin S. Communication skills in practice vs. communication in the real world: Insights from an international medical student symposium. Patient Educ Couns 2023; 115:107848. [PMID: 37406472 DOI: 10.1016/j.pec.2023.107848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE To explore and compare medical students' experiences with communication skills training (CST) in medical education. METHOD Five medical students from the U.S., U.K., and Ireland shared their experiences with CST at a 90-minute symposium held at the 2022 International Conference on Communication in Healthcare (ICCH). RESULTS Students identified two areas of CST that may affect their preparedness for real-world clinical practice: 1) the impact of the COVID-19 pandemic on communication teaching and learning, and 2) the need to effectively communicate with diverse patient populations. CONCLUSION The COVID-19 pandemic brought major changes to CST, and though training programs varied in their approach, students found that they were able to successfully adapt while gaining valuable skills needed to navigate communicating with patients on virtual platforms. When learning to communicate with patients from diverse backgrounds, students perceived generalized strategies that equipped them with the skills needed to adapt to uncertainty to be the most valuable. PRACTICE IMPLICATIONS Collaboration between medical schools, both nationally and internationally, provides opportunity to share areas of strength and avenues for improvement in CST. Representation of learner perspectives is essential in order to better understand how well current educational methodologies prepare learners to enter real world clinical practice.
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Affiliation(s)
- Emily Ruba
- University of Iowa Carver College of Medicine, United States.
| | | | - Ahmad Khan
- Leicester Medical School, United Kingdom
| | | | - Sally Heaberlin
- University of Iowa Carver College of Medicine, United States
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Sharma C, Singh P, Shekhar S, Bhardwaj A, Jhirwal M, Ghuman NK, Gothwal M, Yadav G, Kathuria P, Mishra V. Pre-COVID and COVID experience of objective structured clinical examination (OSCE) as a learning tool for post-graduate residents in Obstetrics & Gynecology - a quality improvement study. Obstet Gynecol Sci 2023:ogs.22266. [PMID: 37073604 PMCID: PMC10375219 DOI: 10.5468/ogs.22266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 04/04/2023] [Indexed: 04/20/2023] Open
Abstract
Objective Due to its comprehensive, reliable, and valid format, the objective structured clinical examination (OSCE) is the gold standard for assessing the clinical competency of medical students. In the present study, we evaluated the importance of the OSCE as a learning tool for postgraduate (PG) residents assessing their junior undergraduate students. We further aimed to analyze quality improvement during the pre-coronavirus disease (COVID) and COVID periods. Methods This quality-improvement interventional study was conducted at the Department of Obstetrics and Gynecology. The PG residents were trained to conduct the OSCE. A formal feedback form was distributed to 22 participants, and their responses were analyzed using a five-point Likert scale. Fishbone analysis was performed, and the 'plan-do-study-act' (PDSA) cycle was implemented to improve the OSCE. Results Most of the residents (95%) believed that this examination system was extremely fair and covered a wide range of clinical skills and knowledge. Further, 4.5% believed it was more labor- and resource intensive and time-consuming. Eighteen (81.8%) residents stated that they had learned all three domains: communication skills, time management skills, and a stepwise approach to clinical scenarios. The PDSA cycle was run eight times, resulting in a dramatic improvement (from 30% to 70%) in the knowledge and clinical skills of PGs and the standard of OSCE. Conclusion The OSCE can be used as a learning tool for young assessors who are receptive to novel tools. The involvement of PGs in the OSCE improved their communication skills and helped overcome human resource limitations while manning various OSCE stations.
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Affiliation(s)
- Charu Sharma
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, India
| | - Pratibha Singh
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, India
| | - Shashank Shekhar
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, India
| | - Abhishek Bhardwaj
- Department of Dermatology, Venereology and Leprology, Jodhpur, Rajasthan, India
| | - Manisha Jhirwal
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, India
| | - Navdeep Kaur Ghuman
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, India
| | - Meenakshi Gothwal
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, India
| | - Garima Yadav
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, India
| | - Priyanka Kathuria
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, India
| | - Vibha Mishra
- Department of Gyneoncocology, Pandit Madan Mohan Malviya Cancer Centre, Varanasi, India
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Erici S, Lindqvist D, Lindström MB, Gummesson C. Three perspectives on learning in a simulated patient scenario: a qualitative interview study with student, simulated patient, and teacher. Adv Simul (Lond) 2023; 8:10. [PMID: 36941693 PMCID: PMC10029280 DOI: 10.1186/s41077-023-00249-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 03/01/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Patient simulation can be useful for medical students in developing communication skills for vulnerable situations. Three participants are primarily involved in the patient simulation activities: the student, the simulated patient (SP), and the teacher. We here aimed to explore these participants' perceptions of learning in a patient simulation scenario. METHODS We conducted individual interviews with eight students, three teachers, and one SP at a psychiatry placement of a Medical Doctor Program (5th year). During the interviews we asked the participants to watch a video of their participation in a patient simulation session. Thus, we obtained three perspectives on each of the eight recordings. We analysed our data with qualitative content analysis. RESULTS Three themes were generated: identity formation, collaborative learning, and learning intentions. This highly emotional scenario forced students out of their comfort zone, to the intersection of their roles as private person and professional. The SP perceived the collaborative creation of the scenario as significant learning. The teacher took a professional position and perceived the learning in the perspective of a future colleague. CONCLUSIONS The mutually created emotionally loaded scenario was found to be important from all three perspectives, forcing the students to identify unexpected ways of communicating. This possibly enhanced their professional identity development. Implications for future research can be to explore the process of skills transfer.
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Affiliation(s)
- Sten Erici
- Centre for Teaching and Learning, Faculty of Medicine, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
| | - Daniel Lindqvist
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Lund, Sweden
| | - Mats B Lindström
- Department of Clinical Sciences Malmö, Psychiatry, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Christina Gummesson
- Faculty of Medicine, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Siemerkus J, Petrescu AS, Köchli L, Stephan KE, Schmidt H. Using standardized patients for undergraduate clinical skills training in an introductory course to psychiatry. BMC Med Educ 2023; 23:159. [PMID: 36922802 PMCID: PMC10016160 DOI: 10.1186/s12909-023-04107-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The goal of this study was to assess the value and acceptance of Standardized or Simulated Patients (SPs) for training clinically inexperienced undergraduate medical students in psychiatric history taking, psychopathological assessment, and communication with psychiatric patients. METHODS As part of a newly developed introductory course to psychiatry, pairs of 3rd year medical students conducted psychiatric assessments of SPs, including history and psychopathological state, under the supervision of a clinical lecturer. Prior to the assessment, students attended introductory lectures to communication in psychiatry and psychopathology but were clinically inexperienced. After the interview, the students' summary of their findings was discussed with other students and the lecturer. Students, lecturers, and actors were invited to a survey after the course. Questions for the students included self-reports about perceived learning success and authenticity of the interviews. RESULTS 41 students, 6 actors and 8 lecturers completed the survey (response rates of 48%, 50%, and 100%, respectively). The survey results indicated that, despite their lack of clinical experience, students learned how to conduct a psychiatric interview, communicate in a non-judgmental and empathetic manner, take a psychiatric history and perform a psychopathological examination. SPs were perceived as authentic. The survey results suggested that this setting allowed for an enjoyable, non-distressful and motivating learning experience within a restricted time frame of just two afternoons. CONCLUSION The results indicated that the SP approach presented is useful for teaching clinical skills in psychiatry to students with limited previous clinical experience and knowledge of psychiatry. We argue that SPs can be used to teach practical psychiatric skills already during an early phase of the curriculum. Limitations of our study include a limited sample size, a temporal gap between the course and the survey, reliance on self-reports, and lack of comparison to alternative interventions.
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Affiliation(s)
- Jakob Siemerkus
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland.
| | - Ana-Stela Petrescu
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Laura Köchli
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Klaas Enno Stephan
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
- Max Planck Institute for Metabolism Research, Cologne, Germany
| | - Helen Schmidt
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
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Duffy B, Tully R, Stanton AV. An online case-based teaching and assessment program on clinical history-taking skills and reasoning using simulated patients in response to the COVID-19 pandemic. BMC Med Educ 2023; 23:4. [PMID: 36600232 PMCID: PMC9811710 DOI: 10.1186/s12909-022-03950-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The COVID-19 pandemic has created unprecedented challenges for medical students and educators worldwide. Groups 1, 2 and 3 of year 3, semester 2 medical students at the Royal College of Surgeons in Ireland (n = 275) had only completed 2, 5 and 7 weeks, respectively, of their scheduled 10-week clinical medicine and surgery attachments, prior to the Irish shutdown of all in-person non-essential activities, including medical student education. METHODS We developed and delivered an online case-based program, focused on history-taking skills and clinical reasoning, using simulated patients and video technologies. 12 tutorials were delivered over 6 weeks to 35 subgroups of 8 students in line with program learning outcomes. Both simulated patients (n = 36), and tutors (n = 45, from retired clinical professors to newly graduated physicians), were rapidly upskilled in Blackboard Collaborate and Microsoft Teams, and also in the provision of constructive feedback. We evaluated this newly developed program by the following three criteria: student attendance, achieved grades, and student feedback. RESULTS Attendance at the 12 tutorials was higher amongst group 1 and 2 students (75 and 73%) by comparison with group 3 students (60%) (p = < 0.001). Of the 273 students that sat the Year 3 Semester 2 online long case assessment, 93% were successful. Despite group 1 students having the least prior clinical experience, results were similar to those of groups 2 and 3 (1st honors, 2nd honors, pass, and fail grades for group 1, 39%, 33%, 23% and 6%; group 2, 34%, 41%, 17% and 8%; group 3, 39%, 25%, 28% and 7%) (p = 0.48). An increased attendance rate at tutorials was associated with higher numbers of honors grades (p = < 0.001). Anonymous feedback from the students demonstrated considerable satisfaction with program: > 85% agreed that the online program was interactive and very educational. CONCLUSIONS Use of online video technology, tutors of varied experience, and simulated patients were demonstrated to replicate patient encounters, and to facilitate the development of clinical skills remotely during the COVID-19 pandemic.
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Affiliation(s)
- Barbara Duffy
- Schools of Medicine, Pharmacy and Biomolecular Sciences, Royal College of Surgeons, Dublin, Ireland.
| | - Roisin Tully
- Schools of Medicine, Pharmacy and Biomolecular Sciences, Royal College of Surgeons, Dublin, Ireland
| | - Alice V Stanton
- Schools of Medicine, Pharmacy and Biomolecular Sciences, Royal College of Surgeons, Dublin, Ireland
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Isaksson J, Krabbe J, Ramklint M. Medical students' experiences of working with simulated patients in challenging communication training. Adv Simul (Lond) 2022; 7:32. [PMID: 36217210 PMCID: PMC9552443 DOI: 10.1186/s41077-022-00230-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/24/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Physicians' communication skills are important for patient-centered care. Although working with simulated patients (SPs) in case simulations is common for training communication skills, studies seldom include a wide range of challenging behaviors or explore students' own experiences of learning communication skills with SPs. Therefore, this study was aimed at investigating how medical students perceive communication training involving challenging consultations with SPs and the impact on their learning experiences. METHODS Twenty-three medical students from the same class were interviewed in focus groups about their experiences of simulation training with actors as SPs. In the simulation training, the students were instructed to deliver bad news, manage negative patient reactions, and encourage behavioral changes in reluctant patients. This was followed by feedback and a debriefing exercise. The interviews were analyzed with content analysis. RESULTS Students reported that actors as SPs made the simulations more realistic and enabled them to practice various communication skills for challenging consultations in a safe way and manage their own feelings, thereby promoting new learning experiences. Elements such as actors' flexibility in changing behaviors during role-play and exposure to different challenging behaviors, like negative emotions, were regarded as valuable. The importance of an accepting and permissive climate for the debriefing exercise was highlighted, though without taking too much time from the simulation training. Feedback directly from the SP was appreciated. CONCLUSIONS Actors as SPs were perceived as a valuable part of challenging communication training and added elements to the learning process. Future studies should include a wider range of challenging behaviors in training with SPs and evaluate the effects of such training on students' use of communication skills.
