Simulated Interviews Research Articles

Incorporating Simulation-Based Education Into Stroke Training.

Incorporating Simulation-Based Education Into Stroke Training.

Mindfulness Improves Otolaryngology Residents’ Performance in a Simulated Bad-News Consultation: A Pilot Study

Delivering bad news is a stressful moment for both patient and clinician. As poor bad-news consultation quality may lead to misunderstandings, lack of treatment adherence, acute or even post-traumatic stress in patients, training interventions to improve communication skills and stress-management are necessary. Mindfulness is a recognised stress-management strategy that has shown its efficacy in reducing stress in both health professionals and students. We then supposed that a short mindfulness meditation session performed just before a simulated breaking bad-news consultation to patients with laryngeal cancer may help ear, nose and throat (ENT) residents to master their stress and improve their management of this consultation. This study aims at showing how a short mindfulness meditation performed before a simulated bad-news consultation may improve performance in its realisation by ENT residents. We enrolled 53 ENT residents, randomised in 2 groups. The first group completed a 5-minute mindfulness session while the other group listened to a control track. Thereafter, every resident completed an 8-minute simulated bad-news consultation with a standardised patient. Two blinded expert assessors evaluated their performance on a 25-point grid (BNC-OSAS). Residents self-assessed their stress before and after the intervention and simulated patients rated their perception of physician's empathy. The performance was significantly better in the mindfulness group than in the control group (m = 19.8, sd = 3.2 and m = 17.4, sd = 3.7 respectively, F(1,45)=5.27, p = 0.026, d = 0.67), especially in the communication and knowledge subdomains. There was no significant difference in perceived stress between the 2 groups. Empathy perceived by simulated patients was positively correlated to residents' performance. A short mindfulness meditation is effective for improving ENT residents' performance in a simulated bad-news consultation. These results encourage further assessments of this method with objective measures of physiological stress. More research is required concerning the feasibility and efficacy of mindfulness before daily clinical activities such as stressing bad-news consultation.

Integration of Technology in Medical Education on Primary Care During the COVID-19 Pandemic: Students' Viewpoint.

The COVID-19 pandemic has forced medical schools and clinicians to transition swiftly to working online, where possible. During this time, final-year medical students at King’s College London, England, have received some of their general practice teachings in the form of virtual tutor groups. The predominant feature of such groups is online patient simulations, which provide students a valuable experience to help gain insight into current clinical practice amid the pandemic and inform how their practices as incoming junior doctors would continue. Even in the absence of face-to-face teaching and clinical placements, students have been able to hone their medical knowledge and soft skills through these virtual, simulated consultations. They have been exposed to a new consultation style while in a safe and collaborative learning space. Here, we explore how medical students have benefited from these virtual tutor groups and how similar small-group online teaching opportunities can add value to the medical curriculum in the future.

Nurse Training in Gender-Based Violence Using Simulated Nursing Video Consultations during the COVID-19 Pandemic: A Qualitative Study.

Gender-based violence (GBV) is a serious global public health problem that becomes aggravated during public health emergencies that involve quarantine measures. It is important to train nursing students on GBV, especially in vulnerable situations, such as the current COVID-19 pandemic. The purpose of our study is to explore the perceptions of third-year nursing students about simulated nursing video consultations for providing assistance to potential cases of GBV victims using a high-fidelity clinical simulation methodology. After all of the simulated scenarios were completed, 48 scripted interviews were carried out following a guide composed of four open-ended questions to facilitate in-depth discussion. A descriptive qualitative study based on the interpretative paradigm was conducted. The nursing students indicated that they improved their knowledge on GBV victim management (mainly their awareness of the problem, recognition of the role of nursing professionals, and performance of non-technical skills), although they also mentioned the need for continuous training (particularly in socio-emotional skills, interview techniques, a holistic nursing care approach, and not presupposing). This innovative high-fidelity simulation methodology allows nursing students to improve their awareness of the GBV problem, acquire a realistic view about their role in addressing GBV, and build their non-technical skills (such as active listening, communication skills, empathy, and generating confidence) required to adequately care for victims of GBV.

