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Establishing a Convention for Acting in Healthcare Simulation Merging Art and Science
Abstract
Summary statement:
Among the most powerful tools available to simulation instructors is a confederate. Although technical and logical realism is dictated by the simulation platform and setting, the quality of role playing by confederates strongly determines psychological or emotional fidelity of simulation. The highest level of realism, however, is achieved when the confederates are properly trained. Theater and acting methodology can provide simulation educators a framework from which to establish an acting convention specific to the discipline of healthcare simulation. This report attempts to examine simulation through the lens of theater arts and represents an opinion on acting in healthcare simulation for both simulation educators and confederates. It aims to refine the practice of simulation by embracing the lessons of the theater community. Although the application of these approaches in healthcare education has been described in the literature, a systematic way of organizing, publicizing, or documenting the acting within healthcare simulation has never been completed. Therefore, we attempt, for the first time, to take on this challenge and create a resource, which infuses theater arts into the practice of healthcare simulation.
... [1] It will not be wrong to state that traditional lecture methods not only fall short in meeting the needs of students with different learning styles, but are also not a suitable option to encourage critical thinking, clinical reasoning, problem-solving, and decision-making skills. [1,2] More often than not, these lectures fail to relate the gained knowledge with clinical practice, and thus students are not able to establish the clinical relevance. This calls for the need to adopt innovative teaching-learning methods to ensure better clinical teaching and improve doctor-patient interactions. ...
... This calls for the need to adopt innovative teaching-learning methods to ensure better clinical teaching and improve doctor-patient interactions. [1,2] ...
... art encourages creativity and curiosity. [2] The use of theater in medical education is not new by any means and has been in practice for quite some time in different medical institutions spread across the world. [1][2][3][4][5][6][7][8][9][10][11][12] Theater is extremely useful to help medical students to understand various life-threatening scenarios and settings that require medical humanities incorporation. ...
The knowledge and skills expected of medical graduates upon completion of their undergraduate training are extremely vast and dynamic. Medicine has to be acknowledged as a combination of science and art, with science appealing to the scientific minds, while art encourages creativity and curiosity. The use of theater in medical education is not new by any means and has been extremely useful to help medical students to understand various life-threatening scenarios and settings that require medical humanities incorporation. To conclude, considering the complexities involved in the clinical training of a medical graduate student, it is our responsibility to adopt innovative teaching-learning methods. The use of theater in medical education delivery has been associated with developing many attributes of the hidden curriculum, including empathy, self-awareness, professionalism, and communication skills. The need of the hour is to acknowledge the potential of theater and integrate it with the existing curriculum to optimize the training of medical students.
... They play important roles in simulation by enriching immersive simulation encounters and bringing a deeper sense of realism to the scenario. Some consider them one of the most powerful educators within simulation encounters (Nestel, Mobley, Hunt, & Eppich, 2014;Sanko et al., 2013). However, there is very little published data on the evaluation of the portrayal accuracy of confederates in immersive simulation encounters (Nestel et al., 2014). ...
... Recent publications are helping to highlight the importance of having well-trained, competent confederates and ways to improve their contributions to simulation-based education (Battista, Antonis, Kenez, Pate, Keenan, & Hermosura, 2016;Nestel et al., 2014;Sanko et al., 2013Sanko et al., , 2015Smith, Gephardt, & Nestle, 2015). However, a reliable and valid tool to objectively measure their performance is absent. ...
... A practice guide was published in August of 2013 (Sanko et al., 2013) and provided a foundation for the development of the Actions, Communication, and Teaching in ...
Confederates defined as an individual other than the (standardized/simulated) patient who is scripted in a simulation to provide realism, additional challenges, or additional information for the participant are considered important for the success of simulation encounters; however, these support people are only as good as the quality of their contribution to the overall educational experience. Assessment of confederates is important in the establishment of consistent and high-quality educational experiences. The Actions, Communication, and Teaching in Simulation tool is a single-factor, five-item measure, utilizing a seven-point behaviorally anchored scale rating structure developed to tap into important attributes of confederates' role portrayal in simulation encounters. The assessed items include acting, verbal, and nonverbal characterization; flexibility and adaptability; use of props and attire; and interactions with participants and other confederates.
... One of the challenges for SPs and those who train them can be to create authentic and engaged characters. To address this need, there has been increasing interest in borrowing from theories and practices in the dramatic arts that focus on actor training (Case & Brauner, 2010;Nestel, Fleishman, & Bearman, 2015;Sanko et al., 2013;Wallace, 2007). There are some key differences between actors and SPs related to the unique professional attributes and skills of each occupation and also to the objectives of each task (McNaughton, 2012;Nelles, 2011;Smith, Edlington, Lawton, & Nestel, 2015). ...
... Even in an apparently simple role, SPs must simultaneously integrate domains (cognitive, physical, and psychological) to portray someone else as they interact with trainees, who are also playing the role of themselves. Within a session, SPs may be both in and out of role, engaging trainees by demonstrating appropriate verbal and nonverbal behaviour, providing relevant cues to guide the interaction, calibrating their performance to increase or decrease a trainee's cognitive load, and sometimes retaining information that they will use to assess trainees or provide feedback (Nestel et al., 2014;Paige & Morin, 2013;Sanko et al., 2013;Smith et al., 2015). SPs must also be trained in such a way that their portrayal is linked to the goals and objectives and the level of learner in the simulation session. ...
... Trainees should be able to feel that the SPs are as real as the proxies they represent. Casting SPs in roles that they cannot realistically portray can derail the learning objectives and leave trainees and SPs feeling self-conscious or incompetent (Dieckmann, Manser, Wehner, & Rall, 2007b;Nestel et al., 2014;Sanko et al., 2013). Realism is a relative concept to all involved in the simulation activity. ...
This article examines how the approach of Russian theatre practitioner Constantin Stanislavski (1863-1938) can inform and guide simulated participants (SPs) such as simulated/standardized patients and confederates to step into role, or character, and authentically engage health care trainees. We will address concepts related to SP role portrayal, including role play and realism, and then present a model for creating characters based on aspects of Stanislavski's theory, including origins, an overview and selected features. Finally, applications to SP role portrayal in health care will be explored. A systematic and person-centred experiential training process for role portrayal that incorporates elements of Stanislavski's approach, such as proposed by Nestel, Fleishman, and Bearman (2015), can optimize the impact of SP engagement. © 2015 International Nursing Association for Clinical Simulation and Learning.
... Simulation is an activity, which represents real or potentially real world activities, including hypothetical situations such as major disasters. Examples can range from the focused practice of a skill such as a surgical procedure to a communication exercise with a simulated patient or a confederate who is someone acting the role of a patient relative or a clinician for a specific purpose in relation to the scenario learning objectives (Sanko et al., 2013). The focus of this article is the fidelity of the simulation experience from the perspective of the learners and not the simulators used. ...
... The deception can also be linked to the technological aspect of the simulation experience, whereby participants are made to believe that a drain is connected to the patient whereas it is linked to a reservoir located in a control room where an operator adjusts the flow of blood or urine. Another common area that can be perceived as deceptive from the perspective of the learners is the use of well-trained confederates in a scenario and whose role can significantly enhance the level of realism of a scenario thanks to their acting capabilities, but they can also play an important role as purposeful distractors unknowingly to the learners or be supportive colleagues (Sanko et al., 2013). We would however like to expand on Dieckmann's suggestion and instead suggest a more pragmatic approach which we term benevolent deception, a term that is sometimes used in healthcare whereby deception is used to benefit the deceived, in this case the trainee. ...
... We would however like to expand on Dieckmann's suggestion and instead suggest a more pragmatic approach which we term benevolent deception, a term that is sometimes used in healthcare whereby deception is used to benefit the deceived, in this case the trainee. This is done so specific events can occur realistically during a scenario, bringing up pre-determined learning objectives enhancing the learning experience of the trainees (Alinier, 2011;Sanko et al., 2013). ...
Background. Fidelity - an intrinsic property of simulation is crucial to simulation design and to educational effectiveness. Yet the term fidelity is inconsistently used, which makes it difficult to draw inferences from current literature and translate research into practice.