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Affiliation(s)
- Johan Isaksson
- Child and Adolescent Psychiatry and Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden. .,Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
| | - Julia Krabbe
- Child and Adolescent Psychiatry and Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Mia Ramklint
- Child and Adolescent Psychiatry and Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Aoki S, Shikama Y, Yasui K, Moroi Y, Sakamoto N, Suenaga H, Tang Z, Yasuda M, Chiba Y, Stanyon M, Otani K. Optimizing simulated interviews and feedback to maximize medical students' self-efficacy in real time. BMC Med Educ 2022; 22:438. [PMID: 35672701 PMCID: PMC9172145 DOI: 10.1186/s12909-022-03512-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Self-efficacy is crucial in improving medical students' communication skills. This study aims to clarify where medical students' self-efficacy is greatest following an interview with a simulated patient and subsequent feedback. METHODS A total of 162 medical students (109 men, 53 women) in their fourth or fifth year at a university in Japan participated in this study. The degree of self-efficacy in medical interviewing was measured before and after a medical interview with a simulated patient, and after the subsequent feedback session. RESULTS ANOVA analysis revealed that self-efficacy for medical interviews was higher after both the interview and the feedback session than before the interview. Among all three time points, self-efficacy was highest after the feedback session. CONCLUSIONS Feedback following a simulated interview with a simulated patient is important to improve the self-efficacy of medical students when learning medical interviewing skills.
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Affiliation(s)
- Shuntaro Aoki
- Center for Medical Education and Career Development, Fukushima Medical University, Hikarigaoka 1, Fukushima, 960-1247, Japan.
| | - Yayoi Shikama
- Center for Medical Education and Career Development, Fukushima Medical University, Hikarigaoka 1, Fukushima, 960-1247, Japan
| | - Kiyotaka Yasui
- Center for Medical Education and Career Development, Fukushima Medical University, Hikarigaoka 1, Fukushima, 960-1247, Japan
| | - Yoko Moroi
- Center for Medical Education and Career Development, Fukushima Medical University, Hikarigaoka 1, Fukushima, 960-1247, Japan
| | - Nobuo Sakamoto
- Center for Medical Education and Career Development, Fukushima Medical University, Hikarigaoka 1, Fukushima, 960-1247, Japan
| | - Hiroki Suenaga
- Center for Medical Education and Career Development, Fukushima Medical University, Hikarigaoka 1, Fukushima, 960-1247, Japan
| | - Zunyi Tang
- Center for Medical Education and Career Development, Fukushima Medical University, Hikarigaoka 1, Fukushima, 960-1247, Japan
| | - Megumi Yasuda
- Center for Medical Education and Career Development, Fukushima Medical University, Hikarigaoka 1, Fukushima, 960-1247, Japan
| | - Yasuko Chiba
- Center for Medical Education and Career Development, Fukushima Medical University, Hikarigaoka 1, Fukushima, 960-1247, Japan
| | - Maham Stanyon
- Center for Medical Education and Career Development, Fukushima Medical University, Hikarigaoka 1, Fukushima, 960-1247, Japan
| | - Koji Otani
- Center for Medical Education and Career Development, Fukushima Medical University, Hikarigaoka 1, Fukushima, 960-1247, Japan
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12
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Fuehrlein B, Hochschild A, Goldman M, Amsalem D, Chilton J, Martin A. Learning About and Destigmatizing Substance Use Disorders: a Video-Based Educational Module Using Simulated Patients. Acad Psychiatry 2022; 46:342-346. [PMID: 34751939 PMCID: PMC8577171 DOI: 10.1007/s40596-021-01559-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/28/2021] [Indexed: 05/02/2023]
Abstract
OBJECTIVE The authors developed and tested video clips depicting three paradigmatic substance use disorder (SUD) clinical scenarios, each portrayed by a different simulated patient interacting with the same clinician. METHODS The authors embedded 21 short video clips (with a cumulative duration of 27 min) into a 2-h session on SUDs. The didactic was delivered online through synchronous videoconferencing with Zoom. The primary outcome compared learners' scores on the Attitudes and Confidence in the Treatment of Patients with Substance Use Disorders (ACT-SUDS) before and after participating in the didactic. RESULTS Fifty-eight second-year medical students participated and completed the survey prior to the didactic; 42 (72%) of them completed the survey immediately after. Compared to baseline, ACT-SUDS increased after the didactic: from 3.7 ± 0.5 to 4.0 ± 0.4 (mean difference = 0.4 [95% confidence interval = 0.2-0.5], paired-t = 5.75, p < 0.001), as did each of its four subscales: confidence, enjoyment, SUD as a medical disorder, and attitudes toward Alcoholics Anonymous (AA; t ≥ 3.0, p ≤ 0.005). CONCLUSIONS The video-based educational module proved easy to implement in the virtual classroom and led to measurable changes in perceptions and attitudes toward SUDs. The module is available to view or freely download and is amenable for adaptation by end-use instructors.
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Affiliation(s)
| | | | - Mia Goldman
- Tel Aviv University Faculty of Medicine, Ramat Aviv, Israel
| | - Doron Amsalem
- Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
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George RE, Wells H, Cushing A. Experiences of simulated patients in providing feedback in communication skills teaching for undergraduate medical students. BMC Med Educ 2022; 22:339. [PMID: 35505323 PMCID: PMC9066858 DOI: 10.1186/s12909-022-03415-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 04/27/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Simulated Patients (SPs) are commonplace in the teaching of communication skills in medical education and can provide immediate feedback to students from the patient's perspective. The experiences of SPs and their perspective on providing feedback is an under-studied area. This study aims to explore SP experiences and views on feedback, factors influencing their feedback and implications for training. METHODS Using a constructivist grounded theory approach, we conducted six focus groups with 30 SPs. Participants included experienced simulated patients from a London-based actor agency, used in undergraduate teaching programmes of communication skills. Consistent with the principles of grounded theory, data was collected and analysed in an iterative process to identify themes. RESULTS Five over-arching themes were identified: 1.) Feedback processes, 2.) Challenges in providing feedback, 3.) Cumulative experiences, 4.) Web of interpersonal relationships and dynamics and 5.) Portraying the character and patient representations. DISCUSSION These SPs regarded the sharing of the emotions they experienced during the consultation as the focus of their feedback. Their preference was for giving a 'sandwich style' of feedback and 'out-of-role' approach. The relationship with facilitators and students and politeness conventions emerged as significant factors when providing feedback. Sensitivity to the social dynamics of groups and implicit facilitator expectations were challenges they experienced as was divergence in views of student performance. CONCLUSION This study explored SP experiences and perspectives on providing feedback. Findings reveal complex social and structural dynamics at play in providing feedback which have not been reported so far in the literature. It is recommended that these issues should be addressed in training of both SPs and facilitators, in addition to feedback guidelines.
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Affiliation(s)
- Riya Elizabeth George
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Robin Brook Centre, St Bartholomew's Hospital, London, EC1A 7BE, UK.
| | - Harvey Wells
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Robin Brook Centre, St Bartholomew's Hospital, London, EC1A 7BE, UK
| | - Annie Cushing
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Robin Brook Centre, St Bartholomew's Hospital, London, EC1A 7BE, UK
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Potts LC, Bakolis I, Deb T, Lempp H, Vince T, Benbow Y, Waugh W, Kim S, Raza S, Henderson C. Anti-stigma training and positive changes in mental illness stigma outcomes in medical students in ten countries: a mediation analysis on pathways via empathy development and anxiety reduction. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1861-1873. [PMID: 35451604 PMCID: PMC9375761 DOI: 10.1007/s00127-022-02284-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/31/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Studies of mental illness stigma reduction interventions have been criticised for failing to evaluate behavioural outcomes and mechanisms of action. This project evaluates training for medical students entitled 'Responding to Experienced and Anticipated Discrimination' (READ), developed to focus on skills in addition to attitudes and knowledge. We aimed to (i) evaluate the effectiveness of READ with respect to knowledge, attitudes, and clinical communication skills in responding to mental illness-related discrimination, and (ii) investigate whether its potential effectiveness was mediated via empathy or/and intergroup anxiety. METHODS This is an international multisite non-randomised pre- vs post-controlled study. Eligible medical students were currently undertaking their rotational training in psychiatry. Thirteen sites across ten countries (n = 570) were included in the final analysis. RESULTS READ was associated with positive changes in knowledge (mean difference 1.35; 95% CI 0.87 to 1.82), attitudes (mean difference - 2.50; 95% CI - 3.54 to - 1.46), skills (odds ratio 2.98; 95% CI 1.90 to 4.67), and simulated patient perceived empathy (mean difference 3.05; 95% CI 1.90 to 4.21). The associations of READ with knowledge, attitudes, and communication skills but not with simulated patient perceived empathy were partly mediated through student reported empathy and intergroup anxiety. CONCLUSION This is the first study to identify mediating effects of reduced intergroup anxiety and increased empathy in an evaluation of anti-stigma training that includes behavioural measures in the form of communication skills and perceived empathy. It shows the importance of both mediators for all of knowledge, skills, and attitudes, and hence of targeting both in future interventions.
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Affiliation(s)
- Laura C. Potts
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF UK
| | - Ioannis Bakolis
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF UK ,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Tanya Deb
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Heidi Lempp
- Centre for Rheumatic Diseases, King’s College London, London, UK
| | - Tushar Vince
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Yasmin Benbow
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - William Waugh
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - San Kim
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Syed Raza
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Claire Henderson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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ElGeed H, El Hajj MS, Ali R, Awaisu A. The utilization of simulated patients for teaching and learning in the pharmacy curriculum: exploring pharmacy students' and recent alumni's perceptions using mixed-methods approach. BMC Med Educ 2021; 21:562. [PMID: 34742275 PMCID: PMC8571846 DOI: 10.1186/s12909-021-02977-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/08/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND The use of simulated patients (SPs) is considered a significant resource for teaching and assessing clinical and communication skills in health professional education. We conducted this study to explore pharmacy students' perspective towards the utilization of SPs in Qatar and to identify areas that require improvement. METHODS An explanatory sequential mixed-methods design was used among students and recent graduates of the College of Pharmacy at Qatar University (QU-CPH). First, their perspectives toward the current utilization of SPs at QU-CPH was explored using a quantitative cross-sectional study design. Following this, we conducted six focus group discussions based on the analysis of the questionnaire results. The findings of the two phases were interpreted through integration of the quantitative and qualitative phases. RESULTS The majority of the participants (> 90%) reported that interactions with SPs are important in building good communication and counseling skills during professional skills course activities. Similarly, most of the respondents (80%) indicated that interactions with SPs prepared them to apply the clinical skills gained during professional skills and patient assessment sessions in real-life. In addition, they reported that interactions with SPs during competency-based assessments were good experiences. The participants disagreed with the notion that interaction with SPs of opposite gender was uncomfortable for them. Themes identified from the focus groups include: interactions with trained SPs compared to faculty SPs, standardization and consistency of SPs' roles, communication and language barriers, simulations of real-life case scenarios, SPs' competence and preparedness, psychological impact associated with interaction with SPs, proposed strategies for improving the SP program. Identified areas for improvement include the need for strengthening the SP training and orientation program as well as the SP selection criteria. CONCLUSION This study showed a positive impact of the utilization of SPs in this pharmacy curriculum as perceived by students and alumni. However, the SP program needs to be optimized in terms of the training and orientation of SPs.
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Affiliation(s)
- Hager ElGeed
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Maguy Saffouh El Hajj
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Raja Ali
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar.
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Sterz J, Gutenberger N, Stefanescu MC, Zinßer U, Bepler L, Linßen S, Schäfer V, Carstensen P, Verboket RD, Adili F, Ruesseler M. Manikins versus simulated patients in emergency medicine training: a comparative analysis. Eur J Trauma Emerg Surg 2021; 48:3793-3801. [PMID: 34331074 PMCID: PMC9532276 DOI: 10.1007/s00068-021-01695-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/30/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Every physician must be able to sufficiently master medical emergencies, especially in medical areas where emergencies occur frequently such as in the emergency room or emergency surgery. This contrasts with the observation that medical students and young residents often feel insufficiently prepared to handle medical emergencies. It is therefore necessary to train them in the treatment of emergency patients. The aim of this study is to analyze the influence of the assignment of manikin versus simulated patients during a training for undergraduate medical students on learning outcomes and the perceived realism. METHODS The study had a prospective cross-over design and took place in a 3-day emergency medicine training for undergraduate medical students. Students completed three teaching units ('chest pain', 'impaired consciousness', 'dyspnea'), either with manikin or simulated patient. Using a questionnaire after each unit, overall impression, didactics, content, the quality of practical exercises, and the learning success were evaluated. The gained competences were measured in a 6-station objective structured clinical examination (OSCE) at the end of training. RESULTS 126 students participated. Students rated simulated patients as significantly more realistic than manikins regarding the possibility to carry out examination techniques and taking medical history. 54.92% of the students would prefer to train with simulated patients in the future. Regarding the gained competences for 'chest pain' and 'impaired consciousness', students who trained with a manikin scored less in the OSCE station than the simulated patients-group. CONCLUSION Simulated patients are rated more realistic than manikins and seem to be superior to manikins regarding gained competence.
