Simulated Patients Research Articles

Feedback-based approach in teaching medical interviewing

Educational feedback is a facilitating tool in improving medical interviewing skills through simulation practices. The simulated patient (SP) programme at the University of Pécs Medical School aims to provide efficient help for educators and students alike in language for medical purposes, communication and clinical courses. The constructivist feedback methodological approach ensures that students in history taking classes learn from role-playing in simulated scenarios and the feedback offered from the simulated patient. Effective assessment includes the learners’ own reflection and the patients’ non-judgmental observation on perceived interpersonal communication skills, observed professional misconduct, students’ ability to cope in emotionally challenging situations, and suggestions for improvement. Giving feedback has to be offered regularly to enable improvement in medical communication and nurture self-confidence. Our questionnaire survey of the students who attended history taking courses involved both self-reflection and instructor feedback based on their performance during simulated scenarios. The results of the study demonstrated substantial developments in relationship-building skills and self-confidence for students in post-course clinical practice.

Evaluation of Community Pharmacists’ Competences in Identifying and Resolve Drug-Related Problems in a Pediatric Prescription Using the Simulated Patient Method

Background: Drug-related problems (DRPs) are a global issue that impacts the efficacy and safety of the therapy, and pediatric patients are considered to be more vulnerable to DRPs, thus requiring more attention. Community pharmacists (CPs) are in a position that allow them to identify and alleviate these DRPs. Objectives: This study evaluated the ability of CPs in identifying and resolving DRPs in a pediatric prescription. Methods: A cross-sectional study was carried out in 235 community pharmacies to evaluate the ability of CPs working in the Khartoum locality to identify DRPs in a pediatric prescription and how they intervene to resolve these problems. Fifth-final year B. Pharm. Students were selected and trained to act as simulated patients (SPs) for this study. The visits were performed by using a simulated prescription that contains three different types of DRPs. The information obtained from the visits was documented immediately by the SPs after leaving the pharmacy in a data collection form. Results: All planned SPs visits were completed. Of the 235 community pharmacies, only 50 (21.3%) CPs were able to identify at least one of the DRPs. The most common type of DRP identified was the wrong duration of the treatment 19%, followed by the wrong dose 4%. The interventions made by CPs to mitigate the identified DRPs included recalculation and correction of the dose according to weight, which was made by 10 CPs, and correction of the duration, which was done by 45 CPs. None of the CPs who identified the presented DRPs communicated with the physician or referred the SP to the prescriber. The average dispensing time of the CPs was 68.18 ± 36.1 s. Conclusions: The majority of the CPs in the Khartoum locality were unable to identify DRPs in a pediatric prescription. Correction of the dose and duration of treatment were from the attempts of CPs to resolve DRPs. However, no collaboration was observed between CPs and physicians. In general, the practice of CPs in Khartoum locality in this area requires substantial improvement.

Evaluation of pharmacist’s practices regarding the antimicrobials dispensing: a simulated patient study

BackgroundThe indiscriminate use of antimicrobials is considered a major contributing factor to the increase in antimicrobial resistance. Community pharmacies are the main source of access to antimicrobials, and pharmacists are in a strategic position to promote rational use of these medicines. Therefore, it is important to know dispensing service quality.ObjectiveTo evaluate the behavior of pharmacists in dispensing antimicrobials in community pharmacies in northeast Brazil.MethodsThis cross-sectional pilot study was conducted from August to October 2021 in a private community pharmacy chain in Sergipe. Dispensing was evaluated using the simulated patient (SP) technique. Two SP asked the pharmacists for the antimicrobials (case clinic 1: upper respiratory infection; case clinic 2: urinary tract infection) and recorded the service through audio. Dispensing practices were independently analyzed by two researchers based on the tools available in the literature. Data were presented using descriptive statistics.ResultsA total of 54 simulated patient visits were conducted. Based on the 12 steps recommended by the research team for good dispensing, pharmacists asked an average of 1 (±1.17) question for upper respiratory infections and 0.3 (±0.54) for urinary tract infections, as well as provided counseling (mean number of recommendations, 2.6 (±1.44) and 4.5 (±2.35), respectively). As for communication skills, pharmacists had a regular score (3.07 ± 0.34). Furthermore, there was no significant difference in the number of steps and counseling recommendations by pharmacists in dispensing clinical cases 1 and 2 (p = 0.0674).ConclusionThe quality of antimicrobial dispensing was evaluated as suboptimal, requiring improvements in practice and multifaceted strategies to promote continuing education of these professionals. In addition, awareness actions for the population must be implemented to promote the rational use of antimicrobials and reduce microbial resistance.

