Learning and teaching professional communication. Added-value of simulation with simulated patient and debriefing

Abstract

editorial reviewedThe "communication" skill is part of the competence framework of the Master of Specialization in General Medicine at ULiège. The teaching devices in communication in the 1st year have two main objectives: to structure the consultation and to seek the patient's perspective. The simulated interview workshops with a simulated patient[2] are part of a continuous and progressive communication learning process. After a small group "theory" workshop, the 100 students participate in two simulation workshops: patient perspective seeking in an acute problem and motivational interviewing in the follow-up of a chronic disease. At the end, each student participates in a test involving Medical Simulated Interviews for formative purposes but also for certification. The physician-teachers and the simulated patients are volunteers. They have been trained on the content and modality of the simulation by the course director and by a professor who is an expert in the field of health simulation in Canada. In each workshop, the students are in pairs: they play one scenario and observe another, using an observation grid. A debriefing is then led by a physician-teacher: the feelings and observations of each person are discussed: student, simulated patient, physician-teacher, in order to identify areas for improvement. The device thus offers students several learning modalities: action in a scenario, familiarization with the criteria of good communication thanks to the use of a grid, multi-source feedback. The implementation of these workshops is the starting point for the implementation of a coherent longitudinal communication curriculum in the training of future general practitioners in Liège. Significant resources were deployed to recruit and train simulated patients and tutors, but also to create scenarios that promote learning of the targeted skills. The support of the university through a pedagogical support grant (CUEF-ULiege) has been decisive. The program is being evaluated for regulatory purposes up to Kirkpatrick Level 2. This evaluation shows that the students have learned a great deal about communication (importance of seeking the patient's perspective, etc.) and modalities (direct feedback from simulated patients and the teacher, etc.). The device allows for the integration of simulated patients in the MSI where previously teachers played the patients. The writing of the scenarios has been improved. Standardization and authenticity of the examination has been increased. The collaboration with simulated patients raises the question of the necessary and sufficient skills for this type of intervention and reposition the place of patients in the training of health professionals. The system will later aim at verifying what has been learned in a real clinical situation (Kirkpatrick level 3). It is indeed planned, in the long term, to organize the supervision of students in clinical activity by direct or recorded and deferred observation