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Affiliation(s)
- Jasmina Sterz
- Department for Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt, Germany.,Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University, Frankfurt, Germany
| | - Niklas Gutenberger
- Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University, Frankfurt, Germany
| | - Maria-Christina Stefanescu
- Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University, Frankfurt, Germany
| | - Uwe Zinßer
- Medical Faculty, SP Training Center, Goethe University, Frankfurt, Germany
| | - Lena Bepler
- Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University, Frankfurt, Germany
| | - Svea Linßen
- Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University, Frankfurt, Germany
| | - Verena Schäfer
- Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University, Frankfurt, Germany
| | - Patrick Carstensen
- Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University, Frankfurt, Germany
| | - René Danilo Verboket
- Department for Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt, Germany
| | - Farzin Adili
- Division of Vascular and Endovascular Surgery, Department of Vascular Medicine, Klinikum Darmstadt, Darmstadt, Germany
| | - Miriam Ruesseler
- Department for Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt, Germany. .,Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University, Frankfurt, Germany.
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Amaratunge S, Harrison M, Perry D, Bond C, Ceulemans M, Foulon V, Clifford R, Seubert L. Assessing the reporting quality of simulated patient studies in pharmacy research using a novel checklist (CRiSP). Res Social Adm Pharm 2021; 18:2301-2307. [PMID: 33896748 DOI: 10.1016/j.sapharm.2021.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/12/2021] [Accepted: 04/05/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Use of simulated patients (SP) to assess the quality of pharmacy services and impact of interventions is increasing. The CRiSP (Checklist for Reporting research using Simulated Patient methodology) checklist was recently developed, assisting researchers to report items necessary to meet a minimum agreed standard. OBJECTIVE(S) To identify which CRiSP items were reported in SP studies for community pharmacy research, identify any gaps in reporting and describe the overall quality of reporting for the SP studies identified. METHODS Papers published during 2018-2020 using SP methodology in community pharmacy settings were identified from MEDLINE and Embase. The 50 most recent ones were selected. Data were extracted independently and in duplicate. Each paper received a coded numerical value denoting compliance with each item of CRiSP (1 = yes, 2 = no, 3 = unclear, 4 = not applicable, 5 = partially complete). Data were analysed using Microsoft Excel and reported as frequencies and percentages of each code for the checklist items, across the 50 papers. RESULTS No paper fulfilled all items in the CRiSP checklist. The mode(s) of delivery of SP assessments (item 17) was reported in all papers, while use of the term SP (item 1); number of SPs (4a); scenario details (9a); describing procedures12; data collection procedure (18); and ethics approval (23a) were reported in at least 80% of papers. Items not reported in over 50% of papers were: scenario development (8a), validation (8b) and flexibility (9b); materials used (10a) and copies of materials (10b); and procedures for SP identification (15). Researchers found interpretation of the checklist unclear and utilised working definitions to ensure consistency in coding. CONCLUSIONS This review identified that pharmacy research involving SP methodology is often inadequately reported by researchers. The CRiSP checklist is a comprehensive tool to assess the quality of SP methodology reporting but may require some refinement to ensure consistency in use.
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Affiliation(s)
- Suvini Amaratunge
- Division of Pharmacy, University of Western Australia, Perth, WA, Australia
| | - Morgan Harrison
- Division of Pharmacy, University of Western Australia, Perth, WA, Australia
| | - Danae Perry
- Division of Pharmacy, University of Western Australia, Perth, WA, Australia
| | - Christine Bond
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Michael Ceulemans
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Veerle Foulon
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Rhonda Clifford
- School of Allied Health, University of Western Australia, Perth, WA, Australia
| | - Liza Seubert
- Division of Pharmacy, University of Western Australia, Perth, WA, Australia.
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Kurz S, Lohse J, Buggenhagen H, Schmidtmann I, Laufenberg-Feldmann R, Engelhard K. Improving competence and safety in pain medicine: a practical clinical teaching strategy for students combining simulation and bedside teaching. BMC Med Educ 2021; 21:133. [PMID: 33632210 PMCID: PMC7905916 DOI: 10.1186/s12909-021-02554-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Pain is a devastating sensation and has to be treated immediately. Therefore, we developed a training program to improve the knowledge of medical students in the field of pain medicine. In the present study, the applicability and efficacy of this training program was tested. METHODS Half of the students attended first a training with simulated patients (SP) followed by bedside teaching (Group 1). Group 2 performed the training programs in reverse order. The evaluation based on standardized questionnaires completed by students (self-assessment) and all students took part in two practical examinations after the learning interventions. RESULTS This study included 35 students. The quality of the simulation was evaluated by the students with average grade 1.1 (1 = very good, 6 = very bad). The practical work on the ward with patients was rated with grade 1.4 of 6, the whole course with 1.1. Students of Group A were significantly better in the final examination (grade 1.7 vs. grade 2.2, p < 0.05). To rate the improvement of skills (self-assessment) we used a Likert Scale (1 = very certain, 5 = very uncertain). The following skills were similar in both groups and significantly better after the course: taking responsibility, expert knowledge, empathy, relationship building and communication. CONCLUSIONS Training with simulated patients in combination with small-group teaching at the bedside with real patients achieves a dramatic increase in student competence. Students prefer learning from the simulation before bedside teaching and propose to include simulation into the curricular teaching of pain medicine.
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Affiliation(s)
- Sandra Kurz
- University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Jana Lohse
- University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Holger Buggenhagen
- University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Irene Schmidtmann
- University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Rita Laufenberg-Feldmann
- University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Kristin Engelhard
- University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
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Yoshida T, Watanabe S, Kono T, Taketa H, Shiotsu N, Shirai H, Nakai Y, Torii Y. What impact does postgraduate clinical training have on empathy among Japanese trainee dentists? BMC Med Educ 2021; 21:53. [PMID: 33446194 PMCID: PMC7807681 DOI: 10.1186/s12909-020-02481-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Enhancing empathy in healthcare education is a critical component in the development of a relationship between healthcare professionals and patients that would ensure better patient care; improved patient satisfaction, adherence to treatment, patients' medication self-efficacy, improved treatment outcomes, and reduced patient anxiety. Unfortunately, however, the decline of empathy among students has been frequently reported. It is especially common when the curriculum transitions to a clinical setting. However, some studies have questioned the significance and frequency of this decline. Thus, the purpose of this study was to determine the impact of postgraduate clinical training on dental trainees' empathy from cognitive, behavioral, and patients' perspective. METHODS This study included 64 trainee dentists at Okayama University Hospital and 13 simulated patients (SPs). The trainee dentists carried out initial medical interviews with SPs twice, at the beginning and the end of their clinical training. The trainees completed the Japanese version of the Jefferson Scale of Empathy for health professionals just before each medical interview. The SPs evaluated the trainees' communication using an assessment questionnaire immediately after the medical interviews. The videotaped dialogue from the medical interviews was analyzed using the Roter Interaction Analysis System. RESULTS No significant difference was found in the self-reported empathy score of trainees at the beginning and the end of the clinical training (107.73 [range, 85-134] vs. 108.34 [range, 69-138]; p = 0.643). Considering the results according to gender, male scored 104.06 (range, 88-118) vs. 101.06 (range, 71-122; p = 0.283) and female 109.17 (range, 85-134) vs. 111.20 (range, 69-138; p = 0.170). Similarly, there was no difference in the SPs' evaluation of trainees' communication (10.73 vs. 10.38, p = 0.434). Communication behavior in the emotional responsiveness category for trainees in the beginning was significantly higher than that at the end (2.47 vs. 1.14, p = 0.000). CONCLUSIONS Overall, a one-year postgraduate dental training program neither reduced nor increased trainee dentists' empathy levels. Providing regular education support in this area may help trainees foster their empathy.
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Affiliation(s)
- Toshiko Yoshida
- Center for Education in Medicine and Health Sciences (Dental Education), Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kita- ku, 700-8558, Okayama, Okayama, Japan.
| | - Sho Watanabe
- Comprehensive Dental Clinic, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, 700-8558, Okayama, Okayama, Japan
| | - Takayuki Kono
- Comprehensive Dental Clinic, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, 700-8558, Okayama, Okayama, Japan
| | - Hiroaki Taketa
- Comprehensive Dental Clinic, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, 700-8558, Okayama, Okayama, Japan
| | - Noriko Shiotsu
- Comprehensive Dental Clinic, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, 700-8558, Okayama, Okayama, Japan
| | - Hajime Shirai
- Comprehensive Dental Clinic, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, 700-8558, Okayama, Okayama, Japan
| | - Yukie Nakai
- Department of Dental Hygiene, University of Shizuoka, Junior College, 2-2-1 Oshika, Suruga- ku, 422-8021, Shizuoka, Shizuoka, Japan
| | - Yasuhiro Torii
- Comprehensive Dental Clinic, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, 700-8558, Okayama, Okayama, Japan
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Kelly T, Surjan Y, Rinks M, Warren-Forward H. Effect of communication skills training on radiation therapy student's confidence and interactions during their first clinical placement. Radiography (Lond) 2020; 27:59-66. [PMID: 32593514 DOI: 10.1016/j.radi.2020.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/15/2020] [Accepted: 05/31/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The University of Newcastle, Radiation Therapy degree (RT) includes a clinical reasoning module that provides students with the opportunity to learn and practice communication skills before their first clinical placement. This study investigates students' perceptions of how well the module prepared them for placement and explores students' perceptions of their communication experiences during placement. METHODS A single survey was administered to students four months following placement (six months after delivery of module), and included a request for perceptions pre-module, post-module and pre and post placement via an online survey comprising 46 closed, Likert scale and open-response questions. Assessment of changes in student confidence, the value of preparation for placement and perceptions concerning interpersonal skills with patients and radiation therapists (RTTs) were examined. Survey data was analysed quantitatively (counts, Fisher's exact) assessing statistical differences in confidence and Weighted Sum Average (WSA) of Likert scales. Qualitative findings were supported by written comments. RESULTS Participants reported increasing confidence levels between pre-module (WSA - 1.13), and post-module (2.88), which was statistically significant (p = 0.039) and between pre-placement (2.0) and after placement (3.38), in their ability to communicate with patients. Similar changes in confidence were noted with interactions with RTTs (WSA scores 1.0, 2.13, 1.75, 3.25 resp). Students reported communication strategies prepared them well for patient interactions. Positive reinforcement from RTTs was acknowledged as creating immediate support of their current patient skills. CONCLUSION Undertaking the clinical reasoning module successfully increased students' confidence and provided opportunities to develop appropriate communication skills for placement. IMPLICATIONS FOR PRACTICE Increased levels of confidence and positive reinforcement from RTTs should positively impact students' knowledge and skills, and provide introspection for improvement for future placements.