Aim. In this article, we attempt to bring some clarity to the term simulation fidelity in healthcare education.
Method. We are opposed to the notion that high-fidelity simulation requires complete and faithful replication of reality, and instead argue for an accurate representation of real-world cues and stimuli. We address a number of issues surrounding the term fidelity and how it is currently used in the literature.
Result. In recognising the limitations of current methods of describing fidelity in the literature, we propose an alternative 3-dimensional framework for fidelity along the axes of the patient, clinical scenario, and healthcare facilities as a means for more precise and practical positioning of current healthcare simulation activities.
Conclusion. All aspects of fidelity significantly hinge on the learners’ perceived realism of the context of the learning episode as opposed to any one particular element such as the technology used.
... Dans ce contexte clinique, les étudiants s'efforcent d'être performants afin de ne pas nuire aux patients ; dans le contexte de simulation, ce facteur de motivation est absent puisque les patients ne sont ni malades ni vulnérables. La motivation des étudiants doit donc être renforcée par des facteurs externes comme le réalisme de la simulation [5]. Ce qui est perçu par les apprenants comme réel ou fictif pendant la simulation est fortement influencé par la crédibilité et la cohérence du jeu de rôle des PS. ...
... Cependant, cette amélioration perçue par les PS sur leurs habiletés de jeu de rôle ne doit pas nous amener à conclure que le briefing est suffisant. Des techniques de formation au jeu de rôle et à la rétroaction devraient être proposées aux PS dans le cadre de formation thématique pour les aider à s'outiller encore mieux pour agir dans le milieu de la simulation [5]. ...
Problématique : La formation des patients simulés (PS) est nécessaire pour répondre aux critères d’authenticité de la simulation. Dans le cadre de cliniques simulées, nous avons mis en place un nouveau format de briefing des PS, créé à partir d’un modèle de formation issu des arts du théâtre, combiné au briefing habituel du monde de la simulation. Objectif : Décrire les effets perçus du briefing en cinq étapes sur la préparation des PS à la pratique simulée. Méthodes : Étude qualitative et descriptive. Dix-sept PS ont répondu à un questionnaire en ligne. L’analyse inductive des données a été effectuée par trois chercheurs. Résultats : Les PS perçoivent une meilleure compréhension du scénario, une amélioration de leurs habiletés d’interprétation et de mémorisation ainsi qu’un renforcement de leur sentiment d’appartenance. Conclusion : Le briefing en cinq étapes répond au besoin d’avoir une formation courte, ponctuelle, ciblée sur le cas et propice à un encadrement sûr des PS. Il est complémentaire des formations longues et thématiques, offertes périodiquement. Une évaluation des effets observables de ce briefing sur la performance réelle des PS devrait être envisagée.
... As SBE is being developed, simulation spaces, locations, and SP presentation should closely mimic actual patient care (Muckler, 2017;Pascucci, Weinstock, O'connor, Fancy, & Meyer, 2014;Sideras et al., 2013). For example, if the intended simulated learning environment is a homecare simulation but is conducted with an SP wearing a hospital gown in a space that mimics acute care, SPs will have difficulty remaining in character, and participants will struggle to suspend disbelief throughout the simulation because the ''scene'' is not cohesive with the identified setting for the interaction (Pascucci, Weinstock, O'connor, Fancy, & Meyer, 2014;Sanko, Shekhter, Kyle, Di Benedetto, & Birnbach, 2013;Wilson & Price, 2015). Environmental fidelity provides the correct auditory and visual cues to improve engagement from both the participants and SPs, fostering an opportunity for assessment of communication skills and high-level decision making (Jones et al., 2011). ...
... Simulated participant programmatic policy and procedure should include principles, such as initial SP training and professional development workshops, SP self-evaluation through video playback, and a process for formalized feedback from the SP educator that will maximize the learning process (Errichetti, 2015b;Nestel et al., 2011;Lewis 2017;Sanko et al., 2013;Smith, O'Byrne, & Nestel, 2015b). Some of the SP educator's primary responsibilities are to recruit, interview, audition, and educate SPs. ...
The integration of human role players into simulation education is at an all-time high. In 2017, the Association of Standardized Patient Educators released the Standards of Best Practice with the intention of complementing the International Nurses Association for Clinical Simulation and Learning Standards of Best Practicesm: Simulation. As the popularity of human role players in simulation rises, it is imperative to wrap the andragogy with a theoretical framework to ensure simulation-based education (SBE) is maximized for safety, psychological fidelity, and educational outcomes.
This article suggests a modification of the NLN Jeffries Theory into SBE, where human role players and simulated participants are integrated. The identified components of Jeffries Theory, context, background, design, educational practices, simulation experience, and outcomes remain unchanged from the original. The suggested adaptations within each component are also discussed. This modification can be referenced to establish, evaluate, and/or modify simulated participant education programs.
... Medical education plays a crucial role in preparing future healthcare professionals, relying extensively on Simulated Patients (SPs) to provide a safe and controlled environment for practicing clinical skills (Gaba 2007;Ziv et al. 2006;Sanko et al. 2013;Mesquita et al. 2010). However, the traditional use of SPs presents significant challenges, primarily due to the high costs associated with recruiting and training qualified individuals (Hillier, Williams, and Chidume 2020;Felix and Simon 2019). ...
Medical education relies heavily on Simulated Patients (SPs) to provide a safe environment for students to practice clinical skills, including medical image analysis. However, the high cost of recruiting qualified SPs and the lack of diverse medical imaging datasets have presented significant challenges. To address these issues, this paper introduces MedDiT, a novel knowledge-controlled conversational framework that can dynamically generate plausible medical images aligned with simulated patient symptoms, enabling diverse diagnostic skill training. Specifically, MedDiT integrates various patient Knowledge Graphs (KGs), which describe the attributes and symptoms of patients, to dynamically prompt Large Language Models' (LLMs) behavior and control the patient characteristics, mitigating hallucination during medical conversation. Additionally, a well-tuned Diffusion Transformer (DiT) model is incorporated to generate medical images according to the specified patient attributes in the KG. In this paper, we present the capabilities of MedDiT through a practical demonstration, showcasing its ability to act in diverse simulated patient cases and generate the corresponding medical images. This can provide an abundant and interactive learning experience for students, advancing medical education by offering an immersive simulation platform for future healthcare professionals. The work sheds light on the feasibility of incorporating advanced technologies like LLM, KG, and DiT in education applications, highlighting their potential to address the challenges faced in simulated patient-based medical education.
... His/her role is to help lead the scenario to the correct and wanted direction that is determined in advance according to the pedagogical objectives set by the main instructor of the scenario. He/she promotes the implementation of a realistic environment and ensure learners' full immersion in the simulated context [9]. EPs are briefed and prepared to avoid unwanted, dangerous events or learners' frustration during HFS. ...
Background
The embedded participant (EP) plays a key role during a full scale/high-fidelity simulation (HFS) session. He/she is expected to guide the learner towards the achievement of the educational objectives of the scenario. However, his/her influence on learners’ performance stands undetermined and this effect remains briefly addressed in the literature. This study primarily aims to assess whether the EP could have an influence on the performance of the learner during a HFS scenario. The secondary aim was to establish an inventory of the EP practices in France.
Methods
This retrospective study was conducted in Lyon Claude Bernard University Health Simulation Centre (France). Anaesthesia and critical care residents in postgraduate years 1 to 5 who were scheduled for their HFS sessions during the 2016 to 2021 academic years were included. Two investigators independently evaluated the resident performance regarding both technical and non-technical skills from video recordings. In addition, a nationwide survey was sent out by email through the networks of the Francophone Healthcare Simulation Society (SoFraSimS, Société Francophone de Simulation en Santé) to collect information on EP practices in French-speaking Simulation centres.
Results
From a total of 344 HFS videos analysed, a cohort of 19 experienced EPs was identified. The EPs had an influence on the technical and non-technical performances of the learners. The 147 responses to the survey showed that predefined rules of EP good practice existed in only 36% of the simulation centres and 65% of respondents believed that specific EP training would be justified.
