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The Role of Simulated Patients in the Education of Doctors 7 th Annual Conference Learning in Law Initiative January 7 th 2005.

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Presentation on theme: "The Role of Simulated Patients in the Education of Doctors 7 th Annual Conference Learning in Law Initiative January 7 th 2005."— Presentation transcript:

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2 The Role of Simulated Patients in the Education of Doctors 7 th Annual Conference Learning in Law Initiative January 7 th 2005

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4 Lessons from Aviation Industry Two Boeing 747s crashed into each other on the runway. 583 people killed. Causes: failures in conflict resolution, assertiveness, communication, situation awareness, decision making.

5 NHS http//: savetheNHS.co.uk

6 Tayside Skills Centres Integral to a high reliability organisation Integral to a high reliability organisation Development of realistic clinical environments for safe practice clinical skills centre, anatomical/theatre skills, surgical skills, orthopaedic skills units Development of realistic clinical environments for safe practice clinical skills centre, anatomical/theatre skills, surgical skills, orthopaedic skills units World of simulated practice World of simulated practice –Identification of training needs –Development of competence –Assessment of performance

7 Role of Simulation in the Education of Doctors Novice Professional Expert Professional ClassroomWorkplace

8 3 Levels of human performance Skill based patterns of thought Skill based patterns of thought Rule based thinking Rule based thinking Knowledge based thinking Knowledge based thinking

9 Minimising Error in human performance The Learning Process Preparation ( schema activation) Preparation ( schema activation) –Evaluate learning Simulated Practice ( schema building) Simulated Practice ( schema building) –Evaluate learning Feedback (schema refinement) Feedback (schema refinement) –Evaluate new learning needs Reinforcement through real practice (schema refinement) Reinforcement through real practice (schema refinement) –Evaluate new learning needs

10 Educational Underpinning in use of Simulation in learning Operant conditioning (Thorndike and Skinner) Operant conditioning (Thorndike and Skinner) Cognitive Constructivism (Dewey, Bruner, Piaget) Cognitive Constructivism (Dewey, Bruner, Piaget) Social Constructivism (Vygotsky,) Social Constructivism (Vygotsky,) Social learning theory (Bandura) Social learning theory (Bandura) Adult learning theory (Knowles, Mezirow) Adult learning theory (Knowles, Mezirow)

11 Shaping the Future of Medical Education European working time directive European working time directive Shifting boundaries Shifting boundaries Modernisation agenda Modernisation agenda Increased patient expectations Increased patient expectations Tomorrows Doctors Tomorrows Doctors Modernising Medical Careers Modernising Medical Careers Scottish Doctor Scottish Doctor Professional practice Professional practice NHS Education for Scotland NHS Education for Scotland E-health E-health

12 Role of simulated /standardised patients in Education of Doctors Novice Professional Expert Professional ClassroomWorkplace

13 Clarifying the Terminology Simulated patient Simulated patient –Person coached to present symptoms and some of signs of an actual patient Standardised patient Standardised patient –Person coached to level where they can consistently portray a medical presentation

14 Who can the simulated/ staandardised patient help? Medical Students Dental Students Nursing Students Professional Examinations e.g. MRCP Postgraduate Education courses Continuing professional education Multi-professional Learning

15 Why are simulated and standardised patients used in medical education? Exposure of students to a wider range of patient conditions Opportunity for medical personnel to receive immediate feedback Assessment of clinical skills Safe and systematic learning environment

16 Value added teaching Realism: Realism: A simulated patient can make the clinical situation real for the student by maintaining a believable character Impact: Simulated patients can enable students to learn from rehearsing and reinforcing good practice Impact: Simulated patients can enable students to learn from rehearsing and reinforcing good practice. Flexibility: Simulated patients are especially valuable when simulations are being repeated as a skill exercise. Flexibility: Simulated patients are especially valuable when simulations are being repeated as a skill exercise. Feedback: A professional SP can be trained in the art of offering unbiased, constructive feedback to the student Feedback: A professional SP can be trained in the art of offering unbiased, constructive feedback to the student

17 What training is required to become a simulated or standardised patient? Advice on scripts Advice on scripts Presenting and involving character Presenting and involving character Role play / Simulation/video Role play / Simulation/video Giving feedback Giving feedback Group work Group work Practice of scenarios Practice of scenarios

18 Chief Complaint: "I’ve been having recurrent “water work” infections" Identifying Data: married, 2 children, good home life. Scenario:You have had 2 episodes of infections in the last 6 months. You have had various courses of antibiotics which initially help but the infections still return. You went through the menopause 10 years ago Patient Profile: Concerned about this problem. You experience pain when passing urine, “feels like peeing broken glass”. You have to pass urine twice as much as usual Occasionally feel unwell and have to go to bed and take paracetamol History of Present Illness :When did it start? 12 months ago. Does it interfere with your life? Yes as you have to look for toilets everywhere. Past Medical History: Answer NO to: allergies, surgery, tobacco, Relieving factors: Drinking plenty of water Medications:.Hormone Replacement tablets, an antibiotic called something ending with –cillin Alcohol: Socially, 1 or 2 glasses of wine a week Hospitalizations: Childbirth, 25 and 20 years ago. Exercise: I usually swim, walk, Family History: Live with spouse Questions to Ask: 1.What do you think is causing these infections? 2.Is this a treatable? 2.Is this a treatable? A Simulated Patient Script