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Affiliation(s)
- T Kelly
- School of Health Sciences, University of Newcastle, Australia; Illawarra Shoalhaven Local Health District, Australia.
| | - Y Surjan
- School of Health Sciences, University of Newcastle, Australia
| | - M Rinks
- Illawarra Shoalhaven Local Health District, Australia
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21
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Sanges S, Farhat MM, Assaraf M, Galland J, Rivière E, Roubille C, Lambert M, Yelnik C, Maillard H, Sobanski V, Lefèvre G, Launay D, Morell-Dubois S, Hachulla E. Raising rare disease awareness using red flags, role play simulation and patient educators: results of a novel educational workshop on Raynaud phenomenon and systemic sclerosis. Orphanet J Rare Dis 2020; 15:159. [PMID: 32576213 PMCID: PMC7310378 DOI: 10.1186/s13023-020-01439-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND As lack of awareness of rare diseases (RDs) among healthcare professionals results in delayed diagnoses, there is a need for a more efficient approach to RD training during academic education. We designed an experimental workshop that used role-play simulation with patient educators and focused on teaching "red flags" that should raise the suspicion of an RD when faced with a patient with frequently encountered symptoms. Our objective was to report our experience, and to assess the improvement in learners' knowledge and the satisfaction levels of the participants. RESULTS The workshop consisted of 2 simulated consultations that both started with the same frequent symptom (Raynaud phenomenon, RP) but led to different diagnoses: a frequent condition (idiopathic RP) and an RD (systemic sclerosis, SSc). In the second simulated consultation, the role of the patient was played by a patient educator with SSc. By juxtaposing 2 seemingly similar situations, the training particularly highlighted the elements that help differentiate SSc from idiopathic RP. When answering a clinical case exam about RP and SSc, students that had participated in the workshop had a higher mean mark than those who had not (14 ± 3.7 vs 9.6 ± 5.5 points out of 20, p = 0.001). Participants mostly felt "very satisfied" with this training (94%), and "more comfortable" about managing idiopathic RP and SSc (100%). They considered the workshop "not very stressful" and "very formative" (both 71%). When asked about the strengths of this training, they mentioned the benefits of being put in an immersive situation, allowing a better acquisition of practical skills and a more interactive exchange with teachers, as well as the confrontation with a real patient, leading to a better retention of semiological findings and associating a relational component with this experience. CONCLUSIONS Through the use of innovative educational methods, such as role-play simulation and patient educators, and by focusing on teaching "red flags", our workshop successfully improved RP and SSc learning in a way that satisfied students. By modifying the workshop's scenarios, its template can readily be applied to other clinical situations, making it an interesting tool to teach other RDs.
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Affiliation(s)
- S Sanges
- Centre de Simulation PRESAGE, Univ. Lille, UFR Médecine, F-59000, Lille, France. .,Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France. .,Département de Médecine Interne et Immunologie Clinique, CHU Lille, F-59037, Lille Cedex, France. .,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Oust de France (CeRAINO), F-59000, Lille, France. .,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France.
| | - M-M Farhat
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France.,Département de Médecine Interne et Immunologie Clinique, CHU Lille, F-59037, Lille Cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Oust de France (CeRAINO), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - M Assaraf
- Département de Médecine Interne et Immunologie Clinique, CHU Lille, F-59037, Lille Cedex, France
| | - J Galland
- Service de médecine interne, Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris, F-75010, Paris, France.,Université de Paris Diderot, F-75010, Paris, France
| | - E Rivière
- Service de médecine interne et maladies infectieuses, CHU de Bordeaux, F-33600, Pessac, France.,Centre de simulation SimBA-S de Bordeaux, CHU de Bordeaux et Université de Bordeaux, F-33000, Bordeaux, France
| | - C Roubille
- Département de médecine interne, CHU de Montpellier, hôpital Lapeyronie, 371, avenue du Doyen Gaston Giraud, F-34295, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Cedex 5, Montpellier, France
| | - M Lambert
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France.,Département de Médecine Interne et Immunologie Clinique, CHU Lille, F-59037, Lille Cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Oust de France (CeRAINO), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - C Yelnik
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France.,Département de Médecine Interne et Immunologie Clinique, CHU Lille, F-59037, Lille Cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Oust de France (CeRAINO), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - H Maillard
- Département de Médecine Interne et Immunologie Clinique, CHU Lille, F-59037, Lille Cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Oust de France (CeRAINO), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - V Sobanski
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France.,Département de Médecine Interne et Immunologie Clinique, CHU Lille, F-59037, Lille Cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Oust de France (CeRAINO), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - G Lefèvre
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France.,CHU Lille, Institut d'Immunologie, F-59000, Lille, France
| | - D Launay
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France.,Département de Médecine Interne et Immunologie Clinique, CHU Lille, F-59037, Lille Cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Oust de France (CeRAINO), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - S Morell-Dubois
- Département de Médecine Interne et Immunologie Clinique, CHU Lille, F-59037, Lille Cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Oust de France (CeRAINO), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - E Hachulla
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France.,Département de Médecine Interne et Immunologie Clinique, CHU Lille, F-59037, Lille Cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Oust de France (CeRAINO), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
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Gamble AS, Nestel D, Bearman M. Listening to young voices: The lived experiences of adolescent simulated patients in health professional education. Nurse Educ Today 2020; 91:104476. [PMID: 32474133 DOI: 10.1016/j.nedt.2020.104476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/06/2020] [Accepted: 05/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Learners should be exposed to the core principles of adolescent specific communication and assessment frameworks as part of health professional curricula. How this is done can vary considerably, but the inclusion of adolescents seems an ideal and realistic option. However, securing their participation can be challenging. A viable option to adolescent patients may be adolescent simulated patients. OBJECTIVE This study describes adolescents' lived experiences of being simulated patients in health professional education. DESIGN & SETTING An interpretive phenomenological approach involving ten adolescent simulated patients from two health professional education programs in Australia. METHODS Consenting/assenting adolescents participated in semi-structured audio-recorded interviews. Data was transcribed verbatim and analysed using van Manen's phenomenological approach. RESULTS Adolescents offered unique insights and intimate knowledge of their lived experiences of simulated patient work. Adolescents reflected upon the often positive but sometimes challenging journey of simulated patient work. The identification of harm, largely unrecognized by adolescents themselves is the most concerning finding of this study. CONCLUSIONS The experiences of adolescent simulated patients can help to shape the future of their involvement. However, their experiences also reveal myriad challenges. The implications for ethical practice must be reviewed before inclusion of adolescents as simulated patients is a feasible option.
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Affiliation(s)
- Andree S Gamble
- Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.
| | - Debra Nestel
- Monash Institute for Health and Clinical Education, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia; Department of Surgery, Melbourne Medical School, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Australia
| | - Margaret Bearman
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Australia
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23
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Kühne F, Heinze PE, Weck F. Standardized patients in psychotherapy training and clinical supervision: study protocol for a randomized controlled trial. Trials 2020; 21:276. [PMID: 32183859 PMCID: PMC7079451 DOI: 10.1186/s13063-020-4172-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/13/2020] [Indexed: 12/30/2022] Open
Abstract
Background Psychotherapy is highly effective and widely acknowledged for treating various mental disorders. Nevertheless, in terms of methods for teaching effective psychotherapeutic approaches and competencies, there has been a lack of investigation. Training and supervision are the main strategies for teaching therapist competencies, and standardized role-plays with simulated patients (i.e., trained individuals playing someone with a mental disorder) seem useful for evaluating training approaches. In medical education, this procedure is now internationally established. However, so far, little use has been made of standardized role-playing to evaluate training and supervision in the area of clinical psychology and psychotherapy. Methods In this study, standardized role-plays are used to evaluate methods for training and supervision. Central cognitive behavioral approaches for treating depression are taught in the training. The first experiment compares an active training approach (i.e., model learning) with a passive one (i.e., reading manual-based instructions). The second experiment compares a direct supervision technique (i.e., supervision based on video analysis) with an indirect one (i.e., supervision based on verbal reporting). In each experiment, 68 bachelor’s and master’s students of psychology will be randomly assigned to the experimental and control groups. Each student takes part in three role-plays (baseline, post and 3-month follow-up), which are all videotaped. Two independent raters assess therapist competencies in each role-play on the basis of a standardized competence scale. Discussion The research project aims to contribute to the development of specific training and supervision methods in order to improve psychotherapy training and patient care. Trial registration ISRCTN Registry, ISRCTN19173895. Registered on 10 December 2019.
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Affiliation(s)
- Franziska Kühne
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany.
| | - Peter Eric Heinze
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany
| | - Florian Weck
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany
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24
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Paramasivan A, Khoo D. Standardized Patients Versus Peer Role Play-Exploring the Experience, Efficacy, and Cost-Effectiveness in Residency Training Module for Breaking Bad News. J Surg Educ 2020; 77:479-484. [PMID: 31889691 DOI: 10.1016/j.jsurg.2019.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/25/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Delivering bad news is a difficult task for the clinician and one that is important to address and nurture in residency training. METHODS Residents were assigned to receive communication training with either standardized patients (SP) or peer role play (RP). Anonymized pre- and post-questionnaires were filled by residents detailing their experience. Independent assessors blinded to the study hypothesis rated the residents' performance using a standardized plus-delta assessment form as a measure of effectiveness of either methods. In our study additionally, corresponding costs were assessed as man-hours resulting from the hours of work of SP, RP, and tutors in order to generate the incremental cost-effectiveness ratio for the use of SP against the use of RP. SETTING The study took place in a tertiary academic hospital, National University Hospital, Singapore. PARTICIPANTS A total of 15 junior residents in anesthetic training entered and completed the study and were evaluated during the 2017-2018 academic year. RESULTS The mean performance scores were 63.3% (RP group) and 74.3% (SP group) attributing advantage to the SP group. Costs however were slighter greater in the SP group (14 man-hours) versus (10 man-hours) in the RP group. The resulting incremental cost-effectiveness ratio was 0.36 man-hours per 1-point increase in the performance score when comparing SP to peer RP. CONCLUSIONS SPs proved to be the more cost-effective modality when employing communication training for delivering bad news. The successful experience and use of SPs should be balanced against the marginally lesser costs involved in peer RP in planning residency teaching sessions.
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25
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Waschwill A, Bittner A, Harendza S. Assessment of medical students' shared decision-making skills in simulated physician-patient encounters. Patient Educ Couns 2020; 103:500-504. [PMID: 31543355 DOI: 10.1016/j.pec.2019.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/10/2019] [Accepted: 09/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare shared decision-making skills of medical students who voluntarily translate medical documents into plain language with students who do not participate in this voluntary task. METHODS 29 medical students who voluntarily translated medical documents for patients into plain language on the online-platform https://washabich.de (WHI group) and 29 medical students who did not (non-WHI group) participated in a simulated virtual consultation hour. Via skype, participants communicated with six simulated patients. All conversations were transcribed and a blinded rater assessed them with the OPTION scale for shared decision-making. RESULTS The WHI group received significantly (p < .001) higher total scores for shared decision-making with the OPTION scale than the non-WHI group. The greatest differences in scores were found for the items "The clinician checks that the patient has understood the information." (WHI: 2.98 ± 0.77 vs. non-WHI: 2.61 ± 0.89, p < .001) and "The clinician offers the patient explicit opportunities to ask questions during the decision-making process." (WHI: 2.83 ± 1.00 vs. non-WHI: 2.40 ± 1.07, p < .001). CONCLUSION Written translation of medical documents is associated with significantly better OPTION scores for shared decision-making in simulated physician-patient encounters. PRACTICE IMPLICATIONS To use written medial translation exercises in general to improve medical students' shared decision-making skills.
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Affiliation(s)
- Alexander Waschwill
- III. Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Bittner
- Deanery, Medical Faculty, University of Bielefeld, Bielefeld, Germany
| | - Sigrid Harendza
- III. Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
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26
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Medendorp NM, Hillen MA, van Maarschalkerweerd PEA, Aalfs CM, Ausems MGEM, Verhoef S, van der Kolk LE, Berger LPV, Wevers MR, Wagner A, Caanen BAH, Stiggelbout AM, Smets EMA. 'We don't know for sure': discussion of uncertainty concerning multigene panel testing during initial cancer genetic consultations. Fam Cancer 2019; 19:65-76. [PMID: 31773425 PMCID: PMC7026220 DOI: 10.1007/s10689-019-00154-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 11/15/2019] [Indexed: 12/14/2022]
Abstract
Pre-test counseling about multigene panel testing involves many uncertainties. Ideally, counselees are informed about uncertainties in a way that enables them to make an informed decision about panel testing. It is presently unknown whether and how uncertainty is discussed during initial cancer genetic counseling. We therefore investigated whether and how counselors discuss and address uncertainty, and the extent of shared decision-making (SDM), and explored associations between counselors’ communication and their characteristics in consultations on panel testing for cancer. For this purpose, consultations of counselors discussing a multigene panel with a simulated patient were videotaped. Simulated patients represented a counselee who had had multiple cancer types, according to a script. Before and afterwards, counselors completed a survey. Counselors’ uncertainty expressions, initiating and the framing of expressions, and their verbal responses to scripted uncertainties of the simulated patient were coded by two researchers independently. Coding was done according to a pre-developed coding scheme using The Observer XT software for observational analysis. Additionally, the degree of SDM was assessed by two observers. Correlation and regression analyses were performed to assess associations of communicated uncertainties, responses and the extent of SDM, with counselors’ background characteristics. In total, twenty-nine counselors, including clinical geneticists, genetic counselors, physician assistants-in-training, residents and interns, participated of whom working experience varied between 0 and 25 years. Counselors expressed uncertainties mainly regarding scientific topics (94%) and on their own initiative (95%). Most expressions were framed directly (77%), e.g. We don’t know, and were emotionally neutral (59%; without a positive/negative value). Counselors mainly responded to uncertainties of the simulated patient by explicitly referring to the uncertainty (69%), without providing space for further disclosure (66%). More experienced counselors provided less space to further disclose uncertainty (p < 0.02), and clinical geneticists scored lower on SDM compared with other types of counselors (p < 0.03). Our findings that counselors mainly communicate scientific uncertainties and use space-reducing responses imply that the way counselors address counselees’ personal uncertainties and concerns during initial cancer genetic counseling is suboptimal.
