Creating authentic simulated patient roles: working with volunteers

Abstract

Context and setting The use of simulated patients (SPs) in medical education is widespread and increasing. These ‘patients’ are valued for many reasons, including their ability to bring patient perspectives to the forefront of student learning. Although SPs bring their own expertise to the encounter, their value is in part dependent on the patient roles they are asked to play. We wanted to generate new SP roles quickly and efficiently and ensure a real patient perspective was offered. Why the idea was necessary Writing roles for SPs can be time-consuming. Although we use a range of approaches, real patients are rarely included in the process. Roles are usually constructed by faculty staff (clinicians and educators) and do not necessarily represent the views of real patients. There are many published examples of discrepancies between clinician and patient experiences of health care. Unless real patients are involved in the process, we are not really in a position to claim authenticity. What was done We invited volunteers from our local community to complete a template for SP roles. Volunteers were asked to respond in relation to the last time they went to a general practitioner and to frame their answers in relation to what they were experiencing at that time. That is, they were asked to give, from their perspective: reason(s) for the consultation; ideas about what was wrong; what they were most concerned about; what they thought the doctor could do; their medical and social history, and their attitude towards the health care service and how they might respond to specific clinician behaviours. All information was anonymised. Evaluation of results and impact A total of 21 roles were produced by 15 female and six male volunteers, aged 17–90 years (mean age = 37.5 years) within 1 week, which quickly expanded our bank. Volunteers recorded a range of acute (e.g. rash, painful swollen knee, sore throat), chronic (e.g. insomnia, lumps, tiredness), multiple pathologies and health-seeking behaviours (e.g. loss of weight, fitness, smoking cessation). We do not know if the information submitted by volunteers is authentic. However, after reviewing roles we became aware of our limitations as faculty in constructing such diverse roles. This was manifested by the volunteers’ use of language to describe their symptoms, their understanding of medical concepts, the names they used for drugs, their priorities in presenting information to the clinician and their expectations of treatment. As faculty, it is challenging to construct roles from the perspectives of a new migrant Ethiopian teenager with little confidence in her spoken English, or a 48-year-old man whose only means of mobility is a wheelchair. Where lay people are willing and able to contribute to medical education by sharing their personal experiences, we should seek ways to tap this input. We easily met our initial goal and the experience has challenged us to think critically and creatively about other ways of including real patients in the development of educational materials, although we recognise there are limitations.