the role of simulated patients in sl

8/12/2019 The Role of Simulated Patients in SL

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The r ol e of si mul at edpat i ent

i n t he ski l l s l abor at or ypr ogr amsGandes Retno Rahayu

Department of Medical EducationGadjah Mada University



The simulated patienta normal person who has been carefully coached toaccurately portray a specific actual patient whengiven the history and physical examination (Barrows1987, 1993)

simulation of reality

Standardized patientspeople, with or without actual diseases, who havebeen trained to portray a medical case in a consistentfashion. These people may portray their ownproblem(s) or ones based on those of other patients(RCSA, 1993; Collins and Harden, 1998)

consistency of presentation



Role Player

allows students to learn about roles and

interpersonal professional interactions,but relies on their understanding of whatthat role is rather than the understanding

of the actual patient or physician.



Subject

People on whom students practice

interview and physical examinationtechniques, or observe and probe as aliving body. These subjects are normal

people and they are not portraying anyparticular patient problem.



Practical Instructor

They are carefully educated to teachmedical students in the techniques ofphysical examination on themselves.

Practical instructors may or may not be

SPs.



Patient Instructor

patients with stable abnormal physicalfindings who have been educated about

their own illnesses and the specificquestions and examination techniques thatshould be carried out to discover their

symptoms and signs. The use of patients inthis way is more common in North America

(Ledingham and Harden, 1998).



Mythological patient

simulations prepared out of the

imagination, patients who never reallyexisted or a compilation of a number

of real patients



Ski l l s t r ai ni ng

1. Arouse motivation2. Preparation stage3. Teacher-guided training session in a group

4. Practice without teacher to develop a stableautomatic reaction scheme5. Working with simulated patients

6. Working with real patients

Assessment at certain points



The use of standardized patients

For supporting learning processFor assessment



Number of medical schools used standardized patients in instruction of medical students in thefollowing skills:

- history-taking (106 schools)- doctor-patient communication skills (104)- general physical examination skills (93)- specialized physical exam skills, such as the

gynecologic or urologic exam (114)Liaison Committee on Medical Education(LCME), 2000-2001)



Real Pat i ent vs Si mul at edPat i ent

Aspect of physicalexamination or historytaking is easily simulated

Physical signs to beassessed are not easilysimulated

Simulation

Simulated patientexpensive

Real patient inexpensiveCost

Formal examination inarranged setting

Assessment on the job,in practice

Context

Continuous examinationsOccasional or intermittentclinical examination

Frequency

Standardization essentialStandardization lessimportant

Standardization

Simulated patientsreadily available

Real patients do notalways available

Availabil ity

Simulated patientReal PatientFactors



Fact or s f or choosi ng SPs

The role expected of the patientThe level of standardization requiredLocal logistics including experience of using

the different approaches, availability of thedifferent options and costThe context for the assessmentThe requirement for realism or authenticity(Collins and Harden, 1998 )



I ssues r el at ed t o SPsRecr ui t ment

Recruit SPs from community volunteers,students, colleagues, acting groups or othergroups such as teachersRecruit SPs by word of mouth, throughexisting patients, from personal contacts andby advertising in the local paper Select individuals who have the ability toportray the important clinical features of apatient’s problem. The characteristic of theindividual are as important.



Personal characteristic of goodSP

intelligence, appropriate motivation, flexible workschedule, stamina, emotional and geographic stability

an appropriate match between case and individual

variables, including age, ethnic origin, gender, andpersonal characteristics such as weight, height andphysical features

Good attitude to medical profession



SPs Tr ai ner

Recruit trainers of SP from healthcareprofessionals, particularly those with aninterest in education

Trainers themselves should receiveappropriate training an will benefit fromobserving experienced trainers in action.

the role of simulated patients in sl

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