Conclusion
The EP can exert an influence on the performance of the learners during HFS. For acting as an EP, a great variability of practices and a lack of training are reported by professionals working in simulation centres. These results suggest that more attention must be paid to EP training and attitudes during simulation, especially if summative simulations are extensively developed.
... His/her role is to help lead the scenario to the correct and wanted direction that is determined in advance according to the pedagogical objectives set by the main instructor of the scenario. He/she promotes the implementation of a realistic environment and ensure learners' full immersion in the simulated context [9]. EPs are briefed and prepared to avoid unwanted, dangerous events or learners' frustration during HFS. ...
Introduction
The embedded participant (EP) plays a key role during a full scale/high-fidelity simulation (HFS) session. He/she is expected to guide the learner towards the achievement of the educational objectives of the scenario. However, his/her influence on learners’ performance stands undetermined and this effect remains briefly addressed in the literature. This study primarily aims to assess whether the EP could influence on the performance of the learner during a HFS scenario. The secondary aim was to establish an inventory of the EP practices in France.
Methods
This retrospective study was conducted in an academic Health Simulation Centre (France). Anaesthesia and critical care residents in postgraduate years 1 to 5 who were scheduled for their HFS sessions during the 2016 to 2021 academic years were included. Two investigators independently evaluated the resident performance regarding both technical and non-technical skills from video recordings. In addition, a nationwide survey was sent out by email through the networks of the Francophone Healthcare Simulation Society (SoFraSimS, Société Francophone de Simulation en Santé) to collect information on EP practices in French-speaking Simulation centres.
Results
From a total of 344 HFS videos analysed, a cohort of 19 experienced EPs was identified. The EPs had an influence on the technical and non-technical performances of the learners. The 147 responses to the survey showed that predefined rules of EP good practice existed in only 36% of the simulation centres and 65% of respondents believed that specific EP training would be justified.
Conclusion
EP can exert an influence on the performance of the learners during HFS. For acting as an EP, a great variability of practices and a lack of training are reported by professionals working in simulation centres. These results suggest that more attention must be paid to EP training and attitudes during simulation, especially if summative simulations are extensively developed.
... The confederate is not a learner, but a member of the pedagogical team with a scripted role during the simulated practice phase [4]. He aims to provide realism, challenges or information when they cannot be transcribed by the simulator [5,6]. The confederate is used to improve the realism by limiting the biases induced by the simulated environment. ...
Background
During simulation training, the confederate is a member of the pedagogical team. Its role is to facilitate the interaction between participants and the environment, and is thought to increase realism and immersion. Its influence on participants' performance in full-scale simulation remains however unknown. The purpose of this study was to observe the effect of the presence of confederates on the participants’ performance during full-scale simulation of crisis medical situations.
Methods
This was a prospective, randomized study comparing 2 parallel groups. Participants were emergency medicine residents engaging in a simulation session, with or without confederates. Participants were then evaluated on their Crisis Resource Management performance (CRM). The overall performance score on the Ottawa Global Rating Scale was assessed as primary outcome and the 5 non-technical CRM skills as secondary outcomes.
Results
A total of 63 simulation sessions, including 63 residents, were included for statistical analysis (n = 32 for Control group and 31 for Confederate group). The mean Overall Performance score was 3.9 ± 0.8 in the Control group and 4.0 ± 1.1 in the Confederate group, 95% confidence interval of the difference [-0.6; 0.4], p = 0.60. No significant differences between the two groups were observed on each CRM items (leadership, situational awareness, communication, problem solving, resource utilization)
Conclusion
In this randomized and controlled study, the presence of confederates during full-scale simulated practice of crisis medical situations does not seem to influence the CRM skills performance of Emergency medicine residents.
Trial registration
This study does not need to be registered on Clintrial as it does not report a health care intervention on human participants.
... The confederate is not a learner, but a member of the pedagogical team with a scripted role during the simulated practice phase [4]. He aims to provide realism, challenges or information when they cannot be transcribed by the simulator [5][6]. The confederate is used to improve the of realism by limiting the biases induced by the simulated environment. ...
Background: During simulation training, the confederate is a member of the pedagogical team. Its role is to facilitate the interaction between participants and the environment, and is thought to increase realism and immersion. Its influence on participants' performance in full-scale simulation remains however unknown. The purpose of this study was to explore the effect of the presence of a confederate on the participants’ performance during full-scale simulation of crisis medical situations.
Methods: This was a prospective, randomized study comparing 2 parallel groups. Participants were emergency medicine residents engaging in a simulation session, with or without confederates. Participants were then evaluated on their Crisis Resource Management performance (CRM). The overall performance score on the Ottawa Global Rating Scale was assessed as primary outcome and the 5 non-technical CRM skills as secondary outcomes.
Results: A total of 63 simulation sessions, including 63 residents, were included for statistical analysis (n= 32 for Control group and 31 for Confederate group). The mean Overall Performance score was 3.9± 0.8 in the Control group and 4.0± 1.1 in the Confederate group, 95% confidence interval of the difference [-0.6; 0.4], p=0.60. No significant differences between the two groups were observed on each CRM items (leadership, situational awareness, communication, problem solving, resource utilization)
Conclusion: In this randomized and controlled study, the presence of confederates during full-scale simulated practice of crisis medical situations does not seem to improve the CRM skills performance of Emergency medicine residents.
Trial registration: this study does not need to be registered on Clintrial as it doesn’t report a health care intervention on human participants.
... AEAs are individuals added to an SP scenario who are scripted to provide realism, specific challenges, or additional information, such as assuming the role of a pharmacist or social worker. 9,10 The AEAs may be either outside nonprofessionals or students in the relevant discipline. In our scenarios, the AEAs played the roles of social work and pharmacy students in an end-of-life discussion and a chronic pain management scenario, respectively, both complex situations requiring interprofessional teamwork. ...
Background and objectives:
Interprofessional education is a critical component of medical student training, yet it is often difficult to implement. Medical students who learn with, from, and about learners from other disciplines have been shown to create more effective and safe health care teams. The investigators wanted to know how participating in two interprofessional observed structured clinical exams (OSCEs) at Tufts University School of Medicine (TUSM) would affect changes in medical students' attitudes and values in interprofessional teamwork.
Methods:
For the academic years 2017 and 2018, two interprofessional case scenarios were integrated into OSCEs for third-year medical students at TUSM, with an allied embedded actor (AEA) playing a social worker to an end-of-life scenario, and an AEA playing the role of a pharmacy student added to a chronic pain scenario. Students participated in didactic training about interprofessional teamwork and received structured feedback regarding interprofessional competencies following simulation cases. Changes in interprofessional knowledge and attitudes were assessed by comparing student pre- and postscenario mean scores on the Interprofessional Socialization and Valuing Scale (ISVS-21, a 21-item scale survey), with students rating themselves on a Likert scale from 1 (not at all) to 7 (to a very great extent). We performed paired t-test analysis on individual pre- and post-ISVS-21 means.
Results:
Three hundred fifty-three of the 417 participating medical students fully completed pre- and postsurveys. Students reported significant changes in interprofessional knowledge and attitudes (mean change=1.3, P<.0001). Students and faculty regarded the interprofessional cases very highly.
Conclusions:
Placing interprofessional cases involving AEAs into OSCE events is easily replicated, and positively impacts students' attitudes and values in interprofessional knowledge.
... Similarly, there is wide variability in the use of humans in simulation scenarios, including portraying the role of patient, healthcare provider, family member or as someone who helps to keep learners on track. [2][3][4] Terminology used to describe humans' roles in simulation-based education (SBE) has broad variation in the literature. Terms that appear throughout the literature, in standards of practice and professional dictionaries include standardised patient, [5][6][7] simulated patient, [6][7][8] simulated participants, 6 confederate, 4-7 9 embedded actor, 5 6 9 embedded participant 5-7 10 and scenario role player 5 6 9 to name a few. ...
Background
Terminology describing humans’ roles in simulation varies widely. Inconsistent nomenclature is problematic because it inhibits use of a common language, impacting development of a cohesive body of knowledge.