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Affiliation(s)
- Niki M Medendorp
- Department of Medical Psychology - Amsterdam UMC, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands. .,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. .,Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - Marij A Hillen
- Department of Medical Psychology - Amsterdam UMC, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Pomme E A van Maarschalkerweerd
- Department of Medical Psychology - Amsterdam UMC, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Cora M Aalfs
- Department of Clinical Genetics - Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Division of Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Margreet G E M Ausems
- Division of Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Senno Verhoef
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Lieke P V Berger
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Marijke R Wevers
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anja Wagner
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Barbara A H Caanen
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology - Amsterdam UMC, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Genetics - Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Deinzer R, Kiupel S, Weik U. Endocrine and psychological stress response in simulated doctor-patient interactions in medical education. Psychoneuroendocrinology 2019; 105:172-7. [PMID: 30292650 DOI: 10.1016/j.psyneuen.2018.09.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Training of doctor-patient interactions by means of patient actors is considered a useful didactic tool in medical education. However, though students report it as being highly stressful little systematic research has verified this notion. AIMS To assess the endocrine and psychological stress responses of students in the doctor vs. the observer role in simulated doctor-patient interactions. METHODS Salivary cortisol and anxiety was assessed in N = 86 participants of a mandatory course on doctor-patient interactions on three consecutive days. During two of these days they were in the observer role and gave feedback to another student and on one of these days they were in the doctor role and were being given feedback. Saliva was sampled at 4 points in time per day: prior to interaction (T1); after watching the video of the interaction (T2); after feedback (T3); after observation of another interaction (T4). Assessments on observer days took place at the respective time points and at the same time of the day. 3-way mixed ANOVAs were computed with the factors "day of data sampling" (F1); "day with doctor role" (F2); "measurement time"(F3). RESULTS Significant two-way interactions F1 × F2 and three-way interactions F1 × F2 × F3 were observed both for cortisol and for anxiety (all p < .001). Neither cortisol nor anxiety were related to task severity. Anxiety at T1 correlated with cortisol increase from T1 to T2 (r = .266; p = .013). DISCUSSION Results confirm that playing the doctor role in a simulated doctor-patient interaction represents a significant stressor in medical students. Effect sizes considerably exceed those observed in laboratory stress. This brings about new questions regarding moderating factors, effects of repetitions and relationship to medical performance. The ecological validity of this stressor can also make it a useful tool in basic endocrine research.
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Kühne F, Ay DS, Otterbeck MJ, Weck F. Standardized Patients in Clinical Psychology and Psychotherapy: a Scoping Review of Barriers and Facilitators for Implementation. Acad Psychiatry 2018; 42:773-781. [PMID: 29423828 DOI: 10.1007/s40596-018-0886-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The use of simulated and standardized patients (SP) is widely accepted in the medical field and, from there, is beginning to disseminate into clinical psychology and psychotherapy. The purpose of this study was therefore to systematically review barriers and facilitators that should be considered in the implementation of SP interventions specific to clinical psychology and psychotherapy. METHODS Following current guidelines, a scoping review was conducted. The literature search focused on the MEDLINE, PsycINFO and Web of Science databases, including Dissertation Abstracts International. After screening for titles and abstracts, full texts were screened independently and in duplicate according to our inclusion criteria. For data extraction, a pre-defined form was piloted and used. Units of meaning with respect to barriers and facilitators were extracted and categorized inductively using content-analysis techniques. From the results, a matrix of interconnections and a network graph were compiled. RESULTS The 41 included publications were mainly in the fields of psychiatry and mental health nursing, as well as in training and education. The detailed category system contrasts four supercategories, i.e., which organizational and economic aspects to consider, which persons to include as eligible SPs, how to develop adequate scenarios, and how to authentically and consistently portray mental health patients. CONCLUSIONS Publications focused especially on the interrelation between authenticity and consistency of portrayals, on how to evoke empathy in learners, and on economic and training aspects. A variety of recommendations for implementing SP programs, from planning to training, monitoring, and debriefing, is provided, for example, ethical screening of and ongoing support for SPs.
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Boukouvalas EA, El-Den S, Chen TF, Moles R, Saini B, Bell A, O'Reilly CL. Confidence and attitudes of pharmacy students towards suicidal crises: patient simulation using people with a lived experience. Soc Psychiatry Psychiatr Epidemiol 2018; 53:1185-95. [PMID: 30155558 DOI: 10.1007/s00127-018-1582-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/20/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE Health care professionals, including pharmacists, have the potential to recognise and assist those at risk of suicide. The primary aim of this study was to assess the impact of utilising people with a lived experience of mental illness as simulated patients on final year pharmacy students' attitudes toward and confidence in caring for people at risk of suicide after first receiving Mental Health First Aid (MHFA) training. METHODS A parallel group repeated measures design was used. People with a lived experience of mental illness enacted patients experiencing a mental health crisis, including possible suicidal ideation. Following MHFA training, the first group directly participated in the simulation, the second group observed, and the final group had no exposure to the simulation. Validated surveys measuring student attitudes and confidence were conducted at three time points; pre and post MHFA, and then at 2-4 weeks follow-up. RESULTS Full datasets of survey responses were received from 34/40 direct participants (85%), 104/146 observers (71%) and 50/66 comparison students (76%). Mean confidence scores significantly improved for all groups post MHFA training (p < 0.05). At follow-up, all 8 confidence items for the direct participant and observer group maintained significance from baseline to post intervention (p < 0.05). Mixed results in relation to attitudes towards suicide were evident at each time point and among each participant group. CONCLUSIONS Utilising people with a lived experience of mental illness as simulated patients has a positive effect on sustaining pharmacy student confidence in discussing suicidal behaviour post MHFA training. The inconsistency in attitudes towards suicide suggests that attitudes are complex in nature, involving multiple dynamic influences.
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Murphy AL, Gardner DM. A simulated patient evaluation of pharmacist's performance in a men's mental health program. BMC Res Notes 2018; 11:765. [PMID: 30367674 PMCID: PMC6204042 DOI: 10.1186/s13104-018-3869-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/17/2018] [Indexed: 12/30/2022] Open
Abstract
Objective The Headstrong program, a pharmacy based men’s mental health promotion program, was designed to enhance pharmacists’ care of men with mental illness and addictions and was focused on six conditions. A simulated patient (SP) encounter on insomnia was used to evaluate pharmacist’s performance as a part of the Headstrong program. Results Six Headstrong pharmacists consented to participate in the SP encounter as part of the evaluation of the Headstrong program. Pharmacists’ mean scores in most categories that were evaluated (e.g., pre-supply/assessment score, sleep score) were lower than expected. In assessing the SP during the encounter, pharmacists’ mean score was 5.7 (SD 2.0) of a possible 13 points. No pharmacists asked about the SP’s age, availability of other supports, allergies, and whether they had an existing relationship with a pharmacist. One pharmacist inquired about medical conditions, and two asked about pre-existing mental health conditions. Three pharmacists inquired about concurrent medications. The Headstrong program was discussed by half of the pharmacists and a resource recommended by the Headstrong program was suggested by one pharmacist. Several pharmacists used self-disclosure as a mechanism to support rapport building. Overall, the SP felt cared for and respected by the pharmacists and had confidence in their knowledge.
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Affiliation(s)
- Andrea L Murphy
- College of Pharmacy, Dalhousie University, 5968 College St., PO Box 15000, Halifax, NS, B3H 4R2, Canada. .,Department of Psychiatry, Dalhousie University, QEII HSC, AJLB 7517, 5909 Veterans' Memorial Lane, Halifax, NS, B3H 2E2, Canada.
| | - David M Gardner
- College of Pharmacy, Dalhousie University, 5968 College St., PO Box 15000, Halifax, NS, B3H 4R2, Canada.,Department of Psychiatry, Dalhousie University, QEII HSC, AJLB 7517, 5909 Veterans' Memorial Lane, Halifax, NS, B3H 2E2, Canada
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Schreckenbach T, Ochsendorf F, Sterz J, Rüsseler M, Bechstein WO, Bender B, Bechtoldt MN. Emotion recognition and extraversion of medical students interact to predict their empathic communication perceived by simulated patients. BMC Med Educ 2018; 18:237. [PMID: 30314497 PMCID: PMC6186136 DOI: 10.1186/s12909-018-1342-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/27/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND This study assessed the impact of medical students' emotion recognition ability and extraversion on their empathic communication, as perceived by simulated patients in a training context. METHODS This study used a crossed-effect data structure and examined 245 students in their fourth year of medical school. The students' personality traits were assessed based on a self-assessment questionnaire of the short form of the Big Five Inventory; their emotion recognition ability was measured using a performance test (Diagnostic Analysis of Nonverbal Accuracy-2, Adult Facial Expressions). Simulated patients evaluated the medical students' empathic communication. RESULTS Students with a combination of high emotion recognition ability and extraversion received more positive ratings from simulated patients than their fellow students with a combination of emotion recognition ability and low extraversion. The main effects of emotion recognition or extraversion were not sufficient to yield similar effects. There were no other effects related to the remaining Big Five variables. CONCLUSIONS The results support the hypothesis that to build rapport with patients, medical staff need to combine emotional capabilities with a dispositional interest in interpersonal encounters.
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Affiliation(s)
- Teresa Schreckenbach
- Department of General and Visceral Surgery, Frankfurt University Hospital, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Falk Ochsendorf
- Department of Dermatology, Frankfurt University Hospital, Frankfurt/Main, Germany
| | - Jasmina Sterz
- Department of Trauma Surgery, Frankfurt University Hospital, Frankfurt/Main, Germany
| | - Miriam Rüsseler
- Department of Trauma Surgery, Frankfurt University Hospital, Frankfurt/Main, Germany
| | - Wolf Otto Bechstein
- Department of General and Visceral Surgery, Frankfurt University Hospital, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Bernd Bender
- Department of Trauma Surgery, Frankfurt University Hospital, Frankfurt/Main, Germany
| | - Myriam N. Bechtoldt
- Department of Management & Economics, EBS University of Business and Law, Oestrich-Winkel, Germany
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Hammad EA, Elayeh E, Tubeileh R, Watson M, Wazaify M. A simulated patient study assessing over the counter supply and counseling in Jordan: responding to headache complaints. Int J Clin Pharm 2018; 40:982-6. [PMID: 29967966 DOI: 10.1007/s11096-018-0679-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 06/22/2018] [Indexed: 10/28/2022]
Abstract
Background Community pharmacists are the most accessible health professionals for patients seeking advice on minor ailments and over the counter supply. Objectives To assess the management of patients seeking advice for headache in community pharmacies in Jordan. Method A cross-sectional study was conducted using simulated patient in three cities in Jordan. A trained simulated patient enacted an advice-seeking scenario for the treatment of a headache. The visits were evaluated using pre-defined criteria relating to content and communication skills. Results Of 72 community pharmacies invited, 50 (69.4%) agreed to participate. Of these, 38 (76%) pharmacies were visited. The median duration of the visit was 2 min (20 s-4 min). All visits resulted in selling a drug. Paracetamol combinations often with caffeine were recommended in over 50% of visits. Drug sale recommendations were often made without obtaining essential information about symptoms or patient medical history. Only brand names and doses were often highlighted to the simulated patient. No written information was offered. Conclusion Community pharmacies in Jordan appear not to offer adequate counseling for patients seeking advice for headache. Both counseling and communication skills are suboptimal. Exploration of factors and reasons of suboptimal practice is recommended.