Letter to the Editor: Distant surgical teaching during COVID‐19 ‐ A pilot study on final year medical students

Letter to the Editor: Distant surgical teaching during <scp>COVID</scp>‐19 ‐ A pilot study on final year medical students

Holding a mirror up to nature: the role of medical humanities in postgraduate primary care training

ABSTRACT The humanities are academic disciplines that study aspects of human society, experience and culture. Typically, the humanities, including philosophy, literature, art, music, history and language have been used to interpret and record our understanding of the world. In recent decades, the humanities have seen somewhat of a renaissance within medicine, particularly within undergraduate medical education. This leading article explores the value of utilising medical humanities, such as art, poetry and theatre, within postgraduate primary care training. Using examples of approaches already interwoven into the fabric of undergraduate medical education, such as simulated patient consultations and anatomical body painting, the tangible benefits of applying humanities disciplines within general practice training are discussed. The humanities have much to offer from the value of utilising an artistic lens to examine the body, the creation of socially cohesive working environments and supporting the development of empathy within trainees. This article recommends the provision of both increased informal and formal engagement with the medical humanities within postgraduate primary care training, providing practical tips for GP educators looking to integrate the humanities within pre-existing tutorials.

Simulated Video Consultations as a Learning Tool in Undergraduate Nursing: Students' Perceptions.

Simulated video consultations, a teaching tool based on high-fidelity simulations, were implemented in response to the necessary adaptation of high-fidelity clinical simulation sessions to the online or virtual modality during the university closure due to the COVID-19 confinement. The purpose of our study was to explore the undergraduate nursing students’ satisfaction and perceptions about simulated video consultations using the high-fidelity simulation methodology. A mixed-method was utilized with 93 undergraduate nursing students using a validated satisfaction questionnaire (quantitative data), which included an observations section (qualitative data). Of the total sample, 97.8% of the students expressed a high overall satisfaction with simulated video consultations, highlighting their practical utility and positive learning outcomes. From the students’ comments, two main themes and their related categories emerged: advantages (satisfaction and enjoyment, learning, and calmness during simulated scenarios), and disadvantages (technical issues and technical skills development). Simulated video consultations may be considered as one more high-fidelity simulation teaching option. Nursing students should be trained in this modality of healthcare to face the challenge brought on by its increased use in healthcare services, beyond the specific adaptation of clinical simulation sessions due to the closure of universities during this pandemic.

A randomised controlled trial of feedback to improve patient satisfaction and consultation skills in medical students

BackgroundThe use of feedback has been integral to medical student learning, but rigorous evidence to evaluate its education effect is limited, especially in the role of patient feedback in clinical teaching and practice improvement. The aim of the Patient Teaching Associate (PTA) Feedback Study was to evaluate whether additional written consumer feedback on patient satisfaction improved consultation skills among medical students and whether multisource feedback (MSF) improved student performance.MethodsIn this single site, double-blinded randomised controlled trial, 71 eligible medical students from two universities in their first clinical year were allocated to intervention or control and followed up for one semester. They participated in five simulated student-led consultations in a teaching clinic with patient volunteers living with chronic illness. Students in the intervention group received additional written feedback on patient satisfaction combined with guided self-reflection. The control group received usual immediate formative multisource feedback from tutors, patients and peers. Student characteristics, baseline patient-rated satisfaction scores and tutor-rated consultation skills were measured.ResultsFollow-up assessments were complete in 70 students attending the MSF program. At the final consultation episodes, both groups improved patient-rated rapport (P = 0.002), tutor-rated patient-centeredness and tutor-rated overall consultation skills (P = 0.01). The intervention group showed significantly better tutor-rated patient-centeredness (P = 0.003) comparing with the control group. Distress relief, communication comfort, rapport reported by patients and tutor-rated clinical skills did not differ significantly between the two groups.ConclusionsThe innovative multisource feedback program effectively improved consultation skills in medical students. Structured written consumer feedback combined with guided student reflection further improved patient-centred practice and effectively enhanced the benefit of an MSF model. This strategy might provide a valuable adjunct to communication skills education for medical students.Trial registrationAustralian New Zealand Clinical Trials Registry Number ACTRN12613001055796.

