Transcript Simulating Patient - Pushpa Raj Sharma

Simulated patient/Parent
in teaching communication
skill
Prof. Pushpa Raj Sharma
The golden age
• “ for the junior student in medicine
and surgery it is a safe rule to have
no teaching without a patient for a
text, and the best teaching is that
taught by patient himself”
William Osler, 1905
Osler W. The hospital as a college. ChapterXVI In: Acquaminates, and Other Addresses. London: HK
Lewis, 1905
Present crowd
“ if musicians learned to play their instruments as
physicians learn to interview patients, the
procedure would consist of presenting in lectures or
maybe in a demonstration or two the theory and
mechanism of the music producing ability of the
instrument and telling him to produce a melody. The
instructor of course , would not be present to
observe or listen to the student’s efforts, but would
be satisfied with the student’s verbal report of what
came out of the instrument”
George Engel, after visiting 70 medical schools in North
America
Teaching bedside clinical
medicine :present scenario
specially in paediatrics
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Three months time
Two dozen student
Ethical
Parents concern
The two options
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Brief contact
Passive role
Time limited
Inexperienced
Unplanned
encounter
• Real situation
• Unknown patient
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Prolonged contact
Active role
Time committed
Experienced
Planned encounter
• Simulated situation
• Known patient
The two choice
• Undifferentiated
problem
• General
• Particular focus
• Patient fear
• Hidden attitudes
• Defined problem
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Specific
Known focus
Friendly
Revealed attitudes
Two places
• Crowded ward
• Sitting
arrangement
• Service oriented
• Patient culture
• Teaching room
• Educative
arrangement
• Teaching / learning
oriented
• Student culture
Alternatives
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More months
Less students
Simulated patients / parents
Manikins
Computerized
2005
In 2005 Department
of Child Health, IOM
Introduced simulated
parent for pediatric
history taking.
What is simulated
patient / parent (SPs)?
• Simulated Patient is an individual "who has
been trained to accurately recreate the
history, personality, emotional structure,
responses and physical findings of an actual
patient." (Barrows, 1971)
• Standardized Patients are individuals trained
to present a clinical problem in a
reproducible manner. (Barrows, 1971; Stillman,
1987)
Advantage of Simulated
patient/parent.
• SPs are used for various educational
experiences throughout the Medical
school.
• They are an important resource in
bridging the gap between lectures
and practical applications
What they can teach?
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Interviewing/History Taking
Physical Examination
Interpersonal skills
Patient Education/Counseling
Who can be a simulated
parent / patient?
• Knowledge of: who
is a SP ?
• Motivation for
wanting to be a SP
• Communication
skills
• Comprehension
skills
• Ability to perform
a case
• Availability for
participation
• Ability to complete
a checklist
SPs are selected to
perform cases based upon
the following:
• Case-specific requirements
• Availability for training and performance
• Ability to accurately and consistently
portray the case
• Reliability
• Ability to understand the goals of the case
Pneumonia,
arthritis
Howard Barrows’ creation of the
first standardized patient.
• In the absence of observation and
feedback, errors could persist.
• Patient description: hostile and
performed uncomfortable
examination.
• Film did not include elements of
observation and feedback.
Simulated parents/patients
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Case specific
Convenience
Safe practice
Ethical
compression/expansion time
Efficient use of faculty / students
time
Simulated parents/patients
• Clinical competence is highly specific
• Can ensure broad exposure to a variety
of cases.
• Allows direct comparison of students
clinical skill.
• Students weakness and strengths.
What it should contain?
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Carefully screened and trained.
Global and checklist ratings.
Avoid personal agenda.
Incentives
Opening the history:
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Patient centered communication
Talking with patients
Non verbal communication
Adherence in the doctor-patient
relationship
• Cross cultural communication
Specific concerns
• Lack of opening skills: poor eye
contact, not introducing self, not
making sure patient was comfortable,
no introducing Namaste.
• Lack of engagement skills: no open
ended questions, taking notes of
every statement, rapid fire yes or no
questions, overuse of medical
jargons.
Specific concerns:
• Lack of empathy skills: poor
nonverbal communication (both arm in
pocket, loud commanding voice,
standing, all instruments, pen, paper
in the bed), no acknowledgement of
patients information.
• The closing: abrupt without thanking
and what happens next.
Your department:
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Identify dedicated faculty.
Determine time, cost, facility.
Determine the needed skill
Allot skill to different faculty
Identify the other non medical or
paramedical staff for simulated patient
• Develop a simulated patient bank.
• Provide feed back.
Actors briefing:
• You are a father of 1 yr old son. Afraid of
coming to hospital. You have observed
runny nose and cough for 3 days. Your son
was treated by a faith healer without
improvement.
• You are from village. You are a farmer.
Poor sanitary practices. Home delivery. No
immunization. Smoke, domestic smoke
pollution, not enough food. Three other
children: three girls: yrs 2, 4, 6.
Now we will see a video
clip of a simulated
parent
This
presentation is freely
available on
prsharma.com.np