19 WORKSHOP TITLE Descriptor INDUCTION TRAINING FOR NEW RECRUITS (4 hour session) Brief history of simulated patient programme. Orientation, introduction to scripts and tuition on role play. Patients will have an opportunity to practice their skills. USING SCRIPTS AND DEVELOPMENT OF FUTURE MATERIAL Participative session exploring the use of existing scenarios and scripts and how these can be developed further. ROLE PLAY AND SIMULATION SKILLS Tips and techniques will be discussed to cover: preparation before role play/simulation and clarification of what is required during role play. Tips and techniques will be discussed to cover: preparation before role play/simulation and clarification of what is required during role play. PRESENTATION SKILLS IN ORDER TO CREATE A CONVINCING CHARACTER This workshop will look into the different aspects of presentation skills and explore ideas to help you to prepare for your role. OSCE TRAINING – MEDICAL This will take place prior to any OSCE examination OSCE TRAINING - NURSING This will take place prior to any OSCE examination

20 Provide safe simulated clinical environments for clinical practice Ward simulation exercise Ward simulation exercise GP simulated surgeries GP simulated surgeries

21 The doctor-patient relationship Doctor’s agenda Patient’s agenda

22 Factors affecting doctor-patient relationship Internal factors Internal factors –Personalities –Clinical setting –Expertise level –Problem type –Illness/disease –Power balance External factors External factors –Treatment options –Internet –Specialisms in medicine –Resources –Targets –Evidence base –Public perception

23 Simulated/standardised patients role in education of doctors Physical examinations Physical examinations Performing specific procedures Performing specific procedures Clerking in different clinical settings Clerking in different clinical settings Hospital admission Hospital admission Receiving advice & information Receiving advice & information Receiving bad news scenarios Receiving bad news scenarios Clinical assessment Clinical assessment

24 Simulated patients History and examination skills History and examination skills

25 Performing specific procedures Blood tests Blood tests Blood pressure Blood pressure Patient complaint Patient complaint Wound dressing Wound dressing Giving set needs primed Giving set needs primed

26 Hospital admission

27 Giving advice

28 Clinical Assessment

29 Advantages of simulated patients Availability Availability Staged to level of experience Staged to level of experience Safe to make and analyse errors Safe to make and analyse errors Opportunity for patient feedback Opportunity for patient feedback Links with community Links with community Realistic scenarios Realistic scenarios Sensitive consultations Sensitive consultations

30 Advantages of standardised patients Participation in the assessment process Participation in the assessment process Toleration levels Toleration levels Provide consistency Provide consistency

31 Developing a simulated patient bank Recruitment & retention Recruitment & retention Selection / Screening Selection / Screening Training (Initial and ongoing) Training (Initial and ongoing) Cost (Expenses or Payment) Cost (Expenses or Payment) Time Time Script Writing Script Writing Logistics Logistics

32 Simulated Medical Ward for Assessment of PRHOs Aim: To identify the realistic components Aim: To identify the realistic components for a simulated medical ward for a simulated medical ward

33 Methodology Design of exercise Design of exercise –Content realism PRHO shadowing PRHO shadowing Multi-professional focus groups Multi-professional focus groups Literature review Literature review Inpatient admission review Inpatient admission review PHAST screening tool PHAST screening tool –Process realism Timed interruptions by AHPs Timed interruptions by AHPs SP cues SP cues Staffing Staffing Common pitfalls/errors in practice Common pitfalls/errors in practice Design of evaluation Design of evaluation –Semi-structured interviews

34 Results A spects of realism in relation to content Realistic Patients

35 Realistic Emergencies

36 Results Aspects of realism in relation to process Ward handover Ward handover Interruptions Interruptions Errors/Pitfalls Errors/Pitfalls Nursing support Nursing support External contacts External contacts

37 Teamwork Communication Time Management Decision Making Results Non-technical skills of PRHOs

38 Conclusions Feasibility study Feasibility study Different sources for design Different sources for design Trade off between patient care and focus on performance Trade off between patient care and focus on performance Future use in assessment Future use in assessment Future use in remediation Future use in remediation Future use in other professional groups Future use in other professional groups Future role for patients Future role for patients

39 What support simulated patient want? Aim Aim to ascertain training needs of SPs Methodology Methodology Likert type questionnaire on types of training and desired frequency

40 Simulated Patient Programme Session 2003 / 2004 Evaluation of Training Please allocate your preference for the following training sessions which could be offered to you as a simulated patient. Desire leastDesire most Giving feedback to students Instructions on scripts Role play skills Written feedback on your performances Verbal feedback on performance Video feedback on your performance Standardised OSCE performance How often do you wish to receive this training? (Please tick only one for each training session) 3/126/1212/12 Giving feedback to students[][][] Instruction on scripts[][][] Role play skills[][][] Written feedback on your performances[][][] Verbal feedback on performance[][][] Video feedback on your performance[][][] Standardised OSCE performance[][][]

41 Results Six monthly training sessions were most frequently requested for receiving verbal feedback 1 = 3 months 2 = 6 months 3 = 12 months 4 = Non Applicable

42 Results The majority of Simulated Patients requested training in giving feedback to students. 1 = Desired Least 5 = Desired Most 6 = Non Applicable

43 Opportunities for law Simulated clients Simulated clients –Individual –Commercial company Standardised clients Standardised clients –For standard performance assessment Simulated juries Simulated juries –Develop cross examination skills


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