Simulated Counseling Session Research Articles

A Blended Learning Approach to Teaching Medication Use and Perspectives on Spirituality in Pharmacy Practice

ObjectiveThis study aimed to assess students’ proficiency and perspectives regarding the role of spirituality in pharmacy practice using a blended learning approach. MethodsStudents viewed online preclass videos on general spirituality and 5 major religions in the United States. Next, students attended an interactive lecture followed by a simulated counseling session. Lastly, students completed an anonymous, 38-question, electronic perspective survey. The items were grouped into scales, and the results were compared using paired-sample t tests. Effect sizes were measured by Cohen’s d. Additionally, students could opt to complete a reflection assignment on this activity as part of a concurrent course. A content analysis qualitative approach was utilized to assess these reflections. ResultsAll students (N = 125) completed the counseling session, and 113 (90.4%) completed the survey. The mean score on the counseling session rubric was 94.8%, demonstrating students’ skills in recognizing spiritual concerns in simulated patient interactions. All perspective scale scores indicated a statistically significant change from pre to post, with the greatest change demonstrated in empathic perspective-taking (medium effect), followed by anxiety and lack of multicultural self-efficacy, religious/spiritual openness, and desire to learn (small effects). Students agreed that the instruction helped prepare them as a pharmacist (mean = 5.41) and that hearing from people with authentic experiences was valuable (mean = 5.40). Major learning themes included individualizing care, respect for beliefs, learning about diverse backgrounds, and prohibited medications. ConclusionStudents performed well in counseling patients regarding medication-related spiritual needs using a blended learning approach. In addition, the students perceived an increase in empathy while addressing spiritual considerations in patient care.

Clients' and genetic counselors' perceptions of empathy in Japan: A pilot study of simulated consultations of genetic counseling.

The rapidly increasing availability of genetic testing is driving the acceleration of genetic counseling implementation. Empathy is important in medical encounters in general and forms a core component of a successful genetic counseling session; however, empirical evidence on empathy in genetic counseling is minimal. This study aimed to explore the perceptions of empathy in simulated genetic counseling consultations from the perspectives of clients and genetic counselors. Semi-structured interviews and interpersonal process recall were used with participants of simulated genetic counseling consultations to elicit their experiences of empathy. A constructivist grounded theory was used for data analysis. A total of 15 participants, including 10 clients and 5 genetic counselors, participated in 10 simulated counseling sessions. The genetic counselors attempted to demonstrate empathy and were sensitive toward detecting changes in clients. Meanwhile, the clients' perceptions represented their feelings and thoughts elicited through the counselors' empathic approaches. This was the first process study to examine empathy in simulated genetic counseling sessions. Our model of communication of empathy is a process in which counselors try to address implicit aspects of clients, and clients are provided with time and a safe place for introspection, which contributes to discussions on building good relationships with patients. There is also a suggestion of the utility of simulated consultations for healthcare providers to learn empathic communication.

An initial reliability analysis of a patient counseling rubric to objectively measure student pharmacist performance

Current literature outlines the documented need for improved communication during patient medication counseling. Although many tools exist, there needs to be a national standardized tool that complies with federal and state law, to objectively measure student pharmacist performance during patient counseling in the community pharmacy setting. The primary objective of this study is to perform an initial analysis of the internal consistency reliability of a patient medication counseling rubric designed with an Indian Health Services theoretical framework. Secondary objectives include measuring changes in student performance over the time of the study. The 18-item rubric was developed to objectively measure student pharmacist performance during patient medication counseling sessions in a 21-h Introductory Pharmacy Practice Experience (IPPE) course. The community-pharmacy-based IPPE patient counseling course evaluates students' communication skills and patient-centered counseling techniques in live and simulated patient counseling sessions. Three pharmacist evaluators assessed a total of 247 student counseling sessions. The rubric's internal consistency reliability was analyzed, and student performance improvement was observed within the course. Students' performance was evaluated as “meets expectations” in most live and simulated sessions. However, an independent groups t-test showed that the mean performance score for the live counseling sessions (2.59, SD = 0.29) was higher (p < 0.001) than that for the simulated counseling sessions (2.35, SD = 0.35). Students' performance in the course improved over three weeks [Week 1: mean (SD) = 2.29 (0.32), Week 2: mean (SD) = 2.44 (0.33), Week 3: mean (SD) = 2.62 (0.29); p < 0.001]. A Tukey-Kramer comparison post hoc test found a significant increase in the mean performance scores between weeks (p < 0.05). The overall internal consistency reliability of the counseling rubric was determined acceptable, with a Cronbach's alpha of 0.75. Further study is required, including the assessment of inter-rater reliability, factor analysis, variable analysis, and use in other states with patient confirmation testing necessary to validate the rubric for use with student pharmacists in the community pharmacy setting.