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Porcheret M, Main C, Croft P, Dziedzic K. Enhancing delivery of osteoarthritis care in the general practice consultation: evaluation of a behaviour change intervention. BMC Fam Pract 2018; 19:26. [PMID: 29409449 PMCID: PMC5801670 DOI: 10.1186/s12875-018-0715-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 01/24/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Professionally-focussed behaviour change intervention (BCI) workshops were utilised in the Management of OsteoArthritis in Consultations (MOSAICS) trial investigating the feasibility of implementing the National Institute for Health and Care Excellence (NICE) Osteoarthritis (OA) Guideline in general practice. The workshops aimed to implement the general practitioner (GP) component of the trial intervention: an enhanced consultation for patients presenting with possible OA. This study presents an evaluation of the BCI workshops on GP competency in conducting these enhanced consultations. METHODS A before-and-after evaluation of the workshops, delivered to GPs participating in the intervention arm of the MOSAICS trial, using video-recorded GP consultations with simulated OA patients. GPs attended four workshops, which had been developed using an implementation framework. Videos were undertaken at three time-points (before workshops and at one- and five-months after) and were assessed by independent observers, blinded to time points, for GP competency in undertaking 14 predetermined consultation tasks. RESULTS Videos of 15 GPs were assessed. GP competency increased from a median of seven consultation tasks undertaken by each GP at baseline to 11 at both time-points after the workshops. Specific tasks which were undertaken more frequently after the workshops related to explaining that OA is treatable and not inevitably progressive, eliciting and addressing patient expectations of the consultation, and providing written OA information. However, the use of the word "osteoarthritis" in giving the diagnosis of OA was not enhanced by the workshops. CONCLUSIONS BCI workshops can enhance GP competency in undertaking consultations for OA. Further initiatives to implement the NICE OA Guideline and enhance the care of people with OA in primary care can be informed by the content and delivery of the workshops evaluated in this study.
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Affiliation(s)
- Mark Porcheret
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.
| | - Chris Main
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - Peter Croft
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
| | - Krysia Dziedzic
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK
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Dabaghzadeh F, Hajjari R. Practice of community pharmacists related to multivitamin supplements: a simulated patient study in Iran. Int J Clin Pharm 2018; 40:190-5. [PMID: 29270735 DOI: 10.1007/s11096-017-0579-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/13/2017] [Indexed: 01/08/2023]
Abstract
Background Multivitamin supplements are a subset of dietary supplements sold in pharmacies as over-the-counter medicines. Community pharmacists are regarded as responsible professionals and relied on for their safe practice and efficacy. Objective The aim of this study was to evaluate the counselling practices of community pharmacists relating to typical use, interactions, contraindications, and side effects of multivitamin supplements using simulated patients. Setting Ninety-seven community pharmacies in Kerman, Iran. Method Two male students acted as simulated patients who role-played a scenario in the community pharmacies in two steps. In step 1, they spontaneously mentioned they were a student and did not eat properly through lack of time and requested a multivitamin supplement. In Step 2, if the pharmacists did not request a drug history, they would explain that they had severe acne and had been taking oral isotretinoin for a month. The counselling practice of the pharmacists was audio recorded. Main outcome measure The number of pharmacists who provided information about multivitamin use and identified isotretinoin-vitamin A interaction. Results Thirteen pharmacists in charge were absent at the time of the purchases. None of the pharmacists provided information about contraindications and side effects of multivitamin products. Twenty pharmacists provided instruction for multivitamin use, and two pharmacists took a drug history. In Step 1, only two pharmacists identified isotretinoin-vitamin A interaction, but in Step 2, this number increased to 15. Conclusion The counselling practice of pharmacists should be improved to promote effective and safe use of multivitamin supplements.
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Brezis M, Lahat Y, Frankel M, Rubinov A, Bohm D, Cohen MJ, Koslowsky M, Shalomson O, Sprung CL, Perry-Mezare H, Yahalom R, Ziv A. What can we learn from simulation-based training to improve skills for end-of-life care? Insights from a national project in Israel. Isr J Health Policy Res 2017; 6:48. [PMID: 29110738 PMCID: PMC5674237 DOI: 10.1186/s13584-017-0169-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 08/15/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Simulation-based training improves residents' skills for end-of-life (EOL) care. In the field, staff providers play a significant role in handling those situations and in shaping practice by role modeling. We initiated an educational intervention to train healthcare providers for improved communication skills at EOL using simulation of sensitive encounters with patients and families. METHODS Hospital physicians and nurses (n = 1324) attended simulation-based workshops (n = 100) in a national project to improve EOL care. We analyzed perceptions emerging from group discussions following simulations, from questionnaires before and after each workshop, and from video-recorded simulations using a validated coding system. We used the simulation setting as a novel tool for action research. We used a participatory inquiry paradigm, with repetitive cycles of exploring barriers and challenges with participants in an iterative pattern of observation, discussion and reflection - including a description of our own responses and evolution of thought as well as system effects. RESULTS The themes transpiring included lack of training, knowledge and time, technology overuse, uncertainty in decision-making, poor skills for communication and teamwork. Specific scenarios demonstrated lack of experience at eliciting preferences for EOL care and at handling conflicts or dilemmas. Content analysis of simulations showed predominance of cognitive utterances - by an order of magnitude more prevalent than emotional expressions. Providers talked more than actors did and episodes of silence were rare. Workshop participants acknowledged needs to improve listening skills, attention to affect and teamwork. They felt that the simulation-based workshop is likely to ameliorate future handling of EOL situations. We observed unanticipated consequences from our project manifested as a field study of preparedness to EOL in nursing homes, followed by a national survey on quality of care, leading to expansion of palliative care services and demand for EOL care education in various frameworks and professional areas. CONCLUSIONS Reflective simulation exercises show barriers and paths to improvement among staff providers. When facing EOL situations, physicians and nurses use cognitive language far more often than emotions related expressions, active listening, or presence in silence. Training a critical mass of staff providers may be valuable to induce a cultural shift in EOL care.
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Affiliation(s)
- Mayer Brezis
- Center for Quality and Safety, Hadassah Medical Center & Braun School of Public Health, Hebrew University, Jerusalem, Israel.
| | - Yael Lahat
- Clalit Health Services, Tel Aviv, Israel
| | | | - Alan Rubinov
- Hadassah Medical Center & Hebrew University, Jerusalem, Israel
| | - Davina Bohm
- Center for Quality and Safety, Hadassah Medical Center & Braun School of Public Health, Hebrew University, Jerusalem, Israel
| | - Matan J Cohen
- Center for Quality and Safety, Hadassah Medical Center & Braun School of Public Health, Hebrew University, Jerusalem, Israel
| | - Meni Koslowsky
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Orit Shalomson
- Israel Center for Medical Simulation (MSR), Chaim Sheba Medical Center, Tel Hashomer, Israel & Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | | | - Amitai Ziv
- Israel Center for Medical Simulation (MSR), Chaim Sheba Medical Center, Tel Hashomer, Israel & Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Peabody JW, DeMaria LM, Tamondong-Lachica D, Florentino J, Czarina Acelajado M, Ouenes O, Richie JP, Burgon T. Impact of a protein-based assay that predicts prostate cancer aggressiveness on urologists' recommendations for active treatment or active surveillance: a randomized clinical utility trial. BMC Urol 2017; 17:51. [PMID: 28673277 PMCID: PMC5496184 DOI: 10.1186/s12894-017-0243-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 06/27/2017] [Indexed: 12/20/2022] Open
Abstract
Background Of the more than 1.1 million men diagnosed worldwide annually with prostate cancer, the majority have indolent tumors. Distinguishing between aggressive and indolent cancer is an important clinical challenge. The current approaches for assessing tumor aggressiveness are recognized as insufficient. A validated protein-based assay has been shown to predict tumor aggressiveness from prostate biopsy. The main objective of this study was to measure the clinical utility of this new assay in the management of early-stage prostate cancer. Methods One hundred twenty nine board-certified urologists were asked to participate in a randomized, two-arm experiment. We collected data over 2 rounds using simulated clinical cases administered via an online platform. The cases were all newly diagnosed Gleason 3 + 3 or 3 + 4 prostate camcer patients. Urologists in the intervention arm received a 15-min webinar on this protein-based assay and given assay test results for their simulated patients in round 2. Each case had a preferred recommendation of either active surveillance or active treatment. The measured outcome was rate of preferred recommendation, defined as urologists who recommended the proper treatment course. Analyses were done using difference-in-difference estimations. Results Using multinomial logistical regression, urologists who were given the assay results were significantly more likely to choose the preferred recommendation (active surveillance or active treatment) compared to controls (p = 0.004). These urologists were also significantly more likely to involve their patients in the treatment decision compared to controls (p = 0.001). Conclusions By providing additional information to inform the physician’s treatment plan, a protein-based assay shows demonstrable clinical utility confirmed through a rigorous randomized controlled study design and regression analyses to test for effects.
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Affiliation(s)
- John W Peabody
- QURE Healthcare, 450 Pacific Ave, Suite 200, San Francisco, CA, USA. .,University of California, San Francisco, 500 Beale Street, San Francisco, CA, USA.
| | - Lisa M DeMaria
- QURE Healthcare, 450 Pacific Ave, Suite 200, San Francisco, CA, USA
| | | | | | | | - Othman Ouenes
- QURE Healthcare, 450 Pacific Ave, Suite 200, San Francisco, CA, USA
| | - Jerome P Richie
- Metamark Genetics, 245 First Street, 10th Floor, Cambridge, MA, USA
| | - Trever Burgon
- QURE Healthcare, 450 Pacific Ave, Suite 200, San Francisco, CA, USA
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Paravattil B, Kheir N, Yousif A. Utilization of simulated patients to assess diabetes and asthma counseling practices among community pharmacists in Qatar. Int J Clin Pharm 2017. [PMID: 28466396 DOI: 10.1007/s11096‐017‐0469‐8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Background Patient counseling is one of the most important services a pharmacist can provide to patients. Studies have shown that counseling provided by pharmacists may prevent medication related problems and improve adherence to medication therapy. Objective To explore counseling practices among community pharmacists using simulated patients and to determine if patient, pharmacist, and pharmacy characteristics influence the counseling provided by community pharmacists. Setting Private community pharmacies within Qatar. Method This is a randomized, cross sectional study where simulated patients visited community pharmacies and presented the pharmacist with a new prescription or requested a refill for either a diabetes or asthma medication. Pharmacists completed a questionnaire at the end of the simulated interaction, which was utilized to determine if patient, pharmacist, or pharmacy characteristics had any influence on the counseling provided to patients. A scoring system was devised to assess the pharmacist's counseling practices. Main outcome measure To evaluate the type of information provided by community pharmacists to the simulated patient regarding diabetes and asthma. Results One hundred and twenty-nine pharmacists were enrolled in the study. Eighty one percent of pharmacists had a score <35%. Medication name (95%), directions (47%), indication (43%), and dose (41%) were the most frequently counseled components by pharmacists during the simulated interaction. Male patients received better counseling compared to the female patients (t = 6.177; p < 0.0001). Pharmacists with a master of pharmacy degree provided significantly better counseling (f = 3.261; p = 0.042). Many pharmacists (65%) provided hypoglycemia management to patients, however, 63% referred the patient to the physician when the patient experienced hypoglycemia from inappropriate medication administration. Only 2 (7%) pharmacists correctly counseled the patient on all 8 inhaler administration steps. Majority of pharmacists (50%) educated on the role of the rescue and controller therapy in asthma, however, 33% referred the patient to the physician when the patient inquired about controller therapy use. Conclusion Patient counseling was substandard with the majority of community pharmacists focusing on the name of the medication. Pharmacists rarely assessed patient's medical history or medication use. Disease management and problem solving skills of pharmacists were suboptimal with many referring patients back to the physician.