Methods
A literature search was completed to identify terms used to describe roles played by humans in simulation-based education. Based on these findings, a survey was created to explore the terminology used by simulation educators and researchers to describe human roles in simulation and the perceived need for a consistent nomenclature.
Results
Results demonstrated wide variability in terminology, including terms such as standardised patient, simulated patient, simulated participants, confederate, embedded actor and scenario role player.
Conclusion
Creation of a cohesive body of knowledge for human roles in simulation requires use of common terminology, yet findings suggest a complex landscape of terminology. Building consensus on the terminology describing human roles in simulation can clarify understanding of best practice and allow for advancement in the research and state of the science in simulation-based education.
... Wenn darüber gesprochen wird, wie beim Einsatz von SP größtmögliche Authentizität erreicht werden kann, werden eine Fülle von Strategien benannt. Nicht immer gibt es die Möglichkeit, das in der Praxis alles so umzusetzen, trotzdem ist die Zielrichtung klar beschrieben: Die Fälle sollen möglichst auf realen Patientengeschichten basieren, die Darsteller sind idealerweise Schauspieler, die in aufwendigen Rollentrainings darin geschult werden, die Rolle möglichst überzeugend darzustellen, und das für jeden Lernenden immer wieder erneut und mit gleichbleibendem Schwierigkeitsgrad (Sanko et al. 2013;Smith et al. 2015). Die Darsteller sollen dem Geschlecht, Alter und in ihrer äußeren Erscheinung der dargestellten Person entsprechen. ...
Ausgehend von dem gegenwärtig evidenzbasierten Forschungsbedarf der Künstlerischen Therapien thematisiert der Beitrag methodische Möglichkeiten und Grenzen kunsttherapeutischer Forschung im Gruppenkontext. Kunsttherapie wird dabei als komplexe Intervention beschrieben, die sich durch einen flexiblen und vor allem situationsbezogenen Einsatz verschiedener bildnerisch-künstlerische Mittel und Medien auszeichnet. Sie zielt im Kontext von Gruppen insbesondere auf Ressourcenwahrnehmung und -erweiterung der Patienten und aktiviert das Erleben von Resonanz. Im Rahmen des Beitrages wird ein systemisch-fundiertes Modell und davon abgeleitetes Manual IiGART (Interaction in Group Art Therapy) vorgestellt, welches jüngst zur systematischen Beschreibung und mehrdimensionalen Untersuchung kunsttherapeutischer Prozesse im Gruppensetting entwickelt wurde. Sowohl die forschungsmethodischen Hintergründe und Grundlagen des IiGART-Modells als auch die Handhabung des Manuals werden mit Blick auf weiterführende Perspektiven diskutiert.
... Bearman and Nestel (2015) proposed this shift from simulated patient to this more inclusive termsimulated participant in their discussion of the future of humanbased simulations (Bearman and Nestel 2015). We refer to this extended role of the SP, beyond portraying a patient, in a similar way to confederate (Sanko et al. 2013;Nestel et al. 2014). Two additional points on terms. ...
This article has been written for the 40th year of the publication of Medical Teacher. While we celebrate the contribution of simulated participants (SPs) to health professions education through values and value-based learning, we also offer critical reflection on elements of our practice, commencing with language. We argue for the use of the term simulated rather than standardized and acknowledge the dominant role of the SP as patient and the origins of the methodology. These shifts in terms and their implications in practice reflect changes in the conceptualization of SP-based methodology. Recently published standards for those who work with SPs (SP practitioners) are noted as an important milestone in our community’s development. We consider contemporary practices addressing the complex notions of values and value in SP-based learning. We simultaneously refer to the work of SPs and SP practitioners. Phases of educational design including identifying learning objectives, scenario design, implementation, feedback and debriefing are used to illustrate methodological shifts. Within each of these phases, there are relational issues that have to date often gone unchecked and are under reported in literature. Finally, using the metaphor of a murmuration, we celebrate contemporary practices of the global SP practitioner community.
... Theatre practices are already familiar constituents of simulation (Sanko et al. 2013). Our aim in this project was to enable students in nursing and theatre to practically investigate and extend their knowledge and understanding of simulation and performance in practice. ...
... Another possibility described in the literature is a facilitator acting as a confederate, i.e., an actor or faculty member roleplaying in the scenario also being able to provide extra scenario information [12,13]. The role of a confederate is complex and may require scripting and some acting skills from the facilitator [14]. Another option for facilitators is to provide extra scenario information from the operator room via a loudspeaker or via an earpiece to one of the participants in the scenario [15]. ...
Background
The rationale for introducing full-scale patient simulators in training to improve patient safety is to recreate clinical situations in a realistic setting. Although high-fidelity simulators mimic a wide range of human features, simulators differ from the body of a sick patient. The gap between the simulator and the human body implies a need for facilitators to provide information to help participants understand scenarios. The authors aimed at describing different methods that facilitators in our dataset used to provide such extra scenario information and how the different methods to convey information affected how scenarios played out.
Methods
A descriptive qualitative study was conducted to examine the variation of methods to deliver extra scenario information to participants. A multistage approach was employed. The authors selected film clips from a shared database of 31 scenarios from three participating simulation centers. A multidisciplinary research team performed a collaborative analysis of representative film clips focusing on the interplay between participants, facilitators, and the physical environment. After that, the entire material was revisited to further examine and elaborate the initial findings.
Results
The material displayed four distinct methods for facilitators to convey information to participants in simulation-based teamwork training. The choice of method had impact on the participating teams regarding flow of work, pace, and team communication. Facilitators’ close access to the teams’ activities when present in the simulation suite, either embodied or disembodied in the simulation, facilitated the timing for providing information, which was critical for maintaining the flow of activities in the scenario. The mediation of information by a loudspeaker or an earpiece from the adjacent operator room could be disturbing for team communication.
Conclusions
In-scenario instruction is an essential component of simulation-based teamwork training that has been largely overlooked in previous research. The ways in which facilitators convey information about the simulated patient have the potential to shape the simulation activities and thereby serve different learning goals. Although immediate timing to maintain an adequate pace is necessary for professionals to engage in training of medical emergencies, novices may gain from a slower tempo to train complex clinical team tasks systematically.
... By comparison, ScBS are often employed when the desired learning outcomes include working in a team-based context, practicing communication skills, or responding to a crisis or critical patient event [5]. Additionally, whereas skills-based simulations often seek to minimize complexity, ScBS are employed to incorporate the complexities associated with clinical practice, including engaging socially with the patient or support persons (e.g., simulator, standardized patient) and interacting with other healthcare professionals [5][6][7]. ...
Background
The dominant frameworks for describing how simulations support learning emphasize increasing access to structured practice and the provision of feedback which are commonly associated with skills-based simulations. By contrast, studies examining student participants’ experiences during scenario-based simulations suggest that learning may also occur through participation. However, studies directly examining student participation during scenario-based simulations are limited. This study examined the types of activities student participants engaged in during scenario-based simulations and then analyzed their patterns of activity to consider how participation may support learning.
Methods
Drawing from Engeström’s first-, second-, and third-generation activity systems analysis, an in-depth descriptive analysis was conducted. The study drew from multiple qualitative methods, namely narrative, video, and activity systems analysis, to examine student participants’ activities and interaction patterns across four video-recorded simulations depicting common motivations for using scenario-based simulations (e.g., communication, critical patient management).
Results
The activity systems analysis revealed that student participants’ activities encompassed three clinically relevant categories, including (a) use of physical clinical tools and artifacts, (b) social interactions, and (c) performance of structured interventions. Role assignment influenced participants’ activities and the complexity of their engagement. Importantly, participants made sense of the clinical situation presented in the scenario by reflexively linking these three activities together. Specifically, student participants performed structured interventions, relying upon the use of physical tools, clinical artifacts, and social interactions together with interactions between students, standardized patients, and other simulated participants to achieve their goals. When multiple student participants were present, such as in a team-based scenario, they distributed the workload to achieve their goals.
Conclusion
The findings suggest that student participants learned as they engaged in these scenario-based simulations when they worked to make sense of the patient’s clinical presentation. The findings may provide insight into how student participants’ meaning-making efforts are mediated by the cultural artifacts (e.g., physical clinical tools) they access, the social interactions they engage in, the structured interventions they perform, and the roles they are assigned. The findings also highlight the complex and emergent properties of scenario-based simulations as well as how activities are nested. Implications for learning, instructional design, and assessment are discussed.
