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Simulated Patients (simulated + patient)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

A systematic review of the use of simulated patients and pharmacy practice research

INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 2 2006
Dr. MC Watson MRC fellow
Objective The use of simulated patients to assess current practice, or to derive outcome measures for pharmacy practice research, has received much attention in recent years. A simulated patient is an individual who is trained to visit a pharmacy to enact a scenario testing specific behaviour of the pharmacist or pharmacy staff. The aim of this study was to provide a definitive review of the use of simulated patients as a methodological tool for pharmacy practice research. Method A systematic review was undertaken to identify all pharmacy practice studies that had used simulated patient methodology. The electronic databases searched to identify relevant studies were MEDLINE, EMBASE and CINAHL. Articles fulfilling all the following criteria were considered for inclusion in the review: primary reports of trials conducted in community pharmacy and drug store settings which used simulated patients to derive outcome measures. The review was not restricted by language or by country. The review was restricted to publications from 1976 to May 2005. Key findings In total, 56 full publications were retrieved for further examination, of which 46 studies were included in the review, including: nine randomised controlled trials, three controlled trials, 30 cross-sectional, two time-series and two ,other' studies. Ten publications were excluded: seven reviews, one laboratory-based study, one telephone survey and one study presented only as an abstract. Conclusions There has been steady growth in the use of simulated patient methodology over the past 30 years. Although simulated patients have received negative attention in the pharmaceutical media, they can be a rigorous and robust method of measuring practice if used appropriately. This review demonstrates the range of activities for which this method can be used, including the assessment of counselling and advice provision, the treatment of minor and major illness, and the assessment of the public health activities of pharmacy and drug store staff. Simulated patient methodology has been used in developing countries to a similar, if not greater extent, than the developed world, demonstrating its versatility and applicability to pharmacy practice research globally. [source]

Use of an innovative video feedback technique to enhance communication skills training

MEDICAL EDUCATION, Issue 2 2004
Debra L Roter
Context, Despite growing interest in medical communication by certification bodies, significant methodological and logistic challenges are evident in experiential methods of instruction. Objective, There were three study objectives: 1) to explore the acceptability of an innovative video feedback programme to residents and faculty; 2) to evaluate a brief teaching intervention comprising the video feedback innovation when linked to a one-hour didactic and role-play teaching session on paediatric residents' communication with a simulated patient; and 3) to explore the impact of resident gender on communication change. Design, Pre/post comparison of residents' performance in videotaped interviews with simulated patients before and after the teaching intervention. Individually tailored feedback on targeted communication skills was facilitated by embedding the Roter Interaction Analysis System (RIAS) within a software platform that presents a fully coded interview with instant search and review features. Setting/participants, 28 first year residents in a large, urban, paediatric residency programme. Results, Communication changes following the teaching intervention were demonstrated through significant improvements in residents' performance with simulated patients pre and post teaching and feedback. Using paired t -tests, differences include: reduced verbal dominance; increased use of open-ended questions; increased use of empathy; and increased partnership building and problem solving for therapeutic regimen adherence. Female residents demonstrated greater communication change than males. Conclusions, The RIAS embedded CD-ROM provides a flexible structure for individually tailoring feedback of targeted communication skills that is effective in facilitating communication change as part of a very brief teaching intervention. [source]

Educational and Research Implications of Portable Human Patient Simulation in Acute Care Medicine

ACADEMIC EMERGENCY MEDICINE, Issue 11 2008
Leo Kobayashi MD
Abstract Advanced medical simulation has become widespread. One development, the adaptation of simulation techniques and manikin technologies for portable operation, is starting to impact the training of personnel in acute care fields such as emergency medicine (EM) and trauma surgery. Unencumbered by cables and wires, portable simulation programs mitigate several limitations of traditional (nonportable) simulation and introduce new approaches to acute care education and research. Portable simulation is already conducted across multiple specialties and disciplines. In situ medical simulations are those carried out within actual clinical environments, while off-site portable simulations take place outside of clinical practice settings. Mobile simulation systems feature functionality while moving between locations; progressive simulations are longer-duration events using mobile simulations that follow a simulated patient through sequential care environments. All of these variants have direct applications for acute care medicine. Unique training and investigative opportunities are created by portable simulation through four characteristics: 1) enhancement of experiential learning by reframing training inside clinical care environments, 2) improving simulation accessibility through delivery of training to learner locations, 3) capitalizing on existing care environments to maximize simulation realism, and 4) provision of improved training capabilities for providers in specialized fields. Research agendas in acute care medicine are expanded via portable simulation's introduction of novel topics, new perspectives, and innovative methodologies. Presenting opportunities and challenges, portable simulation represents an evolutionary progression in medical simulation. The use of portable manikins and associated techniques may increasingly complement established instructional measures and research programs at acute care institutions and simulation centers. [source]