Bias in simulation training for healthcare professions: a scoping review

Bias potentially affects simulation-based training (SBT) for healthcare professions. The role bias plays in SBT design, presentations, and in the experiences of learners should be understood. Dual process theory is a well-accepted framework for understanding types of bias. The authors performed a scoping review to map ‘bias’ in SBT of health professions in the literature. Search terms were developed for a query in the PubMed database. Researchers reviewed abstracts, met ten times to discuss which papers’ full texts to read, and then analysed and categorized the articles. Researchers used the Arksey and O’Malley framework for scoping reviews. Three thousand six hundred and twenty abstracts were identified by a detailed query in the PubMed database of which, 115 full-text articles were identified for inclusion. Articles published about bias in SBT cover a broad range of topics, from addressing how bias affects patient care, to bias in raters’ scoring of medical students on exams. Researchers found that the prevalence of articles on bias in SBT increased over time and focused primarily on implicit bias. Specific types of bias in some instances were difficult to identify, and several biases mentioned in papers were unique to this review. The results showed that many SBT methodologies (i.e. manikins, videos, etc.) were referenced in the papers. The type of simulation training most prevalent in the articles was simulated patient (SP) methodology. The results show that biases can be explored in any type of simulation method, indicating that simulationsists should be aware of bias in training during all types of training methodolgy.

Comparison of Students' Self-Assessment and Simulated Patient Assessment in a Patient Counseling Evaluation and Perceived Importance of Communication Skills.

The primary objective of this study was to compare students' self-assessment ratings with simulated patient (SP) assessment ratings of communication skills in a patient counseling Objective Structured Clinical Exam (OSCE). The secondary objective was to evaluate student perceptions of the importance of communication skills in the practice of pharmacy as well as the impact of a virtual OSCE format. First-year pharmacy students completed an OSCE focused on self-care product counseling. The evaluation was graded using a rubric covering both verbal and non-verbal communication. Students who completed the course were provided a 15-question, post-evaluation survey with questions related to self-assessment of communication skills and perceptions of the importance of communication skills. Of the 138 students in the course, 68 completed the optional post-assessment survey (49% response rate). There were no statistically significant differences between the ratings by students and SPs for the four communication elements included in the self-assessment. Most of the students recognized the importance of communication skills, including developing rapport and trust. Recognition of the importance of communication skills to future practice as a pharmacist positively correlated with performance on the evaluation (r2 = 0.5409, p-value = 0.0007). Student self-assessment is an effective and cost-effective mode of feedback for practice experiences as an alternative to the use of SPs.

The Use of Simulated Patients Is more Effective than Student Role Playing in Fostering Patient-Centred Attitudes during Communication Skills Training: A Mixed Method Study.

While simulated patients (SPs) are considered a standard tool in communication skills training, there is no evidence thus far of their comparative benefit to the more cost-effective option of student role playing. We compared the effectiveness of both approaches in developing patient-centred attitudes in students. We retrospectively compared students who participated in the clinical communication course (CCC), based on student role playing (CCCsp-, n = 160), to students who participated in the CCC with SPs (CCCsp+, n = 146), and students with no formal CCC (CCC-, n = 122). We used validated questionnaires to assess patient centredness. We also conducted focus group interviews (FGI) to better understand the impact of CCC with sp. Students after the CCC with simulated patients achieved a significantly higher score in the patient-practitioner orientation scale than other groups (p < 0.001). There is a strong positive correlation between the implementation of simulated patients and patient-centred attitudes among students. Data from the FGI revealed that students perceived training with SP as more realistic, safe, and engaging than student role playing. Practice Implications. Our research provides evidence to justify costs and resources invested in simulated patient programs.