... Theatre techniques seem to be effective and increasingly used as interactive teaching tools in undergraduate medical education [3][4][5][6][7][8][9][10][11][12]. This simulation method of learning does not only enhance the students' comprehension of the doctor-patient relationship, but it also improves their communicational skills and gives them the ability to engage more with the patient [4][5][6][7][8][13][14][15][16]. ...
Introduction:
Theatre models in medical education have been used worldwide in order to train medical students and graduates in managing various situations. However, the literature reports little regarding its appeal to trainees. We conducted a medical seminar, entitled Emergency Cases School, which employed such techniques. Actors simulated the actions of doctors and patients involved in various emergency cases, in front of a large audience, in a specially modified theatre hall which resembled the emergency room environment.
Methods:
A total of 303 undergraduate medical students participated in the seminar. The audience evaluated the course with the DREEM questionnaire, along with two extra questions: Q1. 'Do you think that the course will prove itself beneficial to your clinical skills?' and Q2. 'Would you suggest the course to another student?', in a 0-4 scoring scale. Of the attendees, 281 (92.7%) answered the questionnaire.
Results:
The overall DREEM score was 140.32 (±23.39) out of 150, which is interpreted as 'More positive than negative'. The results of Q1 and Q2 were 3.07 (±0.78) and 3.65 (±0.61), respectively.
Discussion:
The Emergency Cases School received positive feedback as a theatre educational tool, targeted to a large audience. With the advantage of the realistic setting of an emergency room, along with its low-budget needs, this course model could function as a creative alternative of the more traditional lecturing teaching techniques.
... With a few exceptions, there is little empirically based published work on the recruitment and preparation of confederates for scenarios. Sanko et al. [9] and Nestel et al. [5] offer theory-and experience-based accounts of supporting confederates. Sanko et al. draw from the discipline of acting to provide guidance in refining the practice of simulation by embracing lessons and techniques commonly used in the theatre (performing arts) community, while Nestel et al. highlight the importance of drawing on practices from simulated patient methodology for character development and role portrayal. ...
This chapter explores the roles of simulated patients and confederates in simulation-based education. It uses the collective term simulated participant (SP) for both and identifies points of intersection in their work. There are two main types of live simulators. First, simulated (standardized) patients are individuals trained to portray a patient and also to provide feedback to trainees on their performance. Often, simulated patients are recruited from the community and may not necessarily have professional acting experience. Second, confederates are individuals who commonly portray the role of healthcare professionals in mannequin-based scenarios. There are many commonalities in simulated patient and confederate work. An important point of intersection is the emotional work in both roles. Before shifting the focus to these emotional elements and offering considerations for educators in caring for SPs, the chapter explores the roles of simulated patients and confederates in more detail.
... We found adherence to assigned roles supported learner engagement and suspension of disbelief while the opposite occurred with overacting or unplanned improvisation. Sanko, Shekhter, Kyle, Di Benedetto, and Birnbach (2013) identified the need to establish best practices for preparing simulation actors; their best practices drew upon theater and acting methods to establish conventions for acting in simulations. Such methods hold significance for learner engagement. ...
Background
This project used simulation as the strategy for bringing 43 nursing and 21 social work students (N = 64) together to develop interprofessional competence.
Method
A narrative analysis of the qualitative learner responses was conducted.
Results
Four major themes emerged including the interprofessional setting characteristics, the value of collaborative communication between professions, student affective experience, and the student lessons learned.
Conclusions
Results validated the effectiveness of simulation, while also exposing the lack of sufficient interprofessional preparation in the overall curriculum in both programs. Implications for quality improvement and future research are explored.
... Of course not all simulation requires simulators. For example, simulated (standardised) patient (SP) programmes work with trained actors who stand proxy for actual patients, addressing the subtleties of healthcare consultation with great expertise [14][15][16][17]. SPs offer a means of representing patients' perspectives, drawing on authentic experience while placing it at a 'safe distance' and ensuring anonymity. ...
This paper proposes simulation-based enactment of care as an innovative and fruitful means of engaging patients and clinicians to create collaborative solutions to healthcare issues. This use of simulation is a radical departure from traditional transmission models of education and training. Instead, we frame simulation as co-development, through which professionals, patients and publics share their equally (though differently) expert perspectives. The paper argues that a process of participatory design can bring about new insights and that simulation offers understandings that cannot easily be expressed in words. Drawing on more than a decade of our group’s research on simulation and engagement, the paper summarises findings from studies relating to clinician-patient collaboration and proposes a novel approach to address the current need. The paper outlines a mechanism whereby pathways of care are jointly created, shaped, tested and refined by professionals, patients, carers and others who are affected and concerned by clinical care.
... However, there is valuable evidence that is experience and theory based. An important example of the latter is incorporation of dramatic and performing arts theory into training methods for SP role portrayal (12)(13)(14). ...
This chapter explores the concepts and methods of deliberate practice and quality assurance in standardizing simulated patient (SP) performance and the criteria for determining the 'assessment readiness' of SPs, when repeating the portrayal for multiple learners by one SP at one site or involving multiple SPs and trainers in multiple sites, on multiple occasions. It discusses key aspects of SP portrayal for assessment, including standardization. Roles and responsibilities of SPs are outlined and the SP as assessor is considered. The focus of the SP assessment or feedback needs to be carefully considered and clearly framed. SP methodology within assessment is highly influenced by the individual interpretations of all involved, making necessary explicit, strategic and rigorous training strategies that include attention to the portrayal style, the level of standardization and quality assurance processes.
... Even the most comprehensive books on health care simulation make little reference to confederates. A recent and notable exception to understanding the work of confederates is by Sanko, Shekhter, Kyle, Di Benedetto, and Birnbach (2013) who draw on performing art theories to achieve effective involvement. ...
Confederates often enrich immersive health care simulations. In this commentary, we raise issues for consideration when working with confederates. We define the term “confederate,” describe their purpose, scope of practice, commonly encountered challenges for participants and confederates, and make recommendations for practice. We posit that Simulated (Standardized) Patient methodology offers valuable insights to working with confederates. A systematic approach to training for role portrayal drawn from Simulated (Standardized) Patient methodology is likely to improve confederate portrayal. Although the inclusion of confederates in simulations might seem simple enough, there are many considerations to ensure educational or research goals are achieved and confederates unharmed.
... A confederate is defined as an individual invited to participate in a simulation in order to fill a fixed role or perform a fixed function. 17 Confederates consisted of attending pediatric intensivists and pediatric emergency medicine physicians who were selected on the basis of their perceived level of authority by the participants in the case. ...
Objective:
Hierarchy, the unavoidable authority gradients that exist within and between clinical disciplines, can lead to significant patient harm in high-risk situations if not mitigated. High-fidelity simulation is a powerful means of addressing this issue in a reproducible manner, but participant psychological safety must be assured. Our institution experienced a hierarchy-related medication error that we subsequently addressed using simulation. The purpose of this article is to discuss the implementation and outcome of these simulations.
Methods:
Script and simulation flowcharts were developed to replicate the case. Each session included the use of faculty misdirection to precipitate the error. Care was taken to assure psychological safety via carefully conducted briefing and debriefing periods. Case outcomes were assessed using the validated Team Performance During Simulated Crises Instrument. Gap analysis was used to quantify team self-insight. Session content was analyzed via video review.
Results:
Five sessions were conducted (3 in the pediatric intensive care unit and 2 in the Pediatric Emergency Department). The team was unsuccessful at addressing the error in 4 (80%) of 5 cases. Trends toward lower communication scores (3.4/5 vs 2.3/5), as well as poor team self-assessment of communicative ability, were noted in unsuccessful sessions. Learners had a positive impression of the case.
Conclusions:
Simulation is a useful means to replicate hierarchy error in an educational environment. This methodology was viewed positively by learner teams, suggesting that psychological safety was maintained. Teams that did not address the error successfully may have impaired self-assessment ability in the communication skill domain.