Simulated Nursing Video Consultations: An Innovative Proposal During Covid-19 Confinement

BackgroundIn response to the closure of universities and the canceling of in-person classes due to the COVID-19 pandemic, this study was designed to focus on a solution for adapting simulation-based education to this situation. MethodA mixed study was conducted to analyze nursing students’ satisfaction and perceptions (n = 48) about simulated nursing video consultations. ResultsNursing students expressed a high level of satisfaction and positive perceptions about this innovative proposal. ConclusionsSimulated nursing video consultations could be considered as another choice of high-fidelity simulation not only in the current COVID-19 situation, but its use could be extended to other contexts.

Acceptability and usability of a mobile application for management and surveillance of vector-borne diseases in Colombia: An implementation study.

Vector-borne diseases are a public health problem in Colombia, where dengue virus infection is hyperendemic. The introduction of other arboviruses, such as chikungunya and Zika in the last three years, has aggravated the situation. Mobile health (mHealth) offers new strategies for strengthening health care and surveillance systems promoting the collection, delivery, and access of health information to professionals, researchers, and patients. Assessing mobile application performance has been a challenge in low- and middle-income countries due to the difficulty of implementing these technologies in different clinical settings. In this study, we evaluate the usability and acceptability of a mobile application, FeverDX, as a support tool in the management of patients with febrile syndrome and suspected arboviruses infection by general practitioners from Colombia. A pilot implementation study was conducted to evaluate the usability and acceptability of FeverDX using the modified version of the Mobile Application Rating Scale (uMARS). The evaluation form included 25 questions regarding quantity and quality of information, engagement, functionality, aesthetics, impact, and acceptability by healthcare workers. Each item uses a 5-point scale (1-Inadequate, 2-Poor, 3-Acceptable, 4-Good, 5-Excellent). A global score was obtained for the evaluation form test by determining the median scores of each subsection. A descriptive statistical analysis of the data obtained was performed. Between December 2016 and January 2017, a total of 20 general practitioners from the Emergency room and hospitalization areas evaluated FeverDX. Less than half (9/20) of the evaluators had a comprehensive knowledge of the Colombian Ministry of Health's guidelines for the diagnosis and management of arboviruses, and evaluators partially (4/9) or completely (5/9) agreed that the content of the application follows the management guidelines. On uMARS scale, FeverDX excelled regarding impact (median 5; IQR = 5-5), functionality (median 5; IQR = 4.8-5), and information and scientific basis (median 4; IQR = 4-4). FeverDX scored well regarding user feedback (median 4; IQR = 4-4.5), design and aesthetics (median 4; IQR = 4-4.3), and subjective assessment of quality (median 4.5; IQR = 4.3-4.8). FeverDX, a mobile application, is a novel mHealth strategy to strengthen care processes and facilitate the detection and reporting of notifiable surveillance diseases. It could improve adherence to clinical practice guidelines for the management and prevention of prevalent diseases as arboviruses in healthcare settings. Although this pilot study used a small sample size, FeverDx performed adequately in a simulated emergency consultation. Further implementation studies are needed to increase the reliability of mHealth technologies in different scenarios.

Patient autonomy in the consultation: How signalling structure can facilitate patient-centred care