Observed behaviours and suicide assessment language post-Mental Health First Aid training in Australia and the United States: a mixed methods study using discourse analysis

BackgroundMental Health First Aid (MHFA) training teaches participants how to respond to mental health crises, including suicide. Little is known about the impact of training on participants’ observed MHFA behaviours. This exploratory study aimed to compare MHFA-trained Australian and US student pharmacists’ performance and suicide assessment language during simulated patient role-play (SPRP) assessments.MethodsStudent pharmacists (n = 265) completed MHFA training and participated (n = 81) in SPRPs with simulated patients (SP) who were people with lived experience of mental illness. Each SPRP was marked by three raters (student, tutor and SP). One-way ANOVA, chi-squared tests and independent samples t-tests were used to compare scores and pass/fail rates, where appropriate. Transcribed audio-recordings of suicide assessments underwent discourse analysis. A chi-squared test was conducted to investigate the differences in how suicide assessment language was coded across six discursive frames (‘confident’/‘timid’, ‘empathetic’/‘apathetic’, and ‘direct’/‘indirect’).ResultsThree raters assessed 81 SPRPs, resulting in quantitative analysis of 243 rubrics. There were no significant differences between student pharmacists’ mean scores and pass/fail rates across countries. Overall, both cohorts across Australia and the US performed better during the mania scenario, with a low failure rate of 13.9 and 19.0%, respectively. Most students in both countries passed their SPRP assessment; however, 27.8% did not assess for suicide or used indirect language during suicide assessment, despite completing MHFA training. Australian student pharmacists demonstrated, more direct language (76.9% versus 67.9%) and empathy (42.3% versus 32.1%) but less confidence (57.7% versus 60.7%) compared to US student pharmacists, during their suicide assessment; however, these differences were not statistically significant.ConclusionsFindings indicate most MHFA-trained student pharmacists from Australia and the US can provide MHFA during SPRPs, as well as assess for suicide directly, empathetically and confidently. This exploratory study demonstrates the importance of practicing skills post-training and the need for further research exploring participants’ hesitance to assess for suicide, despite training completion.

Integrated behavioral health education using simulated patients for pediatric residents engaged in a primary care community of practice.

Novel teaching curricula using simulated patients (SP) and a team-based approach are needed to teach pediatric residents how to approach behavioral health (BH) conditions in an integrated care setting. This mixed-methods study evaluated a pilot curriculum on BH integration in pediatric primary care. Two 1-hour didactic sessions and 3 hours of SP encounters focused on attention-deficit/hyperactivity disorder (ADHD) and anxiety, followed by facilitated debriefings that included interdisciplinary team members. Residents completed pre- and postcurriculum surveys on self-efficacy in patient assessment and management. A subset of residents participated in semistructured interviews, reviewing video recordings of their SP encounters to facilitate reflection on their learning. We conducted qualitative analysis of interview transcripts until we reached thematic saturation. Residents (n = 31) reported significantly improved self-efficacy in the majority of BH skills (p ≤ .05 to p ≤ .0001), including assessing and discussing concerns with families, using screening tools, developing management plans, prescribing medications, and performing warm handoffs with BH clinicians. In analysis of 15 interviews, four themes emerged: shared experiences, mutual engagement, contextual meaning, and behavioral change, which aligned with the components of the communities of practice framework. Sharing experiences within an integrated BH-pediatric primary care learning community enhanced activated, self-reflective learning and consequent behavioral change that contributed to identity formation. Resident participation in the integrated BH-pediatric curriculum improved self-efficacy in patient care for anxiety and ADHD. Curricula implemented in integrated learning communities could help promote reflection and improve integrated pediatric-BH care, including warm handoffs from pediatric to BH providers. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Enhanced point of care ultrasound skills after additional instruction from simulated patients.