This study examined how incorporating art into an upper-level undergraduate field-based ecology research course influenced students’ communication and collaboration skills, their career goals, and how they conceptualized the scientific method. Student pairs designed an independent research study that used artwork and a scientific research poster to disseminate their findings at an end-of-term exhibit. Students enrolled in either a local or a (subsidized) travel abroad section of the course. Students in both sections found new or deeper connections between art and science, developed a more sophisticated understanding of the science method, became more confident with their science skills, and reported an expanded perspective on their future careers (often including field work and a wider geographic job search). Science–art student teams indicated they wanted more opportunities for collaborative work in the future, and that their final products were more professional due to their collaborations, as compared to science–science teams. Additionally, the travel abroad students benefitted from experiencing new ecosystems and cultures, from working with science and art professionals from other countries, and from working in an isolated field station without distractions.
Contexte : La scénarisation des activités de simulation est très importante. Beaucoup de gabarits sont proposés pour la simulation en immersion clinique simulée (ICS) mais peu sont réellement adaptés à la simulation avec patient simulé (PS). De plus, peu de lignes directrices proposent une réelle démarche de rédaction. Objectifs : Proposer une méthode de scénarisation basée sur une expérience de 15 ans en cliniques simulées. Méthodes : Une démarche empirique d’analyse de pratiques a été mise en œuvre, aboutissant à la formation d’une démarche méthodique « Sujets/Instructions au candidat/Mesures/Patient/Support technique » (SIMPS). Conclusion : La méthode SIMPS facilite la rédaction selon des étapes précises tout en respectant l’intégration des concepts pédagogiques liés à l’apprentissage par simulation. Avec la méthode SIMPS, n’importe quel clinicien qui désire participer à l’enseignement par simulation avec PS pourra se sentir guidé et en confiance. Des recherches doivent être menées pour évaluer cette méthode auprès des rédacteurs de scénarios de simulation.
Zusammenfassung Hintergrund und Ziele Mit der Methode der Simulationspatient*innen wird versucht, Studierenden eine realitätsnahe und sichere Lernumgebung für das Erlernen des Anamnesegesprächs zu ermöglichen. Dabei wird der Kommunikationskompetenz besondere Bedeutung beigemessen. Methoden Im Rahmen einer autoethnographischen Analyse nahm eine Medizinstudentin mit einer abgeschlossenen Schauspielausbildung am Wahlpflichtfach "Anamnesetraining" des Allgemeinmedizinischen Instituts Erlangen teil. Die Daten erhob die Studentin mittels Teilnehmender Beobachtung in Form von Feldnotizen. Im Anschluss erfolgte eine objektiv hermeneutische Auswertung im Vier-Augen-Prinzip. Ergebnisse und Beobachtungen Die Methode der Simulationspatient*innen im Anamnesetraining erzeugt Unsicherheiten bei den Studierenden. Aspekte der Unsicherheit liegen in der schauspielerischen Leistung, welche den Studierenden abverlangt wird; der Antizipation eines ärztlichen Idealbildes und der damit einhergehenden ungenügenden Auseinandersetzung mit dem medizinischen und kommunikativen Fachwissen; und der wenig reflexiven Feedbackkultur. Schlussfolgerungen und Diskussion Der Grund für die Unsicherheiten liegt in dem Anspruch an die Studierenden, eine ideale Lösung für die entsprechende Fallsimulation zu finden, was einer Prüfungssituation ähnelt und individuelle Selbstreflexion verhindert. Statt eine Verbesserung der kommunikativen Fähigkeiten zu erreichen, scheinen vor allem die schauspielerischen Fähigkeiten durch das Anamnesetraining mit Simulationspatient*innen zu wachsen. Das Anamnesetraining mit Simulationspatient*innen bietet in dieser Form noch keine sichere Lernumgebung, in der ein Herantasten an das individuelle zukünftige Rollenbild möglich ist. Für einen konstruktiven Umgang mit Unsicherheiten sollte eine intensive Auseinandersetzung mit dem individuellen ärztlichen Rollenbild angestrebt werden.
Context
Athletic trainers should be able to recognize, refer, and provide support to patients with mental health challenges such as anxiety, depression, and suicidal ideation. However, clinicians may not have the opportunity to identify the signs and symptoms in an authentic scenario until a patient presents in their facility. Therefore, supplemental clinical education via standardized patient (SP) encounters may allow for an opportunity to practice mental health care in a safe manner. However, data to support if a SP encounter has a lasting effect on one's clinical practice are lacking.
Objective
To reflect on a SP encounter focused on a mental health emergency (suicidal ideation) and the influence, if any, the encounter had on one's clinical practice 1.5 to 3 years following the encounter.
Design
Consensual qualitative research tradition.
Setting
One-on-one interview.
Patients or Other Participants
Twelve graduates from the same postprofessional athletic training program (men = 6, women = 6) participated in this study.
Main Outcome Measure(s)
Participants completed a one-on-one interview guided by a 7-question, semistructured interview protocol. A 3-person coding team identified domains and categories.
Results
Two domains emerged from the study: (1) learning experience and (2) patient approach. The learning environment created an emotionally realistic space with reassurance and collaborative learning. Specifically, the participants were able to transform their practice from errors made during the SP encounter. The SP encounter had positive, long-term effects on their clinical care including improvements in empathy, active listening, and emergency planning.
Conclusions
Like other research about the longitudinal effects of SP encounters, participants applied the learning outcomes from the encounter in their clinical practice 1.5 to 3 years later. We suggest mental health SP encounters be used to prepare athletic trainers, regardless of experience, for emergency mental health crises.
Objective Structured Clinical/Practical Examination (OSCE/OSPE) has come a long way since its inception by Harden RM in 1975.
Literature offers many studies and reviews about its applicability in assessment and impact in learning outcomes. The present review
traces the variants of OSCE as it has evolved over time with need and contextual variations, though still being sought after as one of
the most valid tools in assessment of clinical and professional skills. The article reviews various forms viz., Group OSCE, Team OSCE,
Objective structured assessments of technical skills, Shadow OSCE, Inter-professional OSCE, Inter-professional OSCE with Allied
Embedded Actors, Reverse OSCE, Culture OSCE, e OSCE, Tele OSCE and Virtual OSCE in terms of the method and utility. Inspite of
numerous variations, the principle of OSCE remain intact i.e., an effective tool to foster learning and attainment of clinical/practical
competencies by direct observation of skills, timely and developmental feedback. The manuscript also gives an example of blueprint
for assessment of skills wherein such OSCE variations can be planned depending on the nature and objective of assessment.
Background/Aim
The bidirectional benefit of peer-assisted learning is well described in the literature, as is the value of simulation-based activities, particularly in the delivery of education to healthcare professionals. The aim of this paper was to see if physiotherapy students could create a unique simulated patient (SP) and authentically perform the character for their peers during a simulation-based activity that addressed learning outcomes around communication.
Methods
Six final year physiotherapy students developed and then portrayed a unique character to 126 of their peers, who carried out an interview in an outpatient setting. Students participating as interviewers completed a five-question quantitative survey relating to the performance of their peers as SPs. Each question was scored between 1 (strongly disagree) and 10 (strongly agree). Data were analysed using frequencies and is presented descriptively. Students participating as SPs completed written reflections about the experience, and responses were explored using a thematic analysis approach.
Findings
One hundred twenty-six students participating as interviewers rated their peer's performance highly, with an overall mean (SD) score of 8.9 (1.6) for all questions. Qualitative analysis around SP's character development demonstrated three key themes (training, validation and evolution); a further three themes emerged around performance (challenges, delivery, and value). Themes and subthemes are discussed with verbatim examples provided to support coding choices.
Conclusions
Students near the end of their own training may be well placed to authentically cultivate and portray characters during simulation-based learning activities in order to address specific learning outcomes for their peers.
