scholarly journals A realist evaluation exploring simulated patient role-play in pharmacist undergraduate communication training

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Aisling Kerr ◽  
Judith Strawbridge ◽  
Caroline Kelleher ◽  
James Barlow ◽  
Clare Sullivan ◽  
...  

Abstract Background Effective communication between pharmacists and patients is essential and improves health outcomes. Simulated patients (SPs) are trained to reproduce real-life situations and can help pharmacy students to develop and adapt their communication skills in a safe, learner-centred environment. The aim of this research was to explore how SP and pharmacy student role-play supports communication training. Methods A mixed methods realist evaluation approach was adopted to test an initial theory relating to SP role-play for pharmacy students. The intervention tested involved complex communication cases in a men’s and women’s health module in year three of a new MPharm programme. This SP session was the first such session, of the programme which exclusively focused on complex communication skills for the students. Data collected comprised video-recordings of both training and mock OSCE sessions, and from student focus groups. Communication videos were scored using the Explanation and Planning Scale (EPSCALE) tool. Scores from SP and mock OSCE sessions were compared using the Wilcoxon-signed rank test. Focus groups were conducted with students about their experience of the training and analysed thematically, through a realist lens. Data was analysed for Context-Mechanism-Outcome configurations to produce modified programme theories. Results Forty-six students (n = 46/59, 78 %) consented to their video-recorded interactions to be used. Students identified contextual factors relating to the timing within the course and the setting of the intervention, the debrief and student individual contexts. Mechanisms included authenticity, feedback, reflection, self-awareness and confidence. Negative responses included embarrassment and nervousness. They distinguished outcomes including increased awareness of communication style, more structured communication and increased comfort. However quantitative data showed a decrease (p < 0.001) in communication scores in the mock OSCE compared with scores from training sessions. Modified programme theories relating to SP training for pharmacy students were generated. Conclusions SP role-play is a valuable communication skills training approach. Emphasis should be placed on multiple stakeholder feedback and promotion of reflection. Time limits need to be considered in this context and adjusted to meet student needs, especially for students with lower levels of communication comfort and those communicating in languages different to their first language.

2015 ◽  
Vol 29 (4) ◽  
pp. 346-353 ◽  
Author(s):  
Renee D Boss ◽  
Nancy Hutton ◽  
Pamela L Griffin ◽  
Beth H Wieczorek ◽  
Pamela K Donohue

Background: Legislative measures increasingly require consideration of pediatric inpatients for Medical Orders for Life-Sustaining Treatment. Aim: To explore pediatric clinicians’ experiences with life-sustaining treatments prior to the Medical Orders for Life-Sustaining Treatment mandate and to describe clinician and family concerns and preferences regarding pediatric Medical Orders for Life-Sustaining Treatment. Design: Clinician surveys and clinician and parent focus groups. Setting/participants: Pediatric clinicians and parents from one of Maryland’s largest health systems. Results: Of 96 survey respondents, 72% were physicians and 28% were nurse practitioners. A total of 73% of physicians and 34% of nurse practitioners felt able to lead discussions about limiting therapies “most” or “all” of the time. A total of 75% of physicians and 37% of nurse practitioners led such a discussion in the prior year. A total of 55% of physicians and 96% of nurse practitioners had written no order to limit therapies in the past year. Only for children predicted to die within 30 days did >80% of clinicians agree that limitation discussions were warranted. A total of 100% of parent focus group participants, but 17% of physicians and 33% of nurse practitioners, thought that all pediatric inpatients warranted Medical Orders for Life-Sustaining Treatment discussions. Parents felt that universal Medical Orders for Life-Sustaining Treatment would decrease the stigma of limitation discussions. Participants believed that Medical Orders for Life-Sustaining Treatment would clarify decision making and increase utilization of palliative care. Medical Orders for Life-Sustaining Treatment communication skills training was recommended by all. Conclusion: A minority of clinicians, but all parents, support universal pediatric Medical Orders for Life-Sustaining Treatment. Immediately prior to the Medical Orders for Life-Sustaining Treatment mandate, many clinicians felt unprepared to lead limitation discussions, and few had written relevant orders in the prior year. Communication training is perceived essential to successful Medical Orders for Life-Sustaining Treatment conversations.


2019 ◽  
Author(s):  
Shefaly Shorey ◽  
Emily Ang ◽  
John Yap ◽  
Esperanza Debby Ng ◽  
Siew Tiang Lau ◽  
...  