Point of Care Ultrasound (POCUS) training in Canadian undergraduate medical programs is steadily increasing. To date, the simulated patients (SPs) in our program have only provided feedback on comfort and professionalism. Involving the POCUS SPs as teachers (SP-teachers) of POCUS skills provides an additional opportunity for instruction. In this pilot study, we explored the impact of SP-teachers instructing medical trainees while they learned POCUS. Outcomes of interest included the level of proficiency achieved after the session and trainee satisfaction with the learning experience. Second year medical students were randomized into a conventional or SP-teacher learning experience. Both groups received the same video tutorial, instructor guidance, and basic SP feedback (comfort and professionalism). The SP-teaching group received additional instruction (landmarks, transducer technique, and troubleshooting) from the SP-teachers when session instructors were assisting others. Students evaluated the session and were subsequently assessed through direct observation. Students that received SP-teaching scored significantly higher in both image acquisition (p = 0.029, d = 1.26) and overall entrustment (p = 0.002, d =1.75). Both groups rated their sessions highly. Students that received SP-teaching were observed to better acquire images and achieved higher entrustment scores. In this pilot study, SP-teachers had a positive effect on acquisition of POCUS skills.

Using experiential-based simulation learning to develop adult nursing students’ communication skills to support practice

In the light of the practice placement limitations due to COVID-19, the Faculty Practice Simulation Group at a University in South West England, commissioned a pilot programme of simulated practice components for 200 second year adult nursing students over five consecutive days. The aim was to support the development of communication skills required by the Nursing and Midwifery Council Standards [1]. In partnership with an external communication skills organisation, the University provided each student with 37 hours of simulated practice placement, focused on communication skills through participative simulation with simulated patients (SPs) in bespoke, authentic scenarios. This included facilitated participation, structured live feedback from SPs, discussion with students, debriefing and reflection according to ASPiH guidelines for best practice in simulation [2]. Scenarios were designed to challenge and explore the range of skills required in Annex A of the Standards [1], at a level expected of first year students. Learning outcomes included the development of caring conversation techniques, patient management and colleague communication in multiple, varied situations. Students interacted with SPs and relatives who reflected diverse characteristics and ages, and a range of physical and mental health challenges. Students also interacted with simulated colleagues in a variety of professional situations. 106 students completed feedback questionnaires consisting of 41 5-point Likert items, before and after their sessions. Facilitators noted that students described the simulation as a meaningful learning opportunity which allowed them to explore and develop their communication skills and better prepared them for the practice element of their degree. They also noted that students said they preferred simulation as it gave them time to stop and think and to get advice and ideas from their colleagues. This was particularly so in ‘breaking bad news’ scenarios as most had never had to approach this and appreciated the opportunity to consider and practise their response. Consequently, students stated that simulation would have been even more beneficial had it been timed prior to attending practice placement. Facilitators observed the improvement in communication skills was in student’s confidence and their awareness and sensitivity, particularly in complex multi-factorial situations. Evaluations for the programme have yet to be analysed. Experiential learning through simulation-based education with SPs provides a powerful approach, offering a safe and supportive environment, which avoids unsafe situations and enables students to effectively practise and prepare for real world experiences. 1. Nursing and Midwifery Council, Standards of Proficiency for registered nurses. 2. Simulation-Based Education in Healthcare. 2016. Standards Framework and Guidance. Association for simulated practice in healthcare (ASPiH) standards for simulation-based education.