Debriefing framework and approach inform a number of factors, including participant group and learning needs, type of predetermined learning objectives, and those debriefing points that emerge from the discussion. Although general principles for healthcare debriefing exist, special considerations apply for emergency care settings. In emergency medicine, debriefings should highlight the unique logistic and cognitive demands on individuals as well as interprofessional, multi-disciplinary teams. One size does not fit all, and debriefing approach for various components of any one simulation scenario are not mutually exclusive. For emergency settings, aspects about individual thought processes, teamwork, and systems issues may be relevant for a single debriefing session. Debriefing is an essential element of healthcare simulation and the information summarized here helps educators develop and implement an informed strategy.
Pediatric emergency medicine (PEM) is a unique specialty that requires the practitioner to manage a wide spectrum of patients, from the newly born to young adults, presenting with a variety of complaints, including critical illness and injuries. To deliver safe, efficient and high quality care requires skilled clinicians working effectively as a team. Simulation is currently used in an assortment of formats to accomplish teaching goals set by training programs and institutions to assess and improve the care delivered. It can also be used as a valuable tool for systems testing and quality improvement/assessment programs in new and established emergency departments. There are, however, some common challenges associated with integrating and sustaining PEM simulation programs. In this chapter, we will discuss the use of simulation for PEM education, address some of these challenges, and highlight the current benefits and future potential related to this promising methodology.
The demand to integrate human simulation (HS) into experiential activities within health professions and professional fields beyond healthcare has seen a significant growth over the past few decades. To best meet this demand, a comprehensive understanding of the intricacies of human-based simulation is required. In this chapter we will identify and explore the full spectrum within the human simulation modality and introduce the concept of The Human Simulation Continuum Model. We will demonstrate how to apply the HS Continuum Model in the decision-making process in the day-to-day routine of simulation educators and simulationists. We will provide tools on how to select the appropriate HS application, provide sample scenarios and their unique challenges and discuss how to select human role players to meet curricular learning objectives.
Simulation‐based learning (SBL) is regularly integrated into the undergraduate curriculum of diverse health professions education programmes where students learn diverse clinical skills, such as patient assessment, procedural skills, and teamwork. Establishing well‐defined goals is central to the simulation instructional design process and should be done early on because it helps inform later decisions about which simulation method and modalities to use and helps inform decisions about assessment and feedback. Designing a simulation activity or curriculum also requires considering which simulation method(s) will best support the goals and objectives outlined at the beginning. This chapter presents a comparison of skills‐based and scenario‐based simulations, looking at reasons for use, common examples, and rules of participation that should be considered when designing a course or curriculum that integrates SBL. Some common applications of SBL include supporting patient safety and quality programmes, skills training and competency assessment, ameliorating clinical teaching constraints, and supporting the development of interprofessional collaborative practice.
Authentizität gilt als hoher Wert in der medizinischen Ausbildung. Trotzdem bleibt häufig unklar, was damit gemeint ist und wie die geforderte Authentizität zu erreichen wäre. Der vorliegende Beitrag möchte diese „Authentizität“ näher bestimmen und zwar anhand der gängigen Praxis, sogenannte Simulationspatienten (Patientendarsteller) im Unterricht einzusetzen. Diese Methode, mit den Studierenden Untersuchungstechniken und Gesprächsführung zu üben, ist inzwischen international etabliert. Trotzdem wird sie von Diskussionen begleitet, ob „Schauspieler“ als Patienten ausreichend authentisch sein können. Es werden exemplarisch diskursive Praktiken beleuchtet, in Bezug auf die Arbeit mit Simulationspatienten Authentizität herzustellen. Weiter wird am Beispiel von Festreden überlegt, welche Art von Authentizität eigentlich von Ärzten gewünscht wird. Zuletzt wird gefragt, mit welchen Mitteln der Ausbildung dieses authentische Verhalten von Ärztinnen und Ärzten gefördert werden könnte. Die Autorin legt nahe, dass gerade die Methode der Arbeit mit Simulationspatienten dazu geeignet ist.
Statement: Simulation-based education often relies on confederates, who provide information or perform clinical tasks during simulation scenarios, to play roles. Although there is experience with confederates in their more routine performance within educational programs, there is little literature on the training of confederates in the context of simulation-based research. The CPR CARES multicenter research study design included 2 confederate roles, in which confederates' behavior was tightly scripted to avoid confounding primary outcome measures. In this report, we describe our training process, our method of adherence assessment, and suggest next steps regarding confederate training scholarship.
Statement:
Simulation-based education often relies on confederates, who provide information or perform clinical tasks during simulation scenarios, to play roles. Although there is experience with confederates in their more routine performance within educational programs, there is little literature on the training of confederates in the context of simulation-based research. The CPR CARES multicenter research study design included 2 confederate roles, in which confederates' behavior was tightly scripted to avoid confounding primary outcome measures. In this report, we describe our training process, our method of adherence assessment, and suggest next steps regarding confederate training scholarship.
Simulation is increasingly valued as a teaching and learning tool in emergency medicine. Bringing simulation into the workplace to train in situ offers a unique and effective training opportunity for the emergency department (ED) multiprofessional workforce. Integrating simulation in a busy department is difficult but can be done. In this article, we outline 10 tips to help make it happen.
Purpose. The purpose of this theoretical article is to demonstrate how activity theory, a neo-Vygotskian sociocultural theory, can be used to analyze learning during simulation-based activities.
Background. Simulations are complex, dynamic environments that evolve and change throughout implementation. Moreover, simulations simultaneously support multiple participants’ assigned different roles. This means that the learning within them is often co-constructed, rather than individually derived. These characteristics complicate understanding the learning within them.
Method. This article presents a summary of the basic tenants of activity theory (AT), followed by a worked example to demonstrate how AT can be used as an analytic lens to generate rich description and analysis of participant activities as embedded in a complex dynamic simulation.
Conclusions. Activity theory can be used as a theoretical lens in order to account for how participants partake in simulation-based learning contexts, which supports the rich description and analysis of how participants accomplish their goals.
Statement:
Poor teamwork and communication during resuscitations are linked to patient safety problems and poorer outcomes. We present a novel simulation-based educational intervention using game cards to introduce challenges in teamwork. This intervention uses sets of game cards that designate roles, limitations, or communication challenges designed to introduce common communication or teamwork problems. Game cards are designed to be applicable for any simulation-based scenario and are independent from patient physiology. In our example, participants were pediatric emergency medicine fellows undergoing simulation training for orientation. We describe the use of card sets in different scenarios with increasing teamwork challenge and difficulty. Both postscenario and summative debriefings were facilitated to allow participants to reflect on their performance and discover ways to apply their strategies to real resuscitations. In this article, we present our experience with the novel use of game cards to modify simulation scenarios to improve communication and teamwork skills.
Elements of simulated patient (SP) performance informed by dramatic arts theories include creating character, enacting the narrative and relating to the audience. This chapter explores the role of dramatic arts theories in SP methodology. It provides an overview of theoretical conceptions of SPs and performance. SP performance is frequently described with terminology taken from the dramatic arts. SP performances must be authentic in terms of both clinical details and the human experience represented because SPs are proxies for real patients. SPs and learners co-create the narrative of a clinical encounter. SPs often work from a semi-scripted scenario. Rehearsing SPs with various types of anticipated learner performances provides benchmarking so they gain a sense of how to tell their story effectively. Developing strategies so that SPs can recognize and negotiate the boundaries between themselves and learners creates trust and provides safety for all involved in the simulation.
A well-prepared simulated patient (SP) has the ability to draw learners into a scenario quickly, achieving deep engagement. Their mere presence usually prompts interactivity. The terms simulated and standardized patients refer to largely similar simulation modalities, that is, a well person trained to portray a patient. To permit a fair test, the SP must perform consistently within the character of the person they are portraying. The contemporary history of SP methodology has many drivers. These are well documented and originate from humanistic, educational and external issues. Some contemporary SP practices constrain the voice of real patients, which limits their potential in offering patient perspectives. The cost of SP programmes was seen as a driver to sharing resources insomuch as avoiding duplication of investment in their development and learning ‘best practices’.
Background:
The National Surgery Quality Improvement Program (NSQIP) is the standard for assessment of acuity-adjusted outcomes in surgery. The validity of NSQIP has not been well established in colorectal surgery. Technical and process variables, which NSQIP may not consider, affect morbidity rate.