ObjectiveTo identify types and functions of doctors’ verbal signalling behaviours used to share consultation structure with patients. MethodDoctors’ verbal utterances signalling what would happen in the consultation were identified by two independent raters from transcripts of 78 simulated consultations from a postgraduate examination for physicians. In total, 974 behaviours were categorised as informing, inviting or instructing. Principles adopted from Speech Act Theory and Conversation Analysis were used to examine their function from their literal meaning and use in context. ResultsSignalling behaviours to inform were most frequent, particularly ‘signposts’, with less informative signalling behaviours also found (‘posts without signs’ and ‘signs without posts’). Behaviours to invite involvement offered limited choice. Doctors also instructed the patient in what to do (behaviour) or not to do (emotion). Behaviours signalled more ‘micro-level’ changes than broader consultation aims. Signalling behaviours carried roles beyond their literal meaning (‘hyperfunctions’) and were combined (‘stacked’), often seen deflecting the conversation away from patient concerns. ConclusionDoctors use a variety of verbal signalling behaviours with multiple functions. As well as sharing information, these behaviours regulate patient agency in the consultation. Practice implicationsDoctors’ signalling behaviours may play an important role in facilitating or inhibiting patient autonomy.

Developing a Clinical Decision Support Tool for Appropriate Antibiotic Prescribing in Australian General Practice: A Simulation Study.

Background. Inappropriate antibiotic prescribing can lead to antimicrobial resistance and drug side effects. Tools that assist general practitioners (GPs) in prescribing decisions may help to optimize prescribing. The aim of this study was to explore the use, acceptability, and feasibility of a clinical decision support (CDS) tool that incorporates evidence-based guidelines and consumer information that integrates with the electronic medical record (EMR). Methods. Eight GPs completed an interview and brief survey after participating in 2 simulated consultations. The survey consisted of demographic questions, perception of realism and representativeness of consultations, Post-Study System Usability Questionnaire, and System Usability Scale. Qualitative data were analyzed using framework analysis. Video data were reviewed, with length of consultation and time spent using the CDS tool documented. Results. Survey responses indicated that all GPs thought the consultations were "real" and representative of real-life consultations; 7 of 8 GPs were satisfied with usability of the tool. Key qualitative findings included that the tool assisted with clinical decision making and informed appropriate antibiotic prescribing. Accessibility and ease of use, including content (guideline and patient education resources), layout, and format, were key factors that determined whether GPs said that they would access the tool in everyday practice. Integration of the tool at multiple sites within the EMR facilitated access to guidelines and assisted in ensuring that the tool fit the clinical workflow. Conclusion. Our CDS tool was acceptable to GPs. Key features required for the tool were easy navigation, clear and useful guideline content, ability to fit into the clinical workflow, and incorporation into the EMR. Piloting of the tool in general practices to assess the impact and feasibility of use in real-world consultations will now be undertaken.

Communicative hurdles in multilingual interpreter-mediated consultations: what trainee data teach us

ABSTRACT This paper reports on an interprofessional training initiative for medical students and trainee interpreters. Relying on a mixed-method analysis of 10 video-recorded simulated consultations at Ghent University (Belgium), the paper investigates which factors impact on trainee interpreters’ (in)complete rendition of medical students’ communicative goals. Our analysis reveals that incomplete renditions can be attributed to (i) long turns including more than one communicative goal; (ii) long turns including large chunks of information; and (iii) a combination of old (i.e. previously given) and new information. Based upon these results, we formulate the following recommendations for the interprofessional training of trainee interpreters: (i) familiarise students with the Calgary Cambridge guide (ii) prepare them for the interpretation of longer turns (iii) teach them how to interrupt a doctor as a safeguard against inaccurate interpretation and (iv) instruct them how to find the right balance between inserting old and new information.

Simulation haute-fidélité à la consultation d’annonce en oncologie médicale

Medical oncology bad news consultation is a particularly stressful situation for both the patient and the physician. High-fidelity simulation is a learning option that has never been evaluated in France in this field. This is a feedback from simulated announcement consultations carried out from January 2018 to May 2019. Residents from the medical oncology and radiotherapy departments performed high-fidelity simulations at the announcement consultation with an announcement nurse, a psychologist, a certified coach and an oncologist. A competency assessment was completed in pre-test, immediate post-test and after 5 months. Fourteen of the 16 eligible interns participated. The pre-test competency assessment showed that interns over 5 semesters reported being more comfortable at the consultation (P=0.04) and thought they were clearly explaining the disease (P=0.03). However, all residents, regardless of the semester, felt stressed before a consultation. The evolution of parameters skills after the simulation was positive for all criteria, particularly for adaptation to patient reactions, use of appropriate vocabulary and reduction of stress (P<0.05). This evolution was independent of the gender, curriculum, semester, or previous completion of a medical oncology internship. More than 80% of the students were ready to repeat this type of training. This training demonstrates the value of simulation training for medical oncology advertising consultation.