BACKGROUND The ability of nursing undergraduates to communicate effectively with health care providers, patients, and their family members is crucial to their nursing professions as these can affect patient outcomes. However, the traditional use of didactic lectures for communication skills training is ineffective, and the use of standardized patients is not time- or cost-effective. Given the abilities of virtual patients (VPs) to simulate interactive and authentic clinical scenarios in secured environments with unlimited training attempts, a virtual counseling application is an ideal platform for nursing students to hone their communication skills before their clinical postings. OBJECTIVE The aim of this study was to develop and test the use of VPs to better prepare nursing undergraduates for communicating with real-life patients, their family members, and other health care professionals during their clinical postings. METHODS The stages of the creation of VPs included preparation, design, and development, followed by a testing phase before the official implementation. An initial voice chatbot was trained using a natural language processing engine, Google Cloud’s Dialogflow, and was later visualized into a three-dimensional (3D) avatar form using Unity 3D. RESULTS The VPs included four case scenarios that were congruent with the nursing undergraduates’ semesters’ learning objectives: (1) assessing the pain experienced by a pregnant woman, (2) taking the history of a depressed patient, (3) escalating a bleeding episode of a postoperative patient to a physician, and (4) showing empathy to a stressed-out fellow final-year nursing student. Challenges arose in terms of content development, technological limitations, and expectations management, which can be resolved by contingency planning, open communication, constant program updates, refinement, and training. CONCLUSIONS The creation of VPs to assist in nursing students’ communication skills training may provide authentic learning environments that enhance students’ perceived self-efficacy and confidence in effective communication skills. However, given the infancy stage of this project, further refinement and constant enhancements are needed to train the VPs to simulate real-life conversations before the official implementation.


Neurology ◽  
2018 ◽  
Vol 90 (2) ◽  
pp. 93-97 ◽  
Author(s):  
Monica E. Lemmon ◽  
Charlene Gamaldo ◽  
Rachel Marie E. Salas ◽  
Ankita Saxena ◽  
Tiana E. Cruz ◽  
...  

ObjectiveTo characterize features of medical student exposure to difficult conversations during a neurology core clerkship.MethodsThis was a cross-sectional concurrent nested mixed methods study, and all students rotating through a required neurology clerkship between 2014 and 2015 were enrolled. Data collection included an electronic communication tracker, baseline and end-of-clerkship surveys, and 4 facilitated focus groups. Students were asked to log exposure to patient–clinician conversations about (1) new disability, (2) poor prognosis, (3) prognostic uncertainty (4), terminal diagnosis, and (5) end-of-life care.ResultsA total of 159 students were enrolled and 276 conversations were tracked. Most (70%) students observed at least 1 difficult conversation, and conversations about poor prognosis, new disability, and prognostic uncertainty were most commonly logged. At clerkship end, most students (87%) desired additional bedside training in communication skills. Exposure to one of the predefined conversation types did not improve student perceived preparedness to lead difficult conversations in the future. In focus groups, students noted that the educational value of observation of a difficult conversation could be optimized with preconversation planning and postconversation debriefing.ConclusionsDifficult conversations are common in neurology, and represent a valuable opportunity to provide communication skills training on the wards. Future curricula should consider ways to leverage these existing opportunities to enhance communication skills training.


Author(s):  
Liesa Reitz ◽  
Aline Sohny ◽  
Gerrit Lochmann

The authors present a novel way of oral language training by embedding the English as a foreign language (EFL) learning process into a generic 3D Cooperative Virtual Reality (VR) Game. Due to lack of time, resources and innovation, the language classroom is limited in its possibilities of promoting authentic communication. Therefore, the researchers investigated how to induce a VR setting with information gaps, for which they designed a template which intrinsically promotes communication and the students' confidence in using EFL. Thereby, VR enables the simulation of real life situations, creating both comfortable and authentic training environments. The game content is based on the internationally approved Graded Examination in Spoken English (GESE) Trinity Exam and can be adapted to the needs of the learners or the given curricula. The empirical analysis shows that the designed game trains the students' communication skills, evoking a high amount of speech and a qualitative linguistic output.


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Cristina Bagacean ◽  
Ianis Cousin ◽  
Anne-Helene Ubertini ◽  
Mohamed El Yacoubi El Idrissi ◽  
Anne Bordron ◽  
...  

Abstract Background Verbal and non-verbal communication, as well as empathy are central to patient-doctor interactions and have been associated with patients’ satisfaction. Non-verbal communication tends to override verbal messages. The aim of this study was to analyze how medical students use verbal and non-verbal communication using two different educational approaches, student role play (SRP) and actor simulated patient (ASP), and whether the non-verbal behaviour is different in the two different poses. Methods Three raters evaluated 20 students playing the doctor role, 10 in the SRP group and 10 in the ASP group. The videos were analyzed with the Calgary-Cambridge Referenced Observation Guide (CCG) and, for a more accurate evaluation of non-verbal communication, we also evaluated signs of nervousness, and posture. Empathy was rated with the CARE questionnaire. Independent Mann Whitney U tests and Qhi square tests were performed for statistical analysis. Results From the 6 main tasks of the CCG score, we obtained higher scores in the ASP group for the task ‘Gathering information’ (p = 0.0008). Concerning the 17 descriptors of the CCG, the ASP group obtained significantly better scores for ‘Exploration of the patients’ problems to discover the biomedical perspective’ (p = 0.007), ‘Exploration of the patients’ problems to discover background information and context’ (p = 0.0004) and for ‘Closing the session – Forward planning’ (p = 0.02). With respect to non-verbal behaviour items, nervousness was significantly higher in the ASP group compared to the SRP group (p < 0.0001). Concerning empathy, no differences were found between the SRP and ASP groups. Conclusions Medical students displayed differentiated verbal and non-verbal communication behaviour during the two communication skills training methodologies. These results show that both methodologies have certain advantages and that more explicit non-verbal communication training might be necessary in order to raise students’ awareness for this type of communication and increase doctor-patient interaction effectiveness.


