Table Of ContentThe Simulated Patient
Handbook
A COMPREHENSIVE GUIDE FOR FACILITATORS
AND SIMULATED PATIENTS
FIONA DUDLEY
Lecturer, facilitator, trainer and simulated patient
Forewordby
JONATHAN SILVERMAN
Associate Clinical Dean and Director of Communication Studies
School of Clinical Medicine
University of Cambridge
Boca Raton London New York
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Contents
Foreword v
About the author viii
Acknowledgements ix
Part One: Background 1
1 So you want to join the world of the simulated patient? 3
2 Consultation skills training: how important is it? 9
Part Two: Preparation 15
3 Recruiting simulated patients 17
4 Training simulated patients 21
5 Writing scenarios and briefs 60
Part Three: Managing the session 71
6 Immediate preparation 73
7 Dynamic groups or group dynamics 77
8 Communication with your simulated patient 89
9 The consultation 95
10 The simulated patient as teacher 130
11 Managing feedback 133
12 Any other business! 155
Part Four: Assessment and other uses of simulated patients 163
13 Standardised patients in examinations and recruitment interviews 165
14 Other simulated patient challenges and new developments 177
Appendix 1: Consultation skills advanced jargon buster 181
Appendix 2: Sample scenario briefs 185
Appendix 3: Resources for role development 210
Appendix 4: A list of mood indicators 211
Appendix 5: Communication skills 213
Appendix 6: Six Hats Exercise - Edward de Bono 216
Appendix 7: Suggested further reading 217
Index 220
Foreword
The exponential rise in the adoption of simulated patients into mainstream
medical education has been truly phenomenal. Who would have predicted
20 years ago that medical undergraduate finals examinations would regularly
feature simulated rather than real patients? Who would have thought that post
graduate qualifications such as the MRCP, FRCA and the MRCGP would adopt
the use of simulated patients as an established component of their examination
processes? And who would have even considered that working with simulated
patients to practice interviewing skills would not just be commonplace but an
extensive, established, mandatory feature of medical education in most if not all
medical schools in the United Kingdom? Eighteen years ago, I started to think
about how to establish a team of simulated patients to use in medical education
in the East of England. We began working with two regular actors. Our medical
school now employs a simulated patient director and we have over 130 simulated
patients servicing our undergraduate programme.
I always ask our new medical students why on earth we spend so much money
and so much effort in training simulated patients when we have a hospital and
community full of real patients who are only too willing to be interviewed by
medical students. It does not take them long to realise what we can offer in
our programme. Simulated patients provide a situation in which students can
experiment and learn in a safe environment, without the possibility of harming
real patients, yet in as close an approximation to reality as possible. Simulated
patients provide ideal opportunities for rehearsal. Here is the ultimate offer to
learners: feel free to experiment and to rehearse skills over and over again - do
what you can rarely do with real patients in the outside world, say out loud ‘that
didn’t seem to work very well, let me try it again differently’. Simulated patients
are willing for learners to make mistakes and to provide multiple opportuni
ties for trial and error so that learners can practice skills in safety without any
adverse consequences of‘botching’ an attempt at a new skill. Just think about the
impossibility of using real patients to teach learners about interviewing an angry
patient who has been kept waiting for a long time, or giving the diagnosis of
multiple sclerosis to somebody and breaking that bad news for the first time, or
talking to the parent of a child who has just been killed in a road traffic accident.
Yet in the simulated situation, learners can obtain feedback from peers, patient
and facilitator and learn behaviours which will enable them to be much more
V
vi FOREWORD
effective and supportive when later on, in real-life, they face similar difficult and
challenging issues.
Communication skills teaching relies heavily on experiential methodology
utilising active learning in small groups, video recordings, simulated patients and
constructive feedback. In recent years, considerable effort has been employed
in training facilitators to teach communication skills effectively using these
approaches. And of course, it is now being realised that simulated patients need
considerable training and help too. Their increasing numbers has now led to
efforts to professionalise simulated patient training. Simulated patients trainers
in undergraduate medical schools in the UK have come together through the
SPOTS organisation and have held regular national meetings. And a national
meeting of medical educators has looked specifically at the use of non-clinical
teachers in medical education and at ways in which standards could be set and
training maximised.
However, there has been little in the way of handbooks concerning specifically
the use of simulated patients and much training has been by word of mouth.
Fortunately this excellent manual goes some way to redressing this deficiency.
Fiona has extensive experience as both a simulated patient and a facilitator and
she has clearly written this handbook from the heart. She has brought together
all her experience in a highly accessible way that addresses the needs of all those
working as a simulated patient or with simulated patients. Simulated patients
will find this book collates so many good tips and advice about how to work with
learners. Facilitators working with simulated patients will read this book in order
to get a clearer insight into what simulated patients need from them and how to
work together as an effective team.