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Paravattil B, Kheir N, Yousif A. Utilization of simulated patients to assess diabetes and asthma counseling practices among community pharmacists in Qatar. Int J Clin Pharm 2017; 39:759-68. [PMID: 28466396 DOI: 10.1007/s11096-017-0469-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
Abstract
Background Patient counseling is one of the most important services a pharmacist can provide to patients. Studies have shown that counseling provided by pharmacists may prevent medication related problems and improve adherence to medication therapy. Objective To explore counseling practices among community pharmacists using simulated patients and to determine if patient, pharmacist, and pharmacy characteristics influence the counseling provided by community pharmacists. Setting Private community pharmacies within Qatar. Method This is a randomized, cross sectional study where simulated patients visited community pharmacies and presented the pharmacist with a new prescription or requested a refill for either a diabetes or asthma medication. Pharmacists completed a questionnaire at the end of the simulated interaction, which was utilized to determine if patient, pharmacist, or pharmacy characteristics had any influence on the counseling provided to patients. A scoring system was devised to assess the pharmacist's counseling practices. Main outcome measure To evaluate the type of information provided by community pharmacists to the simulated patient regarding diabetes and asthma. Results One hundred and twenty-nine pharmacists were enrolled in the study. Eighty one percent of pharmacists had a score <35%. Medication name (95%), directions (47%), indication (43%), and dose (41%) were the most frequently counseled components by pharmacists during the simulated interaction. Male patients received better counseling compared to the female patients (t = 6.177; p < 0.0001). Pharmacists with a master of pharmacy degree provided significantly better counseling (f = 3.261; p = 0.042). Many pharmacists (65%) provided hypoglycemia management to patients, however, 63% referred the patient to the physician when the patient experienced hypoglycemia from inappropriate medication administration. Only 2 (7%) pharmacists correctly counseled the patient on all 8 inhaler administration steps. Majority of pharmacists (50%) educated on the role of the rescue and controller therapy in asthma, however, 33% referred the patient to the physician when the patient inquired about controller therapy use. Conclusion Patient counseling was substandard with the majority of community pharmacists focusing on the name of the medication. Pharmacists rarely assessed patient's medical history or medication use. Disease management and problem solving skills of pharmacists were suboptimal with many referring patients back to the physician.
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Sargeant S, McLean M, Green P, Johnson P. Applying positioning theory to examine interactions between simulated patients and medical students: a narrative analysis. Adv Health Sci Educ Theory Pract 2017; 22:187-196. [PMID: 27272513 DOI: 10.1007/s10459-016-9691-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 06/01/2016] [Indexed: 06/06/2023]
Abstract
In their journey to becoming doctors, students engage with a range of teachers and trainers. Among these are simulated patients (SPs), who, through role-playing, assist students to develop their communication and physical examination skills, in contexts of formative and summative assessments. This paper explores the teaching and learning relationship between medical students and SPs, and considers how this might affect feedback and assessment. 14 SPs were interviewed on the subject of medical students' professional identity development in 2014. Data were examined using narrative analysis in conjunction with positioning theory to identify the positions that SPs assigned to themselves and to students. Narrative analysis yielded three interpretative positioning themes: Occupational, familial and cultural and discursive and embodied positioning. The interview process revealed that SPs adopt different positions intra-and interpersonally. SPs appear to hold dissonant perceptions of students in terms relating to their emerging professional identities, which may confound assessment and feedback. Training should include reflections on the SP/student relationship to uncover potential biases and positions, giving SPs the opportunity to reflect on and manage their individual and occupational selves.
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Hughes J, Wilson WJ, MacBean N, Hill AE. A tool for assessing case history and feedback skills in audiology students working with simulated patients. Int J Audiol 2016; 55:765-774. [PMID: 27696974 DOI: 10.1080/14992027.2016.1214758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To develop a tool for assessing audiology students taking a case history and giving feedback with simulated patients (SP). DESIGN Single observation, single group design. STUDY SAMPLE Twenty-four first-year audiology students, five simulated patients, two clinical educators, and three evaluators. RESULTS The Audiology Simulated Patient Interview Rating Scale (ASPIRS) was developed consisting of six items assessing specific clinical skills, non-verbal communication, verbal communication, interpersonal skills, interviewing skills, and professional practice skills. These items are applied once for taking a case history and again for giving feedback. The ASPIRS showed very high internal consistency (α = 0.91-0.97; mean inter-item r = 0.64-0.85) and fair-to-moderate agreement between evaluators (29.2-54.2% exact and 79.2-100% near agreement; κweighted up to 0.60). It also showed fair-to-moderate absolute agreement amongst evaluators for single evaluator scores (intraclass correlation coefficient [ICC] r = 0.35-0.59) and substantial consistency of agreement amongst evaluators for three-evaluator averaged scores (ICC r = 0.62-0.81). Factor analysis showed the ASPIRS' 12 items fell into two components, one containing all feedback items and one containing all case history items. CONCLUSION The ASPIRS shows promise as the first published tool for assessing audiology students taking a case history and giving feedback with an SP.
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Affiliation(s)
- Jane Hughes
- a School of Health and Rehabilitation Sciences , The University of Queensland , Australia
| | - Wayne J Wilson
- a School of Health and Rehabilitation Sciences , The University of Queensland , Australia
| | - Naomi MacBean
- a School of Health and Rehabilitation Sciences , The University of Queensland , Australia
| | - Anne E Hill
- a School of Health and Rehabilitation Sciences , The University of Queensland , Australia
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Abstract
Background Simulation is firmly established as a mainstay of clinical education, and extensive research has demonstrated its value. Current practice uses inanimate simulators (with a range of complexity, sophistication and cost) to address the patient ‘as body’ and trained actors or lay people (Simulated Patients) to address the patient ‘as person’. These approaches are often separate. Healthcare simulation to date has been largely for the training and assessment of clinical ‘insiders’, simulating current practices. A close coupling with the clinical world restricts access to the facilities and practices of simulation, often excluding patients, families and publics. Yet such perspectives are an essential component of clinical practice. Main body This paper argues that simulation offers opportunities to move outside a clinical ‘insider’ frame and create connections with other individuals and groups. Simulation becomes a bridge between experts whose worlds do not usually intersect, inviting an exchange of insights around embodied practices—the ‘doing’ of medicine—without jeopardising the safety of actual patients. Healthcare practice and education take place within a clinical frame that often conceals parallels with other domains of expert practice. Valuable insights emerge by viewing clinical practice not only as the application of medical science but also as performance and craftsmanship. Such connections require a redefinition of simulation. Its essence is not expensive elaborate facilities. Developments such as hybrid, distributed and sequential simulation offer examples of how simulation can combine ‘patient as body’ with ‘patient as person’ at relatively low cost, democratising simulation and exerting traction beyond the clinical sphere. The essence of simulation is a purposeful design, based on an active process of selection from an originary world, abstraction of what is criterial and re-presentation in another setting for a particular purpose or audience. This may be done within traditional simulation centres, or outside in local communities, public spaces or arts and performance venues. Conclusions Simulation has established a central role in clinical education but usually focuses on learning to do things as they are already done. Imaginatively designed, simulation offers untapped potential for deep engagement with patients, publics and experts outside medicine.
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Affiliation(s)
- Roger L Kneebone
- 1Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,2Centre for Engagement and Simulation Science (ICCESS), Academic Surgery (3rd Floor), Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH UK
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Peabody JW, Paculdo DR, Tamondong-Lachica D, Florentino J, Ouenes O, Shimkhada R, DeMaria L, Burgon TB. Improving Clinical Practice Using a Novel Engagement Approach: Measurement, Benchmarking and Feedback, A Longitudinal Study. J Clin Med Res 2016; 8:633-40. [PMID: 27540436 PMCID: PMC4974832 DOI: 10.14740/jocmr2620w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Poor clinical outcomes are caused by multiple factors such as disease progression, patient behavior, and structural elements of care. One other important factor that affects outcome is the quality of care delivered by a provider at the bedside. Guidelines and pathways have been developed with the promise of advancing evidence-based practice. Yet, these alone have shown mixed results or fallen short in increasing adherence to quality of care. Thus, effective, novel tools are required for sustainable practice change and raising the quality of care. METHODS The study focused on benchmarking and measuring variation and improving care quality for common types of breast cancer at four sites across the United States, using a set of 12 Clinical Performance and Value(®) (CPV(®)) vignettes per site. The vignettes simulated online cases that replicate a typical visit by a patient as the tool to engage breast cancer providers and to identify and assess variation in adherence to evidence-based practice guidelines and pathways. RESULTS Following multiple rounds of CPV measurement, benchmarking and feedback, we found that scores had increased significantly between the baseline round and the final round (P < 0.001) overall and for all domains. By round 4 of the study, the overall score increased by 14% (P < 0.001), and the diagnosis with treatment plan domain had an increase of 12% (P < 0.001) versus baseline. CONCLUSION We found that serially engaging breast cancer providers with a validated clinical practice engagement and measurement tool, the CPVs, markedly increased quality scores and adherence to clinical guidelines in the simulated patients. CPVs were able to measure differences in clinical skill improvement and detect how fast improvements were made.
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Affiliation(s)
- John W Peabody
- QURE Healthcare, 450 Pacific Ave., Suite 200, San Francisco, CA 94133, USA; University of California, San Francisco and Los Angeles, CA, USA
| | - David R Paculdo
- QURE Healthcare, 450 Pacific Ave., Suite 200, San Francisco, CA 94133, USA
| | | | - Jhiedon Florentino
- QURE Healthcare, 450 Pacific Ave., Suite 200, San Francisco, CA 94133, USA
| | - Othman Ouenes
- QURE Healthcare, 450 Pacific Ave., Suite 200, San Francisco, CA 94133, USA
| | - Riti Shimkhada
- QURE Healthcare, 450 Pacific Ave., Suite 200, San Francisco, CA 94133, USA
| | - Lisa DeMaria
- QURE Healthcare, 450 Pacific Ave., Suite 200, San Francisco, CA 94133, USA
| | - Trever B Burgon
- QURE Healthcare, 450 Pacific Ave., Suite 200, San Francisco, CA 94133, USA
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Douglas SR, Vides de Andrade AR, Boyd S, Leslie M, Webb L, Davis L, Fraine M, Frazer NL, Hargraves R, Bickman L. Communication training improves patient-centered provider behavior and screening for soldiers' mental health concerns. Patient Educ Couns 2016; 99:1203-1212. [PMID: 26884315 DOI: 10.1016/j.pec.2016.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 12/15/2015] [Accepted: 01/25/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of patient-centered communication training for military providers who conduct post-deployment health screening. The half-day interactive workshop included simulated Soldier patients using video technology. METHODS Using a quasi-experimental design, all health care providers at four military treatment facilities were recruited for data collection during a four- to nine-day site visit (23 trained providers, 28 providers in the control group, and one provider declined to participate). All Soldiers were eligible to participate and were blinded to provider training status. Immediately after screening encounters, providers reported on their identification of mental health concerns and Soldiers reported on provider communication behaviors resulting in 1,400 matched pairs. Electronic health records were also available for 26,005 Soldiers. RESULTS The workshop was found to increase (1) providers' patient-centered communication behaviors as evaluated by Soldiers; (2) provider identification of Soldier mental health concerns; and (3), related health outcomes including provision of education and referral to a confidential counseling resource. CONCLUSION Results are promising, but with small effect sizes and study limitations, further research is warranted. PRACTICE IMPLICATIONS A brief intensive workshop on patient-centered communication tailored to the military screening context is feasible and may improve key outcomes.
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Affiliation(s)
| | | | | | - Melanie Leslie
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lynn Webb
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lauren Davis
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melissa Fraine
- Behavioral Health Branch, Clinical Support Directorate, Defense Health Agency, Falls Church, VA, USA
| | - Nicole L Frazer
- Behavioral Health Branch, Clinical Support Directorate, Defense Health Agency, Falls Church, VA, USA
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44
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Young JE, Williamson MI, Egan TG. Students' reflections on the relationships between safe learning environments, learning challenge and positive experiences of learning in a simulated GP clinic. Adv Health Sci Educ Theory Pract 2016; 21:63-77. [PMID: 25952645 DOI: 10.1007/s10459-015-9611-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 04/23/2015] [Indexed: 06/04/2023]
Abstract
Learning environments are a significant determinant of student behaviour, achievement and satisfaction. In this article we use students' reflective essays to identify key features of the learning environment that contributed to positive and transformative learning experiences. We explore the relationships between these features, the students' sense of safety in the learning environment (LE), the resulting learning challenge with which they could cope and their positive reports of the experience itself. Our students worked in a unique simulation of General Practice, the Safe and Effective Clinical Outcomes clinic, where they consistently reported positive experiences of learning. We analysed 77 essays from 2011 and 2012 using an immersion/crystallisation framework. Half of the students referred to the safety of the learning environment spontaneously. Students described deep learning experiences in their simulated consultations. Students valued features of the LE which contributed to a psychologically safe environment. Together with the provision of constructive support and immediate, individualised feedback this feeling of safety assisted students to find their own way through clinical dilemmas. These factors combine to make students feel relaxed and able to take on challenges that otherwise would have been overwhelming. Errors became learning opportunities and students could practice purposefully. We draw on literature from medical education, educational psychology and sociology to interpret our findings. Our results demonstrate relationships between safe learning environments, learning challenge and powerful learning experiences, justifying close attention to the construction of learning environments to promote student learning, confidence and motivation.