2010 ◽  
Vol 8 (4) ◽  
pp. 441-447 ◽  
Author(s):  
Michelle N. Grainger ◽  
Sue Hegarty ◽  
Penelope Schofield ◽  
Vicki White ◽  
Michael Jefford

AbstractObjective:Discussing the transition from active anti-cancer treatment to palliative care can be difficult for cancer patients and oncology health professionals (OHP). We developed a brief communication skills workshop to assist OHP with these conversations, and examined satisfaction with the workshop and perceived confidence regarding these discussions.Method:Interactive workshops were conducted by trained facilitators and included cognitive, behavioral, and experiential components. The major component of the workshop involved role-plays with trained actors (simulated patients). Participants completed an evaluation questionnaire.Results:Sixty-two OHP participated in workshops. Overall, participants were highly satisfied with the workshop content and format. All participants felt the workshop provided relevant practical information, and >80% thought that participation benefited their work. Over 98% said that the workshop had increased confidence in their communication skills.Significance of results:Participants were very satisfied with the workshop, and thought that participation increased confidence in communicating about the transition to palliative care. Dissemination of this model of communication skills training seems warranted.


2017 ◽  
Vol 5 (4) ◽  
pp. 555
Author(s):  
Val Fulmer

Introduction: The University of Pittsburgh School of Medicine Standardized Patient (SP) Program has assisted with communication skills training in medical and other health science departments since 2002. We will explore how the realism of training interpersonal communication skills with Simulated/Standardized Patient (SP) “role play” can enhance the quality and versatility of any communication-based evaluation or training in health and a variety of other environments. Description: Since the early 1960s, collaborations with the dramatic arts have been leveraged in “educational acting” within medical schools around the world. Formal programs that employ SPs to teach and test interpersonal skills using educational “role play” techniques are now common. An SP is defined as “a person trained to consistently portray a patient or other individual in a scripted scenario for the purposes of instruction, practice, or evaluation”. SP methodology is a powerful tool to utilize when training objectives relate to the understanding of individual perspectives, cultural, technical and professional behaviors.Program Results: Initially formed to support the School of Medicine, the desire for collaborative and interprofessional learning has expanded our program’s scope to include seven other health sciences within the University. As interpersonal communication skills have been shown to improve patient-centric care and customer satisfaction, this training provides experiential practice and measurable outcomes of these foundational skills. Implications: As all disciplines move more towards improving the experience of the “consumer”, an increased concern with end user satisfaction is essential. The transferability of SP methodology is applicable across many fields, including Law, Business and Social Work among other programs. Continued collaboration has significant potential for training professionals in all disciplines.


2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 29-29
Author(s):  
Carolyn Lefkowits ◽  
Kerri S. Bevis ◽  
Elise Carey ◽  
Robert Arnold ◽  
Lisa Podgurski

29 Background: Good communication is crucial to good patient care. Gynecologic oncology providers often face challenging communication scenarios, including giving serious news and discussing goals of care. Communication skills training (CST) has been shown to improve skill acquisition among providers of multiple specialties, but it has not been described in providers from gynecologic oncology or any surgical oncology specialty. Methods: We conducted a two-day CST workshop, based on the VitalTalk© model, with four faculty members (2 gynecologic oncologists and 2 palliative care physicians) and 10 gynecologic oncology provider participants (5 fellows and 5 advanced practice providers). Using didactics, demonstrations and practice sessions with simulated patients we focused on giving serious news and discussing goals of care. Pre and immediate post-workshop surveys evaluated acceptability of the workshop, perceived impact of preparedness to address challenging communication scenarios and anticipated impact on clinical practice. We compared pre and post-workshop prevalence of score of 4 or 5 out of 5 on a Likert scale for preparedness to handle 14 challenging communication scenarios. Results: Participants reported statistically significant increase in preparedness to handle 13 out of 14 challenging communication scenarios. Among those 13 topics, magnitude of improvement in proportion of participants rating preparedness 4 or 5 out of 5 ranged from 40-100% (all p < 0.05). All participants would recommend the course to others and all strongly agreed that this training should be required of all gynecologic oncology clinicians. Conclusions: Participants felt strongly that the workshop provided high quality education relevant to their practice. As a result of the workshop, participants reported statistically significantly increased preparedness to handle challenging communication scenarios. CST is feasible and has high perceived effectiveness for clinicians in the primarily surgical oncologic specialty of gynecologic oncology.


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