The prevalence of gender stereotypes in pharmacy student simulated counseling sessions utilizing standardized patients

IntroductionSimulation in healthcare has been a widely adopted modality to gain practical experience prior to working directly with patients. While simulation in academic settings affords many opportunities to enhance learning, it may also present an opportunity to identify cultural stereotypes. The objective of this study was to assess the prevalence of gender stereotypes in pharmacy student simulated counseling sessions. MethodsSimulated counseling sessions completed across several cohorts of pharmacy students were reviewed. A video database of these counseling sessions was manually reviewed retrospectively to determine if students or trained actors portraying the role of the pharmacist and patient, respectively, assigned providers a gender without prompting. Secondary analysis included time to provider gender assignment and acknowledgement. ResultsA total of 73 unique counseling sessions were reviewed. Gender was preferentially assigned in 65 sessions. Assigned provider gender was male for all 65 cases. In most (45 out of 65) cases, gender was assigned by the actors. ConclusionsPredetermined gender stereotypes exist in simulated counseling sessions. Simulation needs to be continually monitored for promoting cultural stereotypes. Integration of cultural competency into counseling simulation scenarios represents an opportunity to better train healthcare professionals to function within a diverse work environment.

Behaving socially with a virtual human role-player in a simulated counseling session

Visual attention is an essential social element in face-to-face conversations between people. The Army is now using virtual environments with virtual human role-players to provide for the development and practice of leader counseling skills. While literature indicates that virtual humans positively impact learning outcomes, this research contributes to the understanding of how people interact with virtual humans. Specifically, the research investigates a person’s social behavior toward a virtual human in a simulated counseling session. Utilizing a computer-based training environment, this research tracked visual attention toward and acceptance of a virtual human role-player by 120 military counselors. Behavior moderators included attentional influences on the counselor from the level of expression and full-body or close-up views of the virtual human. Results indicate trainees do practice appropriate social attention when the virtual human is speaking. Results also indicate counselors attended to an active more than a static full-body view indicating there is value in nonverbal communication channels. Switching from a full-body to a close-up view did not result in significant changes of the counselor’s visual attention. Further, the research indicates switching views may undermine the perception of a natural interaction. Counselors considered the experience useful. The research suggests study and design considerations to enhance future social skills training environments.

The relationship between pharmacy students’ beliefs about medications and their academic achievement in a pharmacy practice counseling course

IntroductionPharmacists’ beliefs about medications have been identified as a potential factor in how patients are counseled. However, no studies have assessed this relationship. MethodsThird year pharmacy students were surveyed using previously validated questionnaires about medication beliefs, including the BMQ-General (General-Overuse and General-Harm subscales), Benefit, and Perceived Sensitivity to Medications (Sensitive Soma) scales; each is rated on a five-point Likert scale (higher scores represent stronger feelings). Belief profiles were created using two-step cluster analysis. Students also reported demographics and prior work in a pharmacy. Grades from simulated counseling sessions were collected via school records. Student t-test and multivariate linear regression were used to compare beliefs with grades. ResultsAmong the 66 responders (84.5% response rate), 54.5% were female, 80.3% white, and 77.3% non-Hispanic; 84.8% reported prior work in a pharmacy. Overall mean (SD) belief scores were General-Overuse 3.12 (0.76), General-Harm 1.83 (0.53), Benefit 3.99 (0.55), and Sensitive Soma 2.37 (0.82). Cluster analyses revealed two beliefs profiles: negative profile (more feelings of overuse, harm, and sensitivity to medications) and positive profile (less feelings of overuse, harm, and sensitivity to medications). Students with positive belief profiles were graded higher by faculty compared to students with negative belief profiles (90.0 vs. 87.2, p = 0.014). Findings remained in a multivariate regression controlling for gender and prior work in a pharmacy. ConclusionsFindings from this study demonstrate the need for greater understanding about the relationship between pharmacists’ beliefs about medications and patient counseling.

Creation of an active learning healthcare communications course using simulations relevant to pharmacy practice

Background and purposeThe purpose of this project was to design and develop a health care communications course built around practice-like simulations and active learning in the first year of a professional pharmacy program. Educational activity and settingA three-credit health care communications course was divided into one didactic (two hours per week) and three simulation components (one hour per week). The simulation components consisted of one written patient education pamphlet, three group presentations, and three one-on-one patient counseling sessions. This was accomplished by breaking the class of approximately 75 students into eight separate sections, each consisting of 8–10 students and one instructor. Each week four sections were devoted to counseling role-plays: half in the role of pharmacists and half as patients. The other four sections were devoted to hour-long professional group presentations—half in the presenting group and half as audience. The students’ performance in the simulated counseling sessions and group presentations has been tracked and analyzed to determine if the simulated exercises had a positive impact on the students’ active communications skills. FindingsConsistently, over the first four years of the implementation of the course, students’ communications skills, as measured by faculty assessments, in both professional group presentations and one-on-one counseling sessions significantly improved. Discussion and summaryIncorporation of active-learning simulation exercises into a healthcare communications course has a positive impact on the development of students’ communications skills. This creates a foundation upon which students can build over the remainder of the professional program and into their future careers.