Virtual safety: using online simulation to prepare trainees for their community safeguarding roles

Conducting child protection medical assessments (CPMA) where there are concerns of non-accidental injury (NAI) is a key clinical skill for paediatricians and part of the Royal College of Paediatrics and Child Health (RCPCH) curriculum [1]. Child Protection (CP) simulation training was commissioned following trainee feedback around unpreparedness when carrying out CPMA. The COVID-19 pandemic forced delivery of online CP simulation. Initial learners were paediatric trainees; with newly qualified school nursing and health visiting colleagues in subsequent delivery; allowing for multi-professional learning in the simulated environment. The session aims were to: - increase familiarity with professional conversations in the CP context - formulate an evidence-based opinion in cases of suspected NAI - rehearse discussing outcomes of CPMA with parents/carers and social workers We rehearsed, modified, and then, using Zoom as a synchronous platform, with a trained simulated patient (SP) and faculty as role players created three 10-minute community-based CP scenarios for a twice-yearly programme. Pre-course information and a pre-briefing explained the online limitations and opportunities, including how we co-create psychological safety, the option of a wellbeing ‘wobble’ room, also outlining the Diamond debriefing model [2]. Pre- and post-course surveys were sent to the 18 participants. Likert scale ratings on confidence and anxiety levels when approaching a CP medical; familiarity with and likelihood of using the HEADSSS tool [3] was analysed using paired T-test probability. 94% (17/18) had no previous CP simulation experience. Confidence in carrying out CPMA increased post-simulation (p= 0.00418) Anxiety going into the CPMA decreased post-simulation (p=0.00624). 44% were familiar with HEADSSS tool pre-course and 94% were more likely to use it post-course (Likert rating 4or5). Confidence in expressing concerns to parent/carer rose from 11% to 82.3% post-course (Likert rating 4or5). Free text learning points included ‘Use what you can agree on (parent and doctor) as a foundation for developing rapport.’ ‘… very useful in preparation for community.’ ‘… very helpful in giving me more confidence in carrying out medicals.’ ‘Never undertaken a simulation with an actor, it felt real (I was surprised)’, ‘interesting to share learning… as practitioners have different perspectives.’ Despite sensitivity of the subject and the emotive realism brought by the SP’s, psychological safety was achieved in this online interprofessional CP simulation training through detailed preparation in course design and faculty preparedness. The pilot was successful in preparing participants to fulfil their safeguarding role. Online training continues to be a synchronous induction for 2022. 1. RCPCH. Progress curriculum. Royal College of Paediatrics and Child Health 2018. 2. Jaye P, Thomas L, Reedy G. The Diamond: a structure for simulation debrief. The Clinical Teacher. 2015; 12(3):171–175. 3. Cohen E, Mackenzie RG, Yates GL. HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth. Journal of Adolescent Health. 1991;12(7):539–44.

Effects of a communication training for oncologists on early addressing palliative and end-of-life care in advanced cancer care (PALLI-COM): a randomized, controlled trial

In advanced cancer care, early communication about palliative care (PC) and end-of-life (EoL)-related issues is recommended, but is often impeded by physicians' communication insecurities. We investigated the effect of a newly developed compact communication skills training 'PALLI-COM' on oncologists' competencies to early address PC/EoL-related issues. We conducted a randomized, controlled trial (RCT) with an intervention group (IG; 2× 90 min training) and a wait list control group (CG) at five sites. At two assessment points, participating oncologists led videotaped medical consultations with simulated patients (SPs) via a privacy compliant video conference platform. SPs were represented by trained actors. The taped conversations were rated for primary outcome (communication skills assessed by adapted COM-ON-checklist and COM-ON-coaching rating scales) by raters blinded for study group. Secondary outcomes included oncologists' self-reported communication skills (Self-Efficacy in Palliative Care Scale, Thanatophobia-Scale, Communication about End of Life Survey, study-specific items) as well as external rating of the SPs. Univariate analyses of covariance with baseline adjustment were used to analyze intervention effects. A total of 141 oncologists [age: mean (standard deviation)= 32.7 (6.3) years, 60% female (nIG= 73, nCG= 68)] participated. Following intervention, the IG showed significantly more improvement in four out of five assessed communication skills: 'reacting to emotions and showing empathy', 'pointing out opportunities and giving hope', 'addressing the EoL' and 'explaining the concept of PC'. IG participants also improved more than CG participants in almost all secondary outcomes assessed by participants and SPs: oncologists' self-efficacy, attitudes towards caring for terminally ill patients, communication strategies and confidence in dealing with PC/EoL-related issues as well as communication quality from the SPs' perspective. Findings indicate that the compact communication skills training PALLI-COM increases oncologists' competencies in early addressing PC/EoL-related issues from different perspectives. Implementation in routine oncology residency might improve advanced cancer care by strengthening these communication skills.