This book clearly describes the variety of backgrounds, not necessarily acting,
from which simulated patients can be drawn and the need for recruitment from
all aspects of society in order to mirror the patients that learners wifi meet in
real-life. It covers the attributes required to work effectively in this field. What
stands out most strongly here is the author s keen appreciation of the need for
anyone working in this way to be on the side of the learner, to be there to help
them rather than hinder them and to appreciate what a difficult and important
job it is to be a health professional.
The manual covers different approaches that can be taken to the use of simu
lated patients, the ways in which simulated patients are used in both formative
teaching and summative examinations and is particularly strong about how to
give feedback, both in role, out of role and in neutral. It also covers just how
closely a simulated patient has to work with the facilitator and the need for dis
cussion both before and after teaching sessions in order to maximise potential
benefits.
Communication skills teaching in medicine has now come of age. Many of
the battles have been won and communication skills teaching and assessment
have become established as central core components of the medical education
landscape. What is needed now is dissemination of good practice and practical
FOREWORD vii
thoughtful help to turn good intentions into excellent teaching and evaluation.
Fiona Dudleys book provides this help and I would highly commend it to all
simulated patients and facilitators
Jonathan Silverman
Associate Clinical Dean and Director of Communication Studies
School of Clinical Medicine
University of Cambridge
October 2011
About the author
After completing a Russian degree and spending a few years travelling, Fiona
returned to England to train as an occupational therapist. She worked for sev
eral years in the fields of adult and child mental health until deciding to become
a full-time mum. She began to work as a simulated patient in the early days
of their development in this country. During the last 20 years she has worked
increasingly and extensively in the field of medical and healthcare education as a
lecturer, facilitator, trainer and, of course, simulated patient. She has worked for
a variety of institutions, including the Leeds School of Medicine; the Hull and
York Medical School, the Yorkshire and the Humber Strategic Health Authority;
the Yorkshire Deanery; and Peninsula Medical School. She is also an active
member of the Simulated Patient Organisers and Trainers organisation, which
continues to share best practice and develop the creative use of simulated patients
nationwide. This book is the culmination of her experiences of all aspects of
working with simulated patients.
Acknowledgements
This book has been a while in the making and so many lovely friends and col
leagues have helped and inspired me along the way that it would be impossible
to mention all by name.
Some have given specific help and guidance with the writing, so thanks
to Steve Attmore, Dean Brown, Steve Duffy, Miriam Hawkins and Jonathan
Silverman.
Thanks also to my dear friends from the simulated patient community for
all their support, encouragement and friendship (not to mention the laughs!)
over the past twenty years, especially Ian Baxter, Kieran Conlan, Jenny Dent,
Jem Dobbs, Alison George, Nabeela Azhar Ibrahim, Alf Israel, Tracey Lucas,
Tony Martin, Hayley Mason, Martina McClements, Robina Mir, Belinda Noda,
Cassie Reynolds, Cynthia Rover, Maggi Stratford, Narelle Summers, Val Tagger,
Godfrey Thorpe, Chris Thomas, Tony Walford, Jane Whittaker, Sally Womersley
and Andy Worthington.
Thanks to my many friends and colleagues at Hull York Medical School -
especially Andy Brown, Sarah Collins, Jay Exley, Anna Hammond and Lesley
Jones.
Many thanks also to Iain Wilkinson and Alison Kitch from the Strategic
Health Authority, and to the rest of the training team there - Kate Barker,
Daphne Franks and Alistair Imrie.
Thanks also to friends and colleagues, past and present, at Leeds Medical
School - Alison Ashworth, Len Biran, Adrian Boonin, Barbara Dransfield,
Sarah Escott, Anne-Marie Howes, Rob Lane, Olwyn Marshall, Penny Morris,
Gail Nicholls, Bernard and Kay Pierce, Miranda Powers, Emma Storr, Jools
Symmons, Ann Wilcock.
Thanks to Karen Roberts and Ramesh Mehay at the Yorkshire Deanery, and
Rob Johnson at Peninsula Medical School.
I am also grateful for the enthusiasm of members of the Simulated Patient
Organisers and Trainers organisation ... especially Karen Barry, Frank Coffey,
Libby Dicken, Michelle Gutteridge, Carrie Hamilton, Pene Herman Smith,
Byron McGuiness, Alison Whitfield.
Many thanks also for the wisdom and expertise of Jamie Etherington and
Gillian Nineham at Radcliffe Publishing Ltd, and Camille Lowe at Undercover
project management.
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