Comparison of Public Health Nurse’s Lifestyle Counseling Skills for Clients with Different Readiness of Behavior Changes in Primary Care Settings

Purpose: Public health nurses (PHNs) are required to assess the readiness of the clients and provide lifestyle counseling accordingly. The purpose of this study was to compare the lifestyle counseling provided for clients with different levels of readiness based on self-evaluations and independent assessment. Methods: Participants were PHNs with 10 years’ experience or less. Lifestyle counseling skills were measured through a simulated counseling session in a primary setting lasting up to 30 minutes, followed by a review session, where the participant provided self-evaluations, and the simulated client provided others-evaluations, of the session. The simulated clients played the role of clients at either the pre-contemplation or contemplation stage of preparedness as per the stages of behavior change theory. Results: The self-evaluation results showed that the mean scores for five of the six skill categories, are lower in the precontemplation-stage client cases than in the contemplation-stage client cases, and significantly so for two skill categories. The others-evaluations showed significantly lower mean scores for all skill categories in the precontemplation cases than in the contemplation cases. Conclusion: The PHNs and simulated clients agreed that lifestyle counseling skills were inadequate for the precontemplation cases, as compared with the contemplation cases. The lifestyle counseling skills of PHNs with less experience may not be well-adjusted to the readiness of the client, indicating difficulties in supporting less prepared clients.

Development of a video decision aid to inform parents on potential outcomes of extreme prematurity.

The objective of the study is to develop and validate a video-based parental decision aid about the outcomes of extremely premature infants. Thirty-one clinicians and 30 parents of extremely premature infants (<26 weeks gestation) previously underwent semi-structured interviews to assess perceptions of antenatal counseling. Interviewees recommended a video. A video was iteratively developed, with final validation by three groups: clinicians (n=16), parents with a history of extreme prematurity (n=14) and healthy 'naïve' women without prior knowledge of prematurity (n=13). Two iterations of the video were created. Following a simulated counseling session, an eight-question survey and the State-Trait Anxiety Inventory (STAI) were administered to parents and 'naïve' participants to assess usefulness and stress provocation. The final 10-min video shows six children/parent dyads of former 23 to 25 week premature children with a wide range of outcomes. This video was well accepted by clinicians as well as parent and 'naïve' participants, who perceived it as 'balanced' with a 'neutral' message. The video was felt to provide useful information and insight on prematurity. The final version of the video did not induce anxiety: parents STAI-S 36.1±12.1; 'naïve' 30.2±8.9. A short video showing the range of outcomes of extreme prematurity has been produced. It is well accepted and does not increase levels of anxiety as measured by the STAI. This video may be a useful and non-stress-inducing aid at the time of counseling parents facing extreme prematurity.

Development and Pretesting of a Decision-Aid to Use When Counseling Parents Facing Imminent Extreme Premature Delivery

To develop and pretest a decision-aid to help parents facing extreme premature delivery during antenatal counseling regarding delivery room resuscitation. Semistructured interviews with 31 clinicians and with 30 parents of children born <26 weeks' gestation were conducted following standard methods of qualitative research. These characterized perceptions of prenatal counseling to identify information that parents value when making decisions regarding delivery room resuscitation. These parental needs were formatted into a decision-aid. We assessed the primary outcome of how effectively the decision-aid improved knowledge during a simulated counseling session. Two groups of women were studied: parents with a history of prematurity ("experienced") and healthy women without prior knowledge of prematurity ("naïve"). Interviewees thought that visual formats to present survival and short- and long-term outcome information facilitated their own preparation, recall, and understanding. Accordingly, we designed a decision-aid as a set of cards with pictures and pictographs to show survival rates and complications. There was significant improvement in knowledge in 13 "experienced" parents (P = .04) and 11 "naïve" women (P < .0001). Participants found the cards useful and easy to understand. A decision-aid for parents facing extreme premature delivery may improve their understanding of complicated information during antenatal counseling.