Children and young people as simulated patients: recommendations for safe engagement

Adult simulated patients (SPs) are now embedded in health professions education, prompting the development of practice standards. The comparatively sparse involvement of children and young people as simulated participants in education may account for the absence of standards to underpin their safe practice. Research suggests that children and young people who fulfil simulated participant roles have specific requirements not covered by existing standards. This paper offers recommendations specific to the safe engagement of simulated participants in health professions education that align with published guidelines for working with adult simulated patients. These recommendations include: Practical considerations, safe work environment, scenario development, training for role portrayal, feedback &amp; completion of assessment instruments, parental responsibility and ethical considerations. We hope these recommendations are valuable for anyone working with children or young people in simulated participant roles.

Development and validation of an online tool for assessment of health care providers’ management of suspected malaria in an area, where transmission has been interrupted

BackgroundThe alertness and practice of health care providers (HCPs) in the correct management of suspected malaria (CMSM) (vigilance) is a central component of malaria surveillance following elimination, and it must be established before malaria elimination certification can be granted. This study was designed to develop and validate a rapid tool, Simulated Malaria Online Tool (SMOT), to evaluate HCPs’ practice in relation to the CMSM.MethodsThe study was conducted in East Azerbaijan Province, Islamic Republic of Iran, where no malaria transmission has been reported since 2005. An online tool presenting a suspected malaria case for detection of HCPs’ failures in recognition, diagnosis, treatment and reporting was developed based on literature review and expert opinion. A total of 360 HCPs were allocated to two groups. In one group their performance was tested by simulated patient (SP) methodology as gold standard, and one month later by the online tool to allow assessment of its sensitivity. In the other group, they were tested only by the online tool to allow assessment of any possible bias incurred by the exposure to SPs before the tool.ResultsThe sensitivity of the tool was (98.7%; CI 93.6–99.3). The overall agreement and kappa statistics were 96.6% and 85.6%, respectively. In the group tested by both methods, the failure proportion by SP was 86.1% (CI 80.1–90.8) and by tool 87.2% (CI 81.4–91.7). In the other group, the tool found 85.6% (CI 79.5–90.3) failures. There were no significant differences in detecting failures within or between the groups.ConclusionThe SMOT tool not only showed high validity for detecting HCPs’ failures in relation to CMSM, but it had high rates of agreement with the real-world situation, where malaria transmission has been interrupted. The tool can be used by program managers to evaluate HCPs’ performance and identify sub-groups, whose malaria vigilance should be strengthened. It could also contribute to the evidence base for certification of malaria elimination, and to strengthening prevention of re-establishment of malaria transmission.

Medical students’ experiences of working with simulated patients in challenging communication training

BackgroundPhysicians’ communication skills are important for patient-centered care. Although working with simulated patients (SPs) in case simulations is common for training communication skills, studies seldom include a wide range of challenging behaviors or explore students’ own experiences of learning communication skills with SPs. Therefore, this study was aimed at investigating how medical students perceive communication training involving challenging consultations with SPs and the impact on their learning experiences.MethodsTwenty-three medical students from the same class were interviewed in focus groups about their experiences of simulation training with actors as SPs. In the simulation training, the students were instructed to deliver bad news, manage negative patient reactions, and encourage behavioral changes in reluctant patients. This was followed by feedback and a debriefing exercise. The interviews were analyzed with content analysis.ResultsStudents reported that actors as SPs made the simulations more realistic and enabled them to practice various communication skills for challenging consultations in a safe way and manage their own feelings, thereby promoting new learning experiences. Elements such as actors’ flexibility in changing behaviors during role-play and exposure to different challenging behaviors, like negative emotions, were regarded as valuable. The importance of an accepting and permissive climate for the debriefing exercise was highlighted, though without taking too much time from the simulation training. Feedback directly from the SP was appreciated.ConclusionsActors as SPs were perceived as a valuable part of challenging communication training and added elements to the learning process. Future studies should include a wider range of challenging behaviors in training with SPs and evaluate the effects of such training on students’ use of communication skills.

