Simulated patient/Parent in teaching communication skill

1. Simulated patient/Parent in teaching communication skill Prof. Pushpa Raj Sharma

2. The golden age • “ for the junior student in medicine and surgery it is a safe rule to have no teaching without a patient for a text, and the best teaching is that taught by patient himself” William Osler, 1905 Osler W. The hospital as a college. ChapterXVI In: Acquaminates, and Other Addresses. London: HK Lewis, 1905

3. Present crowd “ if musicians learned to play their instruments as physicians learn to interview patients, the procedure would consist of presenting in lectures or maybe in a demonstration or two the theory and mechanism of the music producing ability of the instrument and telling him to produce a melody. The instructor of course , would not be present to observe or listen to the student’s efforts, but would be satisfied with the student’s verbal report of what came out of the instrument” George Engel, after visiting 70 medical schools in North America

4. Teaching bedside clinical medicine :present scenario specially in paediatrics • Three months time • Two dozen student • Ethical • Parents concern

7. Brief contact Passive role Time limited Inexperienced Unplanned encounter Real situation Unknown patient Prolonged contact Active role Time committed Experienced Planned encounter Simulated situation Known patient The two options

8. Undifferentiated problem General Particular focus Patient fear Hidden attitudes Defined problem Specific Known focus Friendly Revealed attitudes The two choice

9. Crowded ward Sitting arrangement Service oriented Patient culture Teaching room Educative arrangement Teaching / learning oriented Student culture Two places

10. Alternatives • More months • Less students • Simulated patients / parents • Manikins • Computerized

15. 2005 In 2005 Department of Child Health, IOM Introduced simulated parent for pediatric history taking.

16. What is simulated patient / parent (SPs)? • Simulated Patient is an individual "who has been trained to accurately recreate the history, personality, emotional structure, responses and physical findings of an actual patient." (Barrows, 1971) • Standardized Patients are individuals trained to present a clinical problem in a reproducible manner. (Barrows, 1971; Stillman, 1987)

17. Advantage of Simulated patient/parent. • SPs are used for various educational experiences throughout the Medical school. • They are an important resource in bridging the gap between lectures and practical applications

18. What they can teach? • Interviewing/History Taking • Physical Examination • Interpersonal skills • Patient Education/Counseling

19. Knowledge of: who is a SP ? Motivation for wanting to be a SP Communication skills Comprehension skills Ability to perform a case Availability for participation Ability to complete a checklist Who can be a simulated parent / patient?

20. SPs are selected to perform cases based upon the following: • Case-specific requirements • Availability for training and performance • Ability to accurately and consistently portray the case • Reliability • Ability to understand the goals of the case

21. Pneumonia, arthritis

24. Howard Barrows’ creation of the first standardized patient. • In the absence of observation and feedback, errors could persist. • Patient description: hostile and performed uncomfortable examination. • Film did not include elements of observation and feedback.

25. Simulated parents/patients • Case specific • Convenience • Safe practice • Ethical • compression/expansion time • Efficient use of faculty / students time

26. Simulated parents/patients • Clinical competence is highly specific • Can ensure broad exposure to a variety of cases. • Allows direct comparison of students clinical skill. • Students weakness and strengths.

27. What it should contain? • Carefully screened and trained. • Global and checklist ratings. • Avoid personal agenda. • Incentives

28. Opening the history: • Patient centered communication • Talking with patients • Non verbal communication • Adherence in the doctor-patient relationship • Cross cultural communication

29. Specific concerns • Lack of opening skills: poor eye contact, not introducing self, not making sure patient was comfortable, no introducing Namaste. • Lack of engagement skills: no open ended questions, taking notes of every statement, rapid fire yes or no questions, overuse of medical jargons.

30. Specific concerns: • Lack of empathy skills: poor nonverbal communication (both arm in pocket, loud commanding voice, standing, all instruments, pen, paper in the bed), no acknowledgement of patients information. • The closing: abrupt without thanking and what happens next.

31. Your department: • Identify dedicated faculty. • Determine time, cost, facility. • Determine the needed skill • Allot skill to different faculty • Identify the other non medical or paramedical staff for simulated patient • Develop a simulated patient bank. • Provide feed back.

32. Actors briefing: • You are a father of 1 yr old son. Afraid of coming to hospital. You have observed runny nose and cough for 3 days. Your son was treated by a faith healer without improvement. • You are from village. You are a farmer. Poor sanitary practices. Home delivery. No immunization. Smoke, domestic smoke pollution, not enough food. Three other children: three girls: yrs 2, 4, 6.

34. Now we will see a video clip of a simulated parent

35. This presentation is freely available on prsharma.com.np