Evaluating Simulated Consultation Videos in Teaching Patient-Centered General Practice

This article was migrated. The article was not marked as recommended. Introduction: In the General Practice course at Copenhagen University, students are taught the patient-centered consultation. The aim of this study is to evaluate the feasibility of a new method for measuring the effect of this teaching and of adding access to simulated consultation videos to usual teaching. Methods: The University assigned 293 final-semester students to three groups: a Control group with usual curriculum, an Access group that watched simulated consultation video clips online and a Teaching group where the video clips were discussed in teaching sessions. The outcome was change in students' ability to identify patient-centered elements in a test video, measured with a questionnaire before and after the course. Results: An overall teaching effect was observed, which was most apparent in communication items such as making a contract about the topic for the consultation and summarizing. Changes in clinical items and general issues were small. Conclusion: A tool formeasuring the effect of teaching general practice consultation skills combining a test video and questionnaire is presented. Topics needing to be highlighted in teaching could be identified using the tool.

Simulated Patients’ Feedback after Simulated Doctor-Patient Consultation in Medical Education

Simulated patients (SPs) who give feedback to students after a simulated physician-patient consultation are widely used in medical education for teaching communication skills. However, we can observe inconsistencies between the feedback provided by SPs and the simulated interactions. These inconsistencies cannot be explained by the subjective perspective of SPs. They rather point towards the necessity of appropriate criteria for assessing simulated consultations. Using an example, I will compare and contrast SP feedback statements with the corresponding doctor-patient interactions. Taking communication goals and SP reactions as criteria, I will outline discrepancies between the simulation and the evaluation given in the feedback. I am going to show that problems arise especially with respect to the sequence of the interaction as well as the evaluations implicitly communicated in SP reactions.

Evaluating Simulated Consultation Videos in Teaching Patient-Centered General Practice.

This article was migrated. The article was marked as recommended. Introduction In the general practice course at Copenhagen University, students are taught patient-centered consultations. The aim of this study is to evaluate the feasibility of a new method for measuring the effect of this teaching, and of adding access to simulated consultation videos to usual teaching. Methods The university assigned 293 final-semester students to three groups: a 'Control Group' with usual curriculum, an 'Access Group' that watched simulated consultation video clips online and a 'Teaching Group' where the video clips were discussed in teaching sessions. The outcome was the change in students' ability to identify patient-centered elements in a test video consultation, measured with a questionnaire before and after the course. Results An overall teaching effect was observed, which was most apparent in communication items such as "making a contract about the topic for the consultation" and "summarizing". Changes in clinical items and general issues were small. Conclusion A tool for measuring the effect of teaching general practice consultation skills combining a test video and a questionnaire is presented. Topics needing to be highlighted in teaching could be identified using the tool.

“Am I audible? Are my slides visible?” – Do we need to flatten the webinar curve?

“Am I audible? Are my slides visible?” – Do we need to flatten the webinar curve?

Dental presenting complaints in simulated GP consultations for undergraduate medical students

Dental presenting complaints in simulated GP consultations for undergraduate medical students

Viewpoint: Why I prescribe podcasts to my patients.

During my revision for the Clinical Skills Assessment (CSA) part of the MRCGP examination, I finished many simulated consultations by referring paper leaflets for patients to collect at reception. Such leaflets corroborate information given within the consultation and provide supplementary information about a condition or medication in primary care. In my current practice, I print out leaflets on clinical conditions and on medications but wonder whether patients actually read them, how much they retain, and whether leaflets directly change health behaviour. A systematic review of literature reviews1 suggested that leaflets do improve patient knowledge and medication adherence. However, within many countries health literacy is often low, especially in low socioeconomic groups whose health needs may very well be …