The lived experience of clinical instructors as simulated patients: a qualitative study

Purpose: Simulated patients (SPs) during simulated learning experiences (SLEs) are typically played by a trained actor, potentially requiring significant training time and cost. The participating university’s physical therapist (PT) education program recruits clinical instructors (CIs) to play the SP role during SLEs that represent various learning environments (in and out patient). As there is limited literature exploring the SP experience, especially from a clinician perspective, the purpose of this qualitative inquiry was to describe the lived experience of CIs as SPs. Methods: This qualitative inquiry used an inductive approach to identify the experiences of CIs as SPs. Eight CIs participated in an individual semi-structured interview to gather their perspectives about their experiences playing the SP role during SLEs. A constant-comparative approach was used to develop codes, which were further collapsed into categories and main themes. Member checks and peer review were conducted to establish trustworthiness of the findings. Results: Qualitative analysis revealed four main themes: (1) Becoming the Patient, (2) A Window into the Student Experience, (3) We See It Every Day: Using Experience to Guide Performance, and (4) Giving Back Through Teaching. Conclusion: Being an SP was an enjoyable experience that allowed CIs to participate in teaching and give back to their profession. Empathy gained for both patients and students through the SP experience influenced the CIs’ own clinical practice and may enhance CIs’ preparation for student clinical experiences and improve CI mentoring skills.

Critical appraisal of simulated patient methodology to assess the practice of community pharmacist in the Middle East and North Africa region: A systematic review.

The use of simulated patient (SP) methodology in pharmacy practice settings has increased recently. However, its applications can vary significantly within a region, hence affecting the quality of the SP methodology. The purpose of this systematic review is to critically assess the use of the SP methodology for assessing the practice of community pharmacists (CP) in the Middle East and North Africa (MENA) region. A comprehensive literature search was conducted using EMBASE, MEDLINE, ProQuest, and SCOPUS to identify articles published from 2011 to 2022. The selection of relevant studies for inclusion in the systematic review was based on the pre-determined inclusion criteria. The Mixed Method Appraisal Tool (MMAT) was used to assess the methodological quality of the included studies. Electronic search yielded 478 publications. A total of 45 studies were reviewed. The studies were conducted in 12 countries of the MENA region. The sample size between the reviewed articles ranged from 20 to 1000 (median= 129). A greater number of the included studies measured the adequacy of skill (pre-dispensing and/or post-dispensing) 38 (84.4%). The vast majority of the studies reported unsatisfactory results regarding the competencies of CP. The number of the SP ranged from 1 to 37 (median= 2). Most of the studies recruited only one SP per pharmacy 35 (77.8%). The most common data collection method was written data collection form 42 (93.3%). Few studies only had a detection system for SP visits 11 (24.4%), and only six studies incorporated performance feedback (13.3%). More than two-thirds of the studies provided a training session for SP 37 (82.2%). There was variation in the symptoms and drugs used in the SP scenarios in the studies. Although the results demonstrate the growth in the use of the SP method in MENA region countries, studies showed high variability in the level of reporting the study methodology. Consequently, we argue the need for standardized reporting of these studies.

