How simulated patients contribute to student learning in an authentic way:An interview study

Introduction: Simulated patients (SPs) play an instrumental role in teaching communication skills and enhancing learning outcomes. Prior research mostly focused on the SP’s contribution to students’ learning outcomes by providing feedback afterwards. A detailed understanding of the contribution of the SP during SP-student encounters is currently lacking although the majority of the interaction between SPs and students occurs during the SP-student encounter. Therefore, this study focuses on how SPs see their contribution to meaningful student learning experiences during SP-student encounters. Methods: We interviewed fifteen simulated patients from one institution. We explored their perspectives on meaningful learning experiences during SP-student encounters through in-depth, semi-structured interviews and analyzed using thematic analysis. Results: SPs view their contribution to meaningful student learning during SP-student encounters from two perspectives. A collective perspective as a member of the community of SPs and an individual perspective. From the collective perspective, SPs believe that the fact that students deal with multiple varied SP-student encounters over time is of value for meaningful learning. From the individual perspective, we noticed that SPs think, act, and react from three different positions. First, as the patient in the role description, second, as a teaching aid and third, as an individual with personal experiences, beliefs, and values. SPs mentioned that the ratio between these different positions can vary within and between encounters. Conclusions: According to SPs, we should value the variation between SPs, thereby creating meaningful variation in authentic interactions in SP-student encounters. SPs should be allowed to act and react from different positions during SP-student encounters, including their role description, as teaching aid, and based on their own experiences. In this way, SP-student encounters are optimized to contribute to meaningful student learning through authenticity.</p

Validity evidence and reliability of a simulated patient feedback instrument

Contains fulltext : 110154.pdf (publisher's version ) (Open Access)BACKGROUND: In the training of healthcare professionals, one of the advantages of communication training with simulated patients (SPs) is the SP's ability to provide direct feedback to students after a simulated clinical encounter. The quality of SP feedback must be monitored, especially because it is well known that feedback can have a profound effect on student performance. Due to the current lack of valid and reliable instruments to assess the quality of SP feedback, our study examined the validity and reliability of one potential instrument, the 'modified Quality of Simulated Patient Feedback Form' (mQSF). METHODS: Content validity of the mQSF was assessed by inviting experts in the area of simulated clinical encounters to rate the importance of the mQSF items. Moreover, generalizability theory was used to examine the reliability of the mQSF. Our data came from videotapes of clinical encounters between six simulated patients and six students and the ensuing feedback from the SPs to the students. Ten faculty members judged the SP feedback according to the items on the mQSF. Three weeks later, this procedure was repeated with the same faculty members and recordings. RESULTS: All but two items of the mQSF received importance ratings of > 2.5 on a four-point rating scale. A generalizability coefficient of 0.77 was established with two judges observing one encounter. CONCLUSIONS: The findings for content validity and reliability with two judges suggest that the mQSF is a valid and reliable instrument to assess the quality of feedback provided by simulated patients

Expressive instructions:ethnographic insights into the creativity and improvisation entailed in teaching physical skills to medical students

Introduction Creativity and improvisation are recognized as important aspects of training expertise in domains such as business and the arts, yet rarely discussed in medical education. This article examines how creativity and improvisation play out in the ways teachers give ‘expressive instructions’ to medical students when teaching physical skills. Methods Ethnographic fieldwork was conducted in a medical school in Maastricht, the Netherlands, with first, second and third year students learning physical examination skills. Over 230 h of fieldwork was conducted in the Skills Lab, including 34 tutorials of 1.5 h duration, with 11 different teachers and over 500 students. Patterns found in the fieldnotes were thematically analyzed using an inductive approach, drawing on sociological theories of craftsmanship. Results Findings showed that teachers improvise beyond the standardized lesson structure and classroom set-up, giving what we call, drawing on sociological theory, ‘expressive instructions’. This was visible in two main ways: 1) by teachers using their own bodies; 2) by teachers using materials that came to hand. Discussion This research highlights the important yet underexplored role of creativity and improvisation in teaching physical skills. Creativity and improvisation appear to be particularly important when training expertise in skills that are difficult to articulate and thus require expressive instructions, due for example to their sensory nature. Focusing on how expressive instructions play out in medical education offers insights into the tacit components of expertise development, a process which builds upon a long period of teachers’ skilled practice

Methods for quality assessment in general practice

Background and objectives. There is now a wide variety of methods available to general practitioners who want to engage in quality assessment, quality assurance, or quality improvement activities in their practices. These methods require some kind of performance review, or at least the collection of some performance-related data. As in traditional research, the choice of methods depends on what research questions one wants to address. This paper elaborates on some key concepts related to the choice of methods, making a distinction between whether any method actually covers performance (what a doctor does in daily practice) or competence (what a doctor is capable of doing) as well as a distinction between whether a method is direct (patient-doctor contact is observable) or is indirect. Methods. An overview frame will be presented of the methods most commonly used for data collection within quality assessment. These methods are discussed on their validity, reliability, feasibility and acceptability. Direct methods aimed at recording performance are assumed to hold the highest validity, but practical, economic and logistic factors may favour less ambitious methods for audit or quality improvement activities. Conclusions. One crucial element in all methods is creating a set of empirical data, as a basis for comparisons, reflection, dialogue and discussions among colleagues

Task Complexity and Cognitive Load in Simulation-based Education: A Randomized Trial

CONTEXT: When designing simulation for novices, educators aim to design tasks and environments that are complex enough to promote learning, but not too complex to compromise task performance and cause cognitive overload. OBJECTIVE: To determine the impact of modulating task and environment complexity on novices' performance and cognitive load during simulation. METHODS: Second-year pharmacy students (N=162) were randomly assigned to one of four conditions (2x2 factorial design) in simulation: simple task in simple environment, complex task in simple environment, simple task in complex environment, and complex task in complex environment. Using video recordings, two raters assessed students' performance during the simulation. We measured intrinsic (ICL) and extraneous cognitive load (ECL) with questionnaires after the task, and tested knowledge after task and debriefing. RESULTS: Mean performance scores in simple environment were 28.2/32 (SD=3.8) for simple task and 25.8 (SD=4.2) for complex task. In complex environment, mean performance scores were 24.6 (SD=5.2) for simple task and 25.6/32 (SD=5.3) for complex task. We found significant interaction effects between task and environment complexity for performance. In simple environment, mean ICL scores were 4.2 (SD=2.2) for simple task and 5.7 (SD=1.5) for complex task. In complex environment, mean ICL scores were 4.9/10 (SD=1.8) for simple task and 5.1/10 (SD=1.9) for complex task. There was a main effect of task complexity on ICL. For ECL, we found neither an interaction effect nor main effects of task and environment complexity. There was a main effect of task complexity on knowledge test after task and main effects of both task and environment complexity on knowledge after debriefing. CONCLUSION: Performance was good and cognitive load remained reasonable in all conditions, which suggests that, despite increased complexity, students seemed to strategically manage their own cognitive load and learn from the simulations. Our findings also indicate that environmental complexity contributes to ICL