Simulated Person Research Articles

Shared decision-making and detection of comorbidities in an online acromegaly consultation with and without the Acromegaly Disease Activity Tool ACRODAT® using the simulated person approach

ObjectiveA patient-centered approach to the management of acromegaly includes disease activity control, shared decision-making and identification of comorbidities. The Acromegaly Disease Activity Tool (ACRODAT®) is intended to assist physicians in providing such holistic management. The present study investigated this claim using the simulated person (SP) approach.MethodsWe studied patient-doctor interaction via online video consultation in a randomized prospective study design with SPs trained to simulate a specific acromegaly profile. We analyzed the proportion of conversation time devoted to health content and the specific acromegaly and comorbidity relevant categories mentioned in the conversation. We collected physicians’ feedback on the usefulness of ACRODAT®, SPs subjective perception of the quality of the conversation and compared consultations with and without ACRODAT® using a qualitative approach.ResultsThe sample (N = 30) consisted of endocrinologists treating patients with acromegaly in Germany. For SP-physician interactions (N = 60), the proportion of time spent on conversation content (e.g. IGF-I, quality of life) was distributed according to the focus of the patient profile. Comorbidities were less well identified than the need for a change in therapy. Only 18.3% of the SPs were actively asked to participate in the decision-making process. ACRODAT® did not lead to any significant differences in the course of the discussion.ConclusionsShared decision-making was underrepresented in this SP-physician interaction in acromegaly management. Physicians adapted the content of the discussion to the SP’s needs, but did not adequately address comorbidities. According to the analysis criteria used, ACRODAT® did not contribute to a more holistic patient management in the present study.

Crisis as a chance. A digital training of social competencies with simulated persons at the Medical Faculty of RWTH Aachen, due to the lack of attendance teaching in the SARS-Cov-2 pandemic.

Objective: The AIXTRA Competence Center for Training and Patient Safety at RWTH Aachen University has developed a concept to enable learning of communication skills with simulated persons (SP) digitally. Methodology: Existing SP cases in curricular teaching were checked for digital applicability and modified. Digital seminars with the methodology of simulated conversations with SP, for planned 690 students for the courses “history taking”, 6th semester, conversations in psychiatry, 8th semester, and in the clinical competence course, 10th semester, were conducted via video conferencing software. The structure is similar to SP-seminars in classroom teaching with a case presentation, a doctor/patient dialogue and a feedback session. In the 6th and 10th semester, the seminars were evaluated anonymously by the students using an online questionnaire. SP were asked by e-mail for their assessment. The lecturers were asked about their experience with the digital seminars by means of qualitative interviews.Results: The survey of students with 92 completed questionnaires indicates a high level of acceptance. Digital teaching with SP was rated “very good” by 63% of the students and "good" by 37% as an overall mark for the course. The digital implementation is well practicable, the retention and accessibility of all learning goals is rated as given. Conclusion: Digital teaching with SP can be well realized with appropriate preparation. Specific aspects of digital implementation (e.g. role and data protection) must be taken into account. The differentiated evaluation of the surveys will bring further results and deductive questions.

The digital use of simulated patients in times of the corona pandemic - considerations and proposals.

The corona pandemic has posed major challenges for teaching with simulated persons (SPs), which usually requires the physical presence of the participants. Within a short period of time, a large number of individual solutions were developed. The committee “Simulated Persons” of the Society for Medical Education has developed considerations and proposals in five areas to meet the qualitative challenges of the method.First and foremost, the safety of the SPs is at stake, both in terms of infection prevention and role-related stress to which the SPs are now exposed at home alone instead of the usual setting, where they are in a teaching building with the connection to the staff on site. Furthermore, it should be noted that the changed framework conditions also require a reflection on behalf of the learning objectives, since not all teaching scenarios with SPs can be transferred from a real setting to a digital environment. Furthermore, even under corona conditions, the constructive alignment must not be disregarded, i.e. the question of testability must be considered from the very beginning. Aspects of the technical infrastructure for all participants and compliance with data protection requirements must also be considered. Last but not least, the forced changes are also an opportunity to take a proactive approach to the topic of telemedicine in teaching.

Implementing Virtual Simulated Person Methodology to Support the Shift to Online Learning: Technical Report.

The COVID-19 pandemic has dramatically changed how education is delivered worldwide. The resultant rise of e-learning, whereby teaching is undertaken remotely and on digital platforms, has extensively impacted universities and other higher education organizations around the world. One approach to support this change in education delivery is the use of virtual simulation approaches. Our team at SimXSpace has piloted a virtual workshop using Zoom, an online video-conferencing platform, and virtual simulated persons (SPs) to support communication and interpersonal skills among learners.The main objective of the pilot virtual workshop was to develop and implement the SP methodology remotely via the Zoom platform (Zoom Video Communications, San Jose, California) and to evaluate its effectiveness as an immersive environment for simulation. The virtual workshop involved four instructors who intend to implement virtual SPs within their courses, two workshop facilitators, and two SPs. The workshop was conducted synchronously using Zoom features.The workshop followed a predefined structure and was completed as planned. Outcomes suggest that remote simulation delivery using virtual SPs and delivered online via Zoom is feasible and provides an effective environment in which to conduct SP methodology to teach communication and interpersonal skills. The findings suggest that remote simulation and virtual SPs can support experiential education and provide an effective and engaging learning environment.The virtual workshop was successful and laid a foundation for future online training programs for the use of SP methodology. Moreover, it formed an effective outline for subsequent iterations of this virtual training workshop and prompted discussion of plans for future workshops with various programs across a pan-university context.

Evaluating the Rationality of Antibiotic Dispensing in Treating Common Cold Infections among Pharmacists in Baghdad – Iraq

Background: Common cold is a self limited viral infection, which can be treated symptomatically without the need to antibiotics which are not effective or curative. This study aimed to evaluate the practices of community pharmacists in communicating, diagnosing, treating and counseling patients who are requesting antibiotics for their common cold treatment.Methods: A cross-sectional pilot exploratory study was done in Baghdad – Iraq at which a pharmacist acts as simulated person (SP) in order to collect the data. SP asks the pharmacist about the strongest antibiotic for common cold. SP observed and explored adherence of the pharmacist to law in dispensing over the counter (OTC) and prescription only medications (POM) drugs, patient’s counseling standards, and symptomatic diagnosis of common cold through using WWHAM (who is the patient, what are the symptoms, for how long, any action taken, any medication taken) technique.Results: More than 60% of pharmacists had failed to use WWHAM technique as a method for probing information about the patient and his/her case history. Furthermore there is a significant lack for asking the patients about their past medical history and drug allergy. 45% of Iraqi pharmacists supplied the SP with antibiotic for his common cold. Amoxicillin was the most commonly supplied (44.4%) antibiotic for common cold. Patients' counseling by pharmacists was mostly about the frequency of drug dosing.Conclusion: there are insufficient clinical and communication skills for Iraqi pharmacists who work in community pharmacies, this result not only in an irrational antibiotic dispensing but also in poor pharmacist's ability to counsel and educate the patient about the proper use of the dispensed medications.