A systematic review of the use of simulated patients and pharmacy practice research

Evaluation of accuracy and variability of scoring-area-based plaque indices

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 1 2000
A laboratory model
Abstract Background: Plaque scoring, using a variety of indices and methods, is widely used in clinical dentistry. There is limited information on inter- and intra-examiner variability and almost no data on examiner accuracy. Aims: The aim of this study, was to determine the inter- and intra-examiner variability and accuracy of 15 examiners, of differing plaque-scoring experience, in recording and judging plaque areas from simulated plaque on tooth charts. Methods: Plaque, shaded red, was drawn onto tooth charts of 8 simulated "patients" and measured by planimetry by 1 investigator. For each tooth for each "patient", examiners subjectively copied the plaque onto blank charts and scored plaque in 5% increments for the global plaque index. This was repeated on 2 occasions. Drawn plaque areas were determine by the investigator and comparisons made with the actual areas and % scores of plaque. Results: For both plaque recording methods, intra-examiner variability was low and slighly better than inter-examiner variability. Reproducing plaque areas showed a high level of accuracy in most examiners, as was judging areas in 5% increments, albeit slightly less accurate than area drawing. Overall examiner experience had little influence on judging plaque areas. Conclusion: The data suggest that area-based plaque indices can be scored or recorded accurately and with minimal variability within or between examiners. The laboratory model could be used to train and assess examiners. [source]

Does patient feedback improve the consultation skills of general practice trainees?

MEDICAL EDUCATION, Issue 2 2010
A controlled trial
Medical Education 2010:44: 156,164 Context, This study aimed to assess if an additional patient feedback training programme leads to better consultation skills in general practice trainees (GPTs) than regular communication skills training, and whether process measurements (intensity of participation in the programme) predict the effect of the intervention. Methods, We carried out a controlled trial in which two sub-cohorts of GPTs were allocated to an intervention group (n = 23) or a control group (n = 30), respectively. In 2006, allocated first-year GPTs in the VU University Medical Centre attended a patient feedback training programme in addition to the regular communication skills training. The control group attended only regular communication skills training. Trainees were assessed by simulated patients who visited the practices and videotaped the consultations at baseline and after 3 months. The videotapes were randomly assigned to eight trained staff members. The MAAS-Global Instrument (range 0,6) was used to assess (a change in) trainee consultation skills. Results were analysed using a multi-level, linear mixed-model analysis. Results, Data on 50 GPTs were available for the follow-up analysis. Both intervention group and control group GPTs improved their consultation skills: mean MAAS-Global scores for all participants were 3.29 (standard deviation [SD] 0.75) at baseline and 3.54 (SD 0.66) at follow-up (P = 0.047). The improvement in MAAS-Global scores in the intervention group did not differ significantly from the improvement in the control group. The analysis showed a trend for intensity of participation in the patient feedback programme to predict greater improvement in MAAS-Global scores. Discussion, Although the baseline scores were already in the high range, consultation skills in both groups improved significantly. This is reassuring for current teaching methods. The patient feedback programme did not improve consultation skills more than regular communication skills training. However, a subgroup of GPTs who participated intensively in the programme did improve their consultation skills further in comparison with the less motivated subgroup. [source]

Use of an innovative video feedback technique to enhance communication skills training

Comparison of methods for teaching clinical skills in assessing and managing drug-seeking patients