Evaluation of the FOCUS (Feedback on Counseling Using Simulation) Instrument for Assessment of Client-centered Nutrition Counseling Behaviors

Objective To develop an instrument to assess client-centered counseling behaviors (skills) of student-counselors in a standardized patient (SP) exercise. Methods Descriptive study of the accuracy and utility of a newly developed counseling evaluation instrument. Study participants included 11 female student-counselors at a Midwestern university—10 Caucasian, 1 African-American—for the simulated counseling sessions, in which the Feedback on Counseling Using Simulation (FOCUS) instrument was applied in 2 SP scenarios (cardiovascular disease and diabetes). FOCUS ratings of student-counselors by 4 SPs during 22 sessions were compared with ratings from a 3-member panel of experts who independently viewed the 22 videotaped sessions. Quantitative analysis of instrument validity included inter-rater reliability by computing generalizability coefficients, Pearson correlations, and Spearman rank-order correlations. Results FOCUS criteria encompassed relevant dimensions of nutrition counseling based in a client-centered perspective. The critical points of information gathering and counseling behaviors showed internal consistency overall and good inter-rater reliability with the cardiovascular disease scenario. For both scenarios, pooled ratings of 3 experts agreed with ratings carried out by SPs. Conclusions and Implications Initial findings suggest that the FOCUS instrument with client-centered criteria may enhance evaluation of counseling skills in SP exercises, meriting further study with larger groups.

Development of an Instrument to Evaluate Audiologic Counseling Skills

This study describes the development of an instrument designed to evaluate audiologic counseling skills. In simulated counseling sessions, a trained actor portrayed a parent, and ten graduate audiology students role-played counseling sessions as audiologists informing the "parent" that her infant has a hearing loss. The ten sessions were videotaped, and three raters viewed the taped sessions while evaluating counseling skills with a new evaluation tool, the Audiologic Counseling Evaluation (ACE). The ACE was found to have excellent internal reliability (alpha = .91) and moderate-to-good inter-rater reliability. Raters' subjective evaluations of the tool were generally positive, and students' evaluations of the simulated counseling experience were overwhelmingly so. This instrument can be used by audiology faculty and clinical instructors to help students improve their counseling skills before interacting with parents. It can also be used in clinical settings for professional development by way of self- and peer-evaluation.

Exploring the Affective Inner Experiences of Therapists in Training: The Qualitative Interaction Between Session Experience and Session Content

Thirty-four 1st-year counseling students recorded their inner experiences following a simulated counseling session. Using a qualitative collective case study approach to extract emotion from a large pool of inner experience, 6 judges identified samples of affect through a triangulation process using intensity, extreme, and critical case sampling and then coded them into naturally occurring core ideas and domains. Affective experiences in the inner experiences were found frequently and were often quite intense. Affect was verbally suppressed and was mostly not noticeable on the audiocassettes. Four predominant affective themes emerged from the inner experiences: anger/frustration, disappointment/regret, anxiety/fear, and happiness/excitement.

Counseling Simulations: An Interactive CD-ROM Approach

SUMMARY The Microcounseling Skills Simulation Program uses interactive CD-ROM technology to provide realistic situations to which students can learn and evaluate their microcounseling skills. The contents of the CD-ROM contain simulated counseling sessions first recorded on videotape and videodisc. The initial products consisted of four simulated counseling sessions, documentation consisting of an instructor manual, student worksheets, and scripts of the counseling sessions. This article will relate the process of creating a Microcounseling Skills Simulation Program and its conversion of the videodisc to a CD-ROM. This CD-ROM will include only one of the simulated counseling sessions. (The CD-ROM is being used as a resource activity for a Guided Correspondence Course currently offered on the World Wide Web.)

Preferred Style and Ethnicity of Counselors by African American Males

This study compared reality therapy and person-centered therapy practiced by an African American counselor and a European American counselor African American Job Corps participants were randomly assigned to view one offour videotapes of simulated counseling sessions. Results indicate a statistically significant difference between reality therapy and person-centered therapy, and between an African American counselor and a European American counselor Higher ratings were given to reality therapy over person-centered therapy and to an African American male counselor over a European American male counselor

Attitudes towards a Blind Counselor and Perceived Effectiveness

Attitudes towards a blind counselor and perceived effectiveness were evaluated using a videotape of a simulated counseling session. One group were told the counselor was a blind doctoral student whereas control participants were informed that the counselor was a doctoral student. Participants were then administered the Disability Factor Scale/B and the Barrett-Lennard Relationship Inventory. Analysis showed no difference in groups' scores on the Disability Factor Scale/B. A significant difference was obtained on one of the four scales of the Barrett-Lennard Relationship Inventory, i.e., the blind counselor was perceived to show significantly more unconditional regard.

Situational effects on the communication behaviors of pediatric residents

The variation in communication behaviors of pediatric residents in different interview circumstances was examined. Twenty-three residents were videotaped in three simulated counseling sessions. Two of the sessions entailed counseling a mother of a toddler with multiple handicaps during a well-child visit. The third, which took place between the other two sessions, entailed informing a new mother that her child has Down's syndrome. The residents′ performances were evaluated using a subjective rating scale and an objective frequency count of behaviors. Analysis of variance demonstrated significant effects for both observation scales. Spearman correlations were not significant between any of the situations. The results suggest that residents′ communication behaviors vary with the type of counseling situation.