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Affiliation(s)
- J E Young
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - M I Williamson
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - T G Egan
- Faculty of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Williams B, Song JJY. Are simulated patients effective in facilitating development of clinical competence for healthcare students? A scoping review. Adv Simul (Lond) 2016; 1:6. [PMID: 29449975 PMCID: PMC5796606 DOI: 10.1186/s41077-016-0006-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 01/24/2016] [Indexed: 11/13/2022] Open
Abstract
Background The need to evaluate the effectiveness of SPs in improving clinical competence has attracted a heightened interest across the healthcare professions, with some prevailing gaps in their evidence. Using a scoping review approach, this study aims to provide an overview on the effectiveness of SPs in facilitating the development of clinical competence for healthcare students. Methods This scoping review applied the first five out of the six-stage methodological framework developed by Levac et al. (Implementation Science 5:69), as follows: 1) Identify the research question; 2) identify relevant studies; 3) study selection; 4) charting the data; and 5) collating, summarising and reporting the results. The search was performed on four databases, including Medline, EMBASE, CINAHL and Scopus. Results A total of 33 articles were included in this study (out of 968 identified), comprising of 20 cross-sectional studies, eight randomised controlled trials and five longitudinal studies. The studies were examined and categorised for further discussion in the three domains of clinical competence; technical, non-technical and cognitive skills. Overall, 24 out of 33 studies showed effectiveness of SPs in facilitating students’ clinical competence. Conclusion This scoping review serves to provide guidance for future healthcare education development, by illustrating the effectiveness of SPs in improving students’ clinical competence as evidenced in the literature. In doing so, it highlights the potential of SPs in facilitating students’ acquisition of the necessary skills for clinical practice.
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Affiliation(s)
- Brett Williams
- Department of Community Emergency Health & Paramedic Practice, Monash University, Peninsula Campus, McMahons Road, PO Box 527, 3199 Frankston, VIC Australia
| | - Jane Jee Yeon Song
- Department of Community Emergency Health & Paramedic Practice, Monash University, Peninsula Campus, McMahons Road, PO Box 527, 3199 Frankston, VIC Australia
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Murphy AL, Martin-Misener R, Kutcher SP, Gardner DM. Pharmacists' performance in a telephone-based simulated patient study after a mental health capacity-building program. Int J Clin Pharm 2015. [PMID: 26210258 DOI: 10.1007/s11096-015-0171-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The More Than Meds program was developed to enhance community pharmacy based services for people with mental illness. OBJECTIVE To evaluate the care of pharmacists who participated in this specific program using a telephone-based simulated patient with insomnia. METHODS A trained actor used a simulated patient case scenario and telephoned pharmacists (i.e., intervention group pharmacists) and a control group of pharmacists approximately 6 months following training. Pharmacists were scored on their assessment of the patient and problem, guidance provided on both pharmacological and nonpharmacological care, communications, and overall quality. RESULTS Sixty-three pharmacists (n = 29 intervention, n = 34 controls) were reached. Call duration was longer with intervention versus control group pharmacists [4.93 min (SD 2.3) vs. 4.00 min (SD 1.8)]. Medication recommendations were made by 76 and 100 % of intervention versus control pharmacists (p = 0.002), respectively. Intervention group pharmacists scored significantly higher on most components within communication and overall quality scores. Scores for assessing the patient, the problem, sleep, and medication supply were lower than expected for both groups. CONCLUSION Intervention group pharmacists performed better than controls on several components of a telephone-based simulated patient scenario for insomnia following More Than Meds training. More research is needed regarding telephone consultations in pharmacy practice.
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Affiliation(s)
- Andrea L Murphy
- Department of Psychiatry & College of Pharmacy, Dalhousie University, 5968 College St., PO Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, 5869 University Ave., PO Box 15000, Halifax, NS, B3H 4R2, Canada
| | - Stan P Kutcher
- Sun Life Financial Chair in Adolescent Mental Health, Dalhousie University/IWK Health Centre, 5850 University Ave., PO Box 9700, Halifax, NS, B3K 6R8, Canada
| | - David M Gardner
- Department of Psychiatry & College of Pharmacy, Dalhousie University, QEII HSC, AJLB 7517, 5909 Veterans' Memorial Lane, Halifax, NS, B3H 2E2, Canada
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MacFarlane B, Matthews A, Bergin J. Non-prescription treatment of NSAID induced GORD by Australian pharmacies: a national simulated patient study. Int J Clin Pharm 2015; 37:851-6. [PMID: 25972205 DOI: 10.1007/s11096-015-0129-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/27/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients regularly present to community pharmacies for advice about and treatment for reflux symptoms and NSAIDs are a common cause of these symptoms. There is no published literature detailing the approach that pharmacies take to these enquiries, the pharmacotherapy they recommend or whether they contribute to the safe and effective use of reflux medicines. OBJECTIVES To assess in an observational study design the clinical history gathering, recommendations for GORD management and counselling provided by community pharmacies in a simulated patient scenario involving suspected NSAID induced reflux symptoms. Setting Australian community pharmacies. METHOD Simulated patients visited 223 community pharmacies to request treatment for reflux symptoms. The interaction was audiotaped and assessed against guidelines for the treatment of reflux symptoms. MAIN OUTCOME MEASURES Alignment of community pharmacies with international expert gastroenterologist guidance and national professional practice guidelines for the treatment of reflux symptoms by pharmacists including: consultation with a pharmacist; confirmation of reflux diagnosis based on symptoms; recommendation of short courses proton pump inhibitor (PPI) therapy; advice on the safe and effective use of reflux medicines and referral to a doctor for further assessment. RESULTS Pharmacists consulted with the simulated patient in 77% of cases. Symptoms were enquired about in 95% of cases and a medicines history taken in 69% of cases. Recommendations for treatment included: PPIs (18%), histamine H2 antagonists (57%) and antacids (19%). Advice on product use was given in 83% of cases. Referral to a doctor to discuss reflux symptoms was made in 63% of cases. CONCLUSION When assessing patients for the symptoms of GORD, Australian pharmacists and non-pharmacist support staff take a comprehensive history including symptomatology, duration of symptoms, concomitant medicines and medical conditions and any GORD treatments previously trialled. They provide comprehensive counselling on the use of antisecretory and antacid medicines. Counselling could involve more comprehensive information on lifestyle approaches for GORD management and side effects of antisecretory and antacid medicines. Further alignment with guidelines for the management of GORD would result in greater referral to a doctor for assessment of recurrent GORD and greater recommendation of PPIs for symptoms. However alignment with guidelines by all pharmacists is unrealistic if the guidelines are not universally available to them.
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Affiliation(s)
- Brett MacFarlane
- Australian College of Pharmacy, Level 2, 9/65 Tennant St, Fyshwick, ACT, 2609, Australia.
| | - Andrew Matthews
- Pharmacy Guild of Australia, Level 2, 'Pharmacy Guild House' 15 National Circuit, Barton, ACT, 2600, Australia
| | - Jenny Bergin
- Australian College of Pharmacy, Level 2, 9/65 Tennant St, Fyshwick, ACT, 2609, Australia
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Alabid AHMA, Ibrahim MIM, Hassali MA. Do Professional Practices among Malaysian Private Healthcare Providers Differ? A Comparative Study using Simulated Patients. J Clin Diagn Res 2013; 7:2912-6. [PMID: 24551673 PMCID: PMC3919326 DOI: 10.7860/jcdr/2013/6198.3789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 09/29/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Malaysia, a South East Asian country, legally permits general medical practitioners in private clinics to dispense medicines. This possibly can dilute the pharmacist role in the provision of healthcare and pharmaceutical care and deprive patients to benefit from these services. OBJECTIVE This study explored, assessed and compared the current status of medicines labeling, patient's counseling, and symptomatic diagnosis by general practitioners and community pharmacists. MATERIAL AND METHODS This study used trained Simulated Patients (SP), who participated in a scenario of common cold symptoms at private clinics and community pharmacies. SPs explored medication labeling, patients counseling and symptomatic diagnosis undertaken by general practitioners and community pharmacists. Later, study authors assessed and compared these practices. The study was conducted during June 2011 in Penang, Malaysia. RESULTS The study used descriptive statistics and Fisher-exact test to analyze data. Regarding patients counseling standard, among 100 visits by simulated patients, 64 (64%) from community pharmacists provided information about the medicine name, its indication, dosage and route of administration versus 17 (42.5%) general practitioners during 40 visits (p=0.024). Concerning adherence to labeling standard, for instance, only in one pharmacy visit, (1%) the pharmacist wrote the name of the patient on the medication label versus in 32 (80%) of doctors' visits, the doctors adhered to this labeling standard (p<0.001). In all doctors' visits (n=40, 100%), SPs were asked about symptoms, whereas in 87 (87%) CPs' visits, pharmacists fulfilled this counseling standard (p=0.02). CONCLUSION Although pharmacists showed less compliance to medicine labeling and symptomatic diagnosis compared to doctors, their counseling of patients was better. Separation will definitely contribute to more concentration of each provider on his/her roles and improve and direct the experiences and skills towards being more patient oriented.
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Affiliation(s)
- Alamin Hassan M. A. Alabid
- PhD Candidate, Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Mohamed Izham Mohamed Ibrahim
- PhD Candidate, Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Mohamed Azmi Hassali
- PhD Candidate, Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Chiu M, Wesson V, Sadavoy J. Improving caregiving competence, stress coping, and mental well-being in informal dementia carers. World J Psychiatry 2013; 3:65-73. [PMID: 24255878 PMCID: PMC3832864 DOI: 10.5498/wjp.v3.i3.65] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/18/2013] [Accepted: 10/16/2013] [Indexed: 02/05/2023] Open
Abstract
AIM: To study the effectiveness of Reitman Centre “Coaching, Advocacy, Respite, Education, Relationship, and Simulation” (CARERS) program, which uses problem-solving techniques and simulation to train informal dementia carers.
METHODS: Seventy-three carers for family members with dementia were included in the pilot study. Pre- and post-intervention data were collected from carers using validated measures of depression, mastery, role captivity and overload, caregiving competence and burden, and coping styles. To assess program effectiveness, mean differences for these measures were calculated. One-way ANOVA was used to determine if change in scores is dependent on the respective baseline scores. Clinical effects for measures were expressed as Cohen’s D values.
RESULTS: Data from 73 carers were analyzed. The majority of these participants were female (79.5%). A total of 69.9% were spouses and 30.1% were children of the care recipient. Participants had an overall mean age of 68.34 ± 12.01 years. About 31.5% of participating carers had a past history of psychiatric illness (e.g., depression), and 34.2% sustained strained relationships with their respective care recipients. Results from carers demonstrated improvement in carers’ self-perception of competence (1.26 ± 1.92, P < 0.0001), and significant reduction in emotion-focused coping (measured by the Coping Inventory of Stressful Situations, -2.37 ± 6.73, P < 0.01), Geriatric Depression scale (-0.67 ± 2.63, P < 0.05) and Pearlin’s overload scale (-0.55 ± 2.07, P < 0.05), upon completion of the Program. Secondly, it was found that carers with more compromised baseline scores benefited most from the intervention, as they experienced statistically significant improvement in the following constructs: competence, stress-coping style (less emotion-oriented), sense of mastery, burden, overload.
CONCLUSION: Study results supported the effectiveness of the CARERS Program in improving caregiving competence, stress coping ability and mental well-being in carers caring for family members with dementia.
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