MEDICAL EDUCATION, Issue 4 2000
Taverner
Aims New medical graduates lack clinical skills in assessing and managing patients seeking drugs of dependence. This study compares the effectiveness of three different clinical skills training methods, with similar content, which were developed to teach these skills to senior medical students. Methods A preliminary survey indicated that common problems seen by primary care practitioners included both new and previously known patients seeking either benzodiazepines or opiates. The common content of the teaching was determined from this survey. A didactic small group tutorial (DT), a video-based tutorial (VBT) using professional actors, and a computer-aided instruction package using digitized video (CAI) were developed with this common content, and trialled with undergraduate medical students over 2 years in a parallel-group design. Outcome was assessed by student feedback, performance on a case-based written examination and by a structured evaluation of interviews with simulated patients requesting drugs. Comparison was also made between methods on the basis of knowledge tests. Results No difference was seen in written examination and simulated patient outcomes between the three groups. However, the VBT was thought by the students to be preferable to other methods. The estimated development costs of CAI were higher, but total costs over a 6-year period were lower than for the DT and VBT. The results suggest that clinical skills can be taught equally effectively through several different methods. Collaboration between institutions in the development of widely applicable CAI tools should be an efficient and economical mode of teaching with a wide range of applications. [source]

Discussing sexuality in the clinical setting: The impact of a brief training program for oncology health professionals to enhance communication about sexuality

ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 4 2009
Amanda HORDERN
Abstract Aim: Cancer and its treatments can profoundly affect a person's sexuality and self-image. However, oncology health professionals (OHP) are often reluctant to discuss these issues with patients. Cancer Council Victoria developed a short workshop to increase OHP's discussion of sexuality issues with cancer patients. We examined the immediate and longer term effect of workshop participation on perceived barriers to these discussions, their confidence in initiating the discussions, and changes in the frequency of their discussing sexuality issues with patients. Method: Twenty-one workshops were conducted involving 155 OHP. The workshops were run by trained facilitators and incorporated cognitive, behavioral and experiential components. A major part of the workshop involved role-playing with simulated patients (trained actors). Questionnaires assessing 20 perceived barriers, seven confidence items and seven practices concerning sexuality discussion were completed by the participants pre-workshop, immediately post-workshop, and 8-weeks post-workshop. Results: Overall 89 participants completed all three assessment phases. Data were analysed to assess change in perceived barriers, confidence and behavior across the three assessment points. Mean scores on 16 of the 20 barriers significantly decreased and scores on all seven confidence measures significantly increased between pre- and immediate post-workshop. Most these changes were maintained 8 weeks later. The mean frequency of sexuality issue discussion in the previous 2 months increased significantly from 3.34 times at pre-workshop to 3.82 times 8 weeks later (P = 0.003). Conclusion: This workshop appeared to reduce perceived barriers, increase confidence and increase actual practices around discussing sexuality issues with cancer patients. [source]

Teaching Mass Casualty Triage Skills Using Immersive Three-dimensional Virtual Reality

ACADEMIC EMERGENCY MEDICINE, Issue 11 2008
Dale S. Vincent MD
Abstract Objectives:, Virtual reality (VR) environments offer potential advantages over traditional paper methods, manikin simulation, and live drills for mass casualty training and assessment. The authors measured the acquisition of triage skills by novice learners after exposing them to three sequential scenarios (A, B, and C) of five simulated patients each in a fully immersed three-dimensional VR environment. The hypothesis was that learners would improve in speed, accuracy, and self-efficacy. Methods:, Twenty-four medical students were taught principles of mass casualty triage using three short podcasts, followed by an immersive VR exercise in which learners donned a head-mounted display (HMD) and three motion tracking sensors, one for their head and one for each hand. They used a gesture-based command system to interact with multiple VR casualties. For triage score, one point was awarded for each correctly identified main problem, required intervention, and triage category. For intervention score, one point was awarded for each correct VR intervention. Scores were analyzed using one-way analysis of variance (ANOVA) for each student. Before and after surveys were used to measure self-efficacy and reaction to the training. Results:, Four students were excluded from analysis due to participation in a recent triage research program. Results from 20 students were analyzed. Triage scores and intervention scores improved significantly during Scenario B (p < 0.001). Time to complete each scenario decreased significantly from A (8:10 minutes) to B (5:14 minutes; p < 0.001) and from B to C (3:58 minutes; p < 0.001). Self-efficacy improved significantly in the areas of prioritizing treatment, prioritizing resources, identifying high-risk patients, and beliefs about learning to be an effective first responder. Conclusions:, Novice learners demonstrated improved triage and intervention scores, speed, and self-efficacy during an iterative, fully immersed VR triage experience. [source]