Comparison of effect between simulated patient clinical skill training and student role play on objective structured clinical examination performance outcomes for medical students in Australia.

Silas Taylor,Boaz Shulruf,Matthew Haywood

doi:10.3352/jeehp.2019.16.3

Abstract

PurposeOptimal methods for communication skills training (CST) are an active research area, but the effects of CST on communication performance in objective structured clinical examinations (OSCEs) has not been closely studied. Student roleplay (RP) for CST is common, although volunteer simulated patient (SP) CST is cost-effective and provides authentic interactions. We assessed whether our volunteer SP CST program improved OSCE performance compared to our previous RP strategy. MethodsWe performed a retrospective, quasi-experimental study of 2 second-year medical student cohorts’ OSCE data in Australia. The 2014 cohort received RP-only CST (N=182) while the 2016 cohort received SP-only CST (N=148). The t-test and analysis of variance were used to compare the total scores in 3 assessment domains: generic communication, clinical communication, and physical examination/procedural skills. ResultsThe baseline characteristics of groups (scores on the Australian Tertiary Admission Rank, Undergraduate Medicine and Health Sciences Admission Test, and medicine program interviews) showed no significant differences between groups. For each domain, the SP-only CST group demonstrated superior OSCE outcomes, and the difference between cohorts was significant (P<0.01). The superiority of volunteer SP CST over student RP CST in terms of OSCE performance outcomes was found for generic communication, clinical communication, and physical examination/procedural skills. ConclusionThe better performance of the SP cohort in physical examination/procedural skills might be explained by the requirement for patient compliance and cooperation, facilitated by good generic communication skills. We recommend a volunteer SP program as an effective and efficient way to improve CST among junior medical students.

Highlights

The results showed that the 2016 cohort was not statistically significantly different from the 2014 cohort in terms of the results of selection tools, with the exception of Undergraduate Medicine and Health Sciences Admission Test (UMAT) scores, which were lower for the 2016 cohort than for the 2014 cohort (62.61 versus 64.39)
objective structured clinical examinations (OSCEs) scores grouped by domain and overall score were significantly higher for the 2016 cohort compared to the 2014 cohort (Table 3)
A simple, transparent statistical analysis indicated that despite the 2016 cohort scoring lower on the UMAT (P = 0.014) and Australian Tertiary Admission Rank (ATAR), they performed better on the OSCE, a finding that further strengthens our assertion regarding the impact of simulated patient (SP)

Summary

Introduction

Are generally augmented by experiential learning approaches to CST, with medical programs tending to employ real patients, simulated patients (SPs), and student roleplay (RP) in various combinations for this purpose; the mix of techniques is determined by factors including the educational stage and needs of the student and resource availability [3]. The available evidence suggests that these methods are equivalent for teaching certain communication skills [4,5,6], RP may be superior to SP in fostering empathy for patient perspectives because RP inherently requires students to assume the patient perspective [4]. A well person playing the role of a patient for the purpose of students learning clinical skills in controlled circumstances (namely, an SP) offers a potentially more acceptable approach to CST by providing students with objective feedback on their performance [1]. SP programs utilising volunteers have been proposed as a more sustainable means to achieve the same teaching outcomes, and have been shown to be effective educationally to RP [11]

Methods

Results

Conclusion