Online student tutorials for effective peer teaching in digital times: a longitudinal quantitative study

BackgroundPeer-assisted learning represents a favoured method of teaching in universities. The COVID-19 pandemic has necessitated transferring medical education to digital formats, and subsequently, the question has arisen of whether online tutorials might be effective. This study, thus, investigated the efficacy of online tutorials in a communication course by assessing the interaction, verbal communication, and nonverbal communication of tutors and students.MethodsSecond-year medical students were invited to participate in this longitudinal quantitative study. Validated and self-developed questionnaires (e.g., Jefferson Empathy Scale) including 39 questions (rated on a 7- or 5-point Likert scale) were used to assess the different variables including interaction, verbal and nonverbal communication and students’ learning success.ResultsOut of 165 medical students, 128 took part in the study. The students as well as tutors reported that they found each other likeable (Mstudents = 4.60±0.71; Mtutors = 4.38±0.53; p > .05). Learning success increased throughout the communication course (Cohen’s d = 0.36–0.74). The nonverbal and verbal communication in the simulated patient (SP) encounter was also rated as high by all three groups (Mnonverbal = 3.90±0.83; Mverbal = 4.88±0.35).ConclusionsInteraction as well as nonverbal and verbal communication occurred in the online format, indicating that online tutorials can be effective. The implementation of SPs increases the efficiency of synchronous online learning as it enhances the simulation of a real patient–physician encounter. Thus, online tutorials are a valuable amendment to medical education.

Influence of using simulated or real patients on undergraduate medical students acquiring competencies in medical conversations in surgery: Aprospective, controlled study.

BackgroundCommunication with patients and their relatives as well as with colleagues and students is an essential part of every physician's daily work. An established method for teaching communication skills is using simulated patients (SPs). However, teaching with SPs is often subjectively perceived by medical students as less instructive than teaching with real patients (RPs). Studies that analyze the influence of SPs compared to RPs for acquiring competencies are lacking. The aim of the present study was therefore to investigate the impact of SPs on long-term learning success for communication skills compared to RPs.Material and MethodsStudy participants were undergraduate third-year medical students who attended a communication unit and were randomized into three groups. The first group trained the role-play part with a SP (SP-group). The second group trained with a SP but thought that the patient was a RP because the students and the tutors were told that they were a RP by the principal investigator (incognito patient group [IP-group]). The third group and their tutors trained with a RP and were told that the patient was a RP (real patient group [RP-group]). Five to 12 weeks after completing the training, the study participants completed a curricular summative objective standardized clinical examination.ResultsThere were 146 students who participated in the study. There were no significant differences between the three study groups at the informed consent stations and for those conducting anamnesis interviews.ConclusionCommunication skills training with SPs appears to be equivalent to training with RPs in terms of competency development in communication-based assessments in surgery. Therefore, SPs should be used in these curricula, especially at an early stage, to enable the students to practice adequate communication skills.

Addressing the opioid epidemic through community pharmacy engagement: Study protocol for a randomized controlled trial

BackgroundDespite the authority to dispense naloxone, pharmacists have been reluctant to offer and dispense it, often due to discomfort communicating about the sensitive topic of opioid overdose. Because existing online naloxone trainings do not sufficiently address how to communicate effectively with patients about naloxone, Nalox-Comm, a training module designed to improve pharmacists' self-efficacy to engage in naloxone discussions, was developed. ObjectiveTo describe the study protocol to evaluate the effectiveness of the Nalox-Comm training module on naloxone dispensing rates. MethodsA randomized controlled trial, which began in July 2021, is used to evaluate the pre-post Nalox-Comm training intervention. Sixty pharmacists are being recruited from 62 pharmacies part of a single grocery store chain in rural counties of the southeastern United States. After completing a baseline survey, pharmacists are observed by simulated patients (SPs) who rate the quality of their pre-training naloxone communication. Pharmacists are then invited to complete either a basic online naloxone training module (control group) or a newly developed Nalox-Comm training (experimental group), after which they complete a post-training survey and are observed a second time by SPs. Three months post-training, study participants complete a final follow-up survey. Naloxone dispensing records are obtained from each participating pharmacy to assess change in naloxone dispensing rates. ConclusionInformed by rural pharmacist stakeholders, the Nalox-Comm training module addresses communication barriers specific to rural communities. Compared to those in the control group, we hypothesize that pharmacies in the experimental group will dispense more naloxone in the three months post-training intervention.