Academic Psychiatry | 2019
Preclinical Medical Student Attitudes Toward Use of Psychiatry Residents as Actors in a Suicide and Violence Risk Assessment Simulation Activity
Abstract
It is important to prepare medical students for the transition to clinical work during their preclinical years and to transform classroom knowledge into clinical skills. Suicide and violence risk assessment is an essential clinical skill that is infrequently taught deliberately in medical education [1]. Experience working with real patients at risk of suicide or violence is critical to gain during clinical years and difficult to gain during preclinical years. When teaching broad psychiatry concepts, simulation offers the advantages of being logistically and economically convenient and more predictable and poses less risk of harm done to real patients [2]. Simulation training can be an effective modality to prepare students for analogous clinical scenarios [3]. Other studies describing simulation-based skills training in mental health care have shown some success in developing clinical skills in psychiatry, including managing agitated patients [4], assessing psychiatric illness [5], engaging in empathic communication [6, 7], and delivering bad news [8]. These activities often involve use of standardized patients. Use of standardized patients to depict psychiatric diagnoses can be problematic because they are attempting to portray complex and unpredictable illness in a way that can be inauthentic [2]. Actors may have little experience portraying mental illness. Psychiatric residents, on the other hand, have a breadth of clinical experience that trained actors typically do not have. Psychiatric residents have interacted with many patients with mental illness during their training. They also have the advantage of understanding the experience of the medical student and what may be helpful to prepare the student for the specific clinical challenge of risk assessment. The authors developed a simulation experience to teach suicide and violence risk assessment in the second-year medical student Brain and Behavior course at the University of Utah School of Medicine using psychiatry trainees as actors. The authors hypothesized that preclinical medical students would perceive the resident portrayal as important to the experience. The authors also wanted to provide preclinical students an early opportunity to practice interacting with patients with whom they may not readily develop rapport in an enjoyable clinical learning activity. There are no other published works that employ psychiatry residents in simulating patients to teach suicide and violence risk assessment in the preclinical medical student curriculum.