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Students' views on the use of real patients and simulated patients in undergraduate medical education.

Purpose To determine students’ views about the strengths and weaknesses of real patient interactions as opposed to simulated patient (SP) interactions in the undergraduate medical curriculum in order to evaluate how their strengths can be optimally used and weaknesses remedied. Method Five focus-group interviews were conducted among fourth- and fifth-year medical students at Maastricht University in 2007, using a preestablished interview guide. The interviews were recorded, transcribed, and analyzed using qualitative methods. Results In general, the 38 participants considered real patient encounters more instructive and more authentic than SP encounters. However, students identified several strengths of SP encounters compared with real patient encounters. For example, SP interactions were helpful in preparing students for real patient interactions (particularly with regard to communication skills and self-confidence), in the teaching of “intimate” physical examination skills, such as gynecological examination skills, and in giving constructive feedback on communication skills. In contrast to what we had anticipated, taking a time-out was considered easier in real patient interactions. Conclusions Both real patient interactions and SP interactions are considered indispensable to undergraduate medical education. Each encounter has unique strengths and weaknesses from the perspectives of students. On the basis of strengths and weaknesses that were identified, suggestions were made for the use of real patients and SPs in undergraduate medical education.

Feedback by simulated patients in undergraduate medical education: a systematic review of the literature.

Objectives  Although the importance of feedback by simulated patients (SPs) is generally recognised, knowledge is scarce about the most effective ways in which SPs can provide feedback. In addition, little is known about how SPs are trained to provide feedback. This study aimed to provide a systematic overview of the ways in which SPs provide feedback to undergraduate medical students, the domains in which SPs provide feedback and the ways in which SPs are trained to provide feedback.

Unannounced standardised patients in real practice: a systematic literature review.

Background No attempt has been made to give a systematic overview of the innovative use of unannounced or incognito standardised patients.

Strengths and Weaknesses of Simulated and Real Patients in the Teaching of Skills to Medical Students: A Review

The aim of this review was to identify the strengths and weaknesses of the roles of real and simulated patients in undergraduate medical education. The literature was reviewed in relation to four patient roles: real patients as educational “resource” (passive role), real patients as teachers (active role), and simulated patients as educational resource and teachers. Each of the four patient roles was found to have specific advantages and disadvantages from the perspectives of teachers, students, and patients. For example, advantages of real patients as educational resource were patient-centered learning and high patient satisfaction. Disadvantages were their limited availability and the variability in learning experiences among students. Despite the considerable amount of literature we found, many gaps in knowledge about patient roles in medical education remain and should be addressed by future studies.

Performance-related stress symptoms in simulated patients

Introduction  During the first 4 years of the 6‐year undergraduate medical curriculum at Maastricht University, the Netherlands, students practise clinical skills in simulated patient (SP) encounters at the Skillslab. Generally, these encounters are instructive and enjoyable for both students and SPs. However, in conversations with SP trainers, some SPs have mentioned experiencing adverse symptoms due to performing a patient role. Some published studies have reported similar findings in SPs. We explored the seriousness of this problem by surveying SPs on the occurrence and severity of stress symptoms related to performing patient roles. We also examined by which variables the symptoms were influenced.

The impact of simulation on people who act as simulated patients: a focus group study

Objective  Previous studies have shown that people who act as simulated patients (SPs) experience negative effects caused by performing patient roles. This study was performed to further explore the impact of simulation and the factors that might affect this impact. The aim was to find ways of preventing negative effects of simulation impacting on our SPs.

Lessons learned from an adolescent simulated patient educational program: Five years of experience

Background: The use of adolescents as standardized patients (SPs) in medical education has scarcely been reported. We evaluated the views of teachers, students and adolescent SPs with regard to the adolescent SP program in our undergraduate curriculum and the changes that were made to the program in the past five years (from 2002–2003 until 2006–2007). Method: Adolescent girls were recruited to portray roles of adolescents asking their general practitioner for an oral contraceptive. Students rated the quality of the adolescent SPs? role performance and feedback on a validated questionnaire (the MaSP). Both adolescent SPs and faculty teachers completed questionnaires on their experiences. Results: Over the past five years, 201 to 341 students gave the adolescent SPs? general performance a mean mark that varied from 7.5 to 8 out of 10. Generally, evaluations by teachers and adolescent SPs about the adolescent SP program were also very positive. The quality of the feedback by adolescent SPs has shown improvement over the past five years, although adolescents find it quite difficult to give feedback. Conclusions: Teachers, students and adolescent SPs have highly valued the adolescent SP program over the past five years. The program has been changed on the basis of the lessons learned and has become mature.

The longitudinal simulated patient program: evaluations by teachers and students and feasibility

Objective: Simulated patients (SPs) are mostly used in single-case encounters. However, for chronic care training longitudinal patient encounters are more suitable. Evaluations of students and teachers regarding a new, longitudinal SP program were explored and compared to the single-case SP program. Furthermore, the feasibility of the program was explored. Methods: Year 3 students participating in the longitudinal SP program (N = 272) had four encounters with the same SP portraying a chronic health problem in eight months. Student evaluations regarding the longitudinal SP program were assessed with a validated questionnaire (the MaSP) and both teachers and students completed another questionnaire on their views. Results: In general, students and teachers were positive about the longitudinal SP program. We found no differences between student evaluations regarding the longitudinal SP program and those regarding the single-case SP program. The longitudinal SP program appeared not to be feasible because of uncooperative faculty staff and the workload. Conclusions: Students consider the longitudinal SP program as good as the single-case SP program. In its current form the longitudinal SP program appeared not to be feasible. Further research is needed in our search for an instructive, enjoyable and feasible SP program to teach students about continuity of care.

Return visits by simulated patients

(P = 0.018), and taking informed consent (P = 0.018). Structured interviews with interns revealed the programme had a definite impact in terms of improving their communication skills, and that the peer review process was an enjoyable and valuable learning experience. All faculty and SPs expressed interest in continuing the programme. The experience suggests that this intervention could be extended to all interns on the surgical rotation. This will pave the way for the introduction of a formal curriculum on communication skills throughout the undergraduate programme.

“Het moet wel een simulatie blijven.” Een onderzoek naar echte klachten bij simulatiepatiënten

Inleiding: In het Skillslab van de Faculteit der Geneeskunde van de Universiteit Maastricht wordt veel gebruik gemaakt van het leermiddel simulatiepatienten. Dit gebeurt met veel plezier voor de student en de simulatiepatient. In contacten met medewerkers van het Skillslab geven simulatiepatienten echter ook wel aan negatieve ervaringen te hebben met het optreden als simulatiepatient. Ook in de literatuur is beschreven dat simulatiepatienten last kunnen hebben van klachten na het spelen van een patientenrol. We hebben daarom onderzocht in hoeverre ook onze simulatiepatienten door het spelen van een rol last of hinder ondervinden van bepaalde klachten.