Objective:
A retrospective observational study was undertaken to determine the accuracy of NSQIP models in predicting morbidity for patients undergoing laparoscopic or open colectomy.
Methods:
NSQIP participant use files for 2005 to 2008 were obtained. Data were selected using Current Procedural Terminology coding for open or laparoscopic colectomy. NSQIP-generated predicted morbidities were used to create area under the receiver operator curves (AUROCs).
Results:
AUROCs demonstrated an accurate predictive model if the value was above 0.8 and indicated a marginal predictor mode if below 0.7. The AUROC for the general NSQIP model was 0.817 (confidence interval [CI] = 0.815-0.819, p < 0.001). AUROC for the combined laparoscopic and open colectomy group was 0.703 (CI = 0.698-0.709, p value < 0.001). AUROCs for the individual laparoscopic and open colectomy groups were 0.627 (CI = 0.615-0.640, p < 0.001) and 0.701 (CI = 0.695-0.707, p < 0.001).
Conclusion:
This study demonstrates that although NSQIP-generated morbidities used to create AUROCs are accurate for patients in an overall surgical model, predictive models for morbidity are marginal for laparoscopic and open abdominal colectomies. NSQIP risk models tend to emphasize comorbidities rather than intraoperative details or technical aspects of colonic resections.
Following the framework of ecological validity, and taking into account the social character of simulation, we investigated how six anesthesiologists each experienced three patient simulation scenarios. Using content analysis, we describe factors mentioned in the 18 half-structured interviews that were relevant for the perceived realism of the scenarios: overall impression and medical plausibility, participants' own actions, role play of the simulator team, workload, technical aspects, group dynamics, and anticipations. Further, we describe the circumstances under which these relevant elements were experienced as fiction cues (emphasizing differences between scenarios and clinical cases) or as reality cues (emphasizing similarities between scenarios and clinical cases). The experience of the scenarios among the anesthesiologists was dynamic over time and differed among participants. Considering the described elements and their character as either fiction or reality cues improves the understanding of the still-unanswered question of why simulators and simulations “work.” Simulators and simulations help in designing, optimizing, conducting, and analyzing patient simulation scenarios in a goal-oriented fashion.
Context: Standardized patients are widely used in health care programs to both teach and evaluate the communication and clinical skills of students. Although athletic training education programs (ATEPs) commonly use simulations, little information exists related to the use and implementation of standardized patients (SPs).
Objective: To provide strategies to use SPs with athletic training students and limited resources.
Background: Standardized patient encounters differ from simulations. Simulations require students to perform clinical skills on a mock patient or athlete who has no training to consistently portray a particular injury or illness. SP encounters are consistent, carefully crafted portrayals of injuries or illnesses by trained individuals.
Synthesis: A feasible way to use SPs in an ATEP is the time-in-time-out method which allows students to not only examine a SP, but also interact with and obtain immediate feedback from their instructor. Research with athletic training students has revealed that SP encounters are both realistic and worthwhile. Many resources exist to initiate the use of standardized patients in ATEPs, including various research publications, and online resources such as MedEd Portal and the Association of Standardized Patient Educators.
Results: The use of SPs enhances learning opportunities for students and provides a format for real-time evaluation for instructors.
Recommendation(s): Educators should consider using athletic training students and/or theater students to serve as SPs. Also, a local hospital or other SP programs at a local university may offer the use of their facilities or resources to initiate the use of SPs in your ATEP.
Conclusion(s): Many resources are needed to implement the use of standardized patients into an ATEP, but the experience can be well worth the expense to provide a realistic and worthwhile learning experience for students.
This article introduces interactive drama as an alterative to student role-plays. Interactive drama increases student engagement and explores complex issues in management. It features scenes from organizational life being performed live by trained actors before a student audience, stopping at pivotal points so the audience can interact with the actors. These sessions result in highly energized students wanting to participate in lively discussions. Because the vivid scenes are so memorable, the students are able later to connect them effectively to management theory or their own experiences in reflective journals or other written assessments. After describing why instructors should consider using interactive drama, the article explains how to use it in the management classroom and concludes by providing five detailed examples of interactive drama scenes.
Background:
We developed a course to introduce incoming third-year medical students to the subject of patient safety, to focus their attention on teamwork and communication, and to create an awareness of patient-safe practices that will positively impact their performance as clinicians.
Methods:
The course, held prior to the start of clinical rotations, consisted of lectures, web-based didactic materials, small group activities and simulation exercises, with an emphasis on experiential learning. First, students inspected a 'room of horrors', which is a simulated clinical environment riddled with errors. Second, we used lenticular puzzles in small groups to elicit teamwork behaviours that parallel real-life interactions in health care. Each team was given 8 minutes to complete a 48-piece puzzle, with five pieces removed at random and given to other teams. The salient teaching point of this exercise is that for a team to complete the task, team members must communicate with members of their own team as well as with other teams. Last, simulation scenarios provided a clinical context to reinforce the skills introduced through the puzzle exercise and lectures. The students were split into groups of six or seven members and challenged with two scenarios. Both scenarios focused on a 56-year-old man in respiratory distress. The teams were debriefed on both clinical management and teamwork.
Results:
The vast majority of the students (93%) agreed that the course improved their patient safety knowledge and skills.
Discussion:
The positive response from students to the introductory course is an important step in fostering a culture of patient safety.
Student exposure to illness-related theatrical performances holds intriguing educational possibilities. This project explored uses of theatrical performance within the context of medical education.
Two 1-person shows, dramatically addressing AIDS and ovarian cancer, were presented to audiences totalling approximately 150 medical students, faculty, community doctors, staff and patients.
Evaluations for both performances indicated increased understanding of the illness experience and greater empathy for patients. They also showed that respondents obtained additional insights into patient care issues, and developed new ways of thinking about their situations.
Presenting illness-related dramatic performances as an adjunct method of enhancing empathy and insight toward patients in a self-selected group of students, doctors, staff and patients was successful. Although this approach might not be effective with all learners, those who participated felt they gained important insights into the nature of the patient experience.
During the past 15 years there has been widespread adoption of simulation in health care education as a method to train and assess learners. Multiple factors have contributed to this movement, including reduced patient availability, limited faculty teaching time, technological advances in diagnosis and treatment that require a new skills set, greater attention to patient safety with the need to reduce medical errors, and a focus on outcomes-based education. In this discussion, simulation refers broadly to any device or set of conditions that attempts to present the patient authentically. While simulation offers many advantages over traditional methods of teaching, there are several challenges that must be addressed to ensure its effective use. This article presents the range of available simulation technologies, explores the challenges that health care educators face when using this method, provides an example of a successful program that has integrated simulation into the culture of learning at its institution, and discusses an approach to maximizing the effectiveness of simulation as a means to learning and practicing skills in a safe, interactive environment.
:Actors hired to play patients in medical-educational contexts are not only subjected to the medical gaze, but are also often subjected to emotionally and physically demanding roles. Laura Jayne Nelles asks how the actor can create a safe "container" in the often blurred boundaries between acting and not-acting.
This paper studies character-role creation by Method actors to begin developing a sociological understanding of artistic creativity and shed light on the construction of social roles. Portrayals on film or stage reflect but also importantly shape audience's understandings of social life. How do actors create these portrayals? The analysis of interviews with and observation of Method actors shows that they employ a variety of creation strategies, which are shaped by artistic conventions and transmitted in educational settings and professional interactions. Striving to create lifelike portrayals, actors draw heavily on culturally available images and end up reproducing existing typifications and cultural mores.
The physician-patient encounter may be structured, but it is never scripted; every physician-patient interaction is to some degree improvised. Both physicians and improvisers must prepare for unpredictability, and the surprising and unrecognized overlap between improvisational theater and medical training and medical practice led the author to develop a seminar that tailors improvisational skills to physician needs, teaching communication, professionalism, and other medical skills through an approach she calls "medical improv." The author observes that there is no example of this teaching strategy as a recurring part of a medical school curriculum reported in the literature, and she describes the contributions medical improv can make to physician skills. The author reports on medical students' positive response to the medical improv seminar she has taught at Northwestern University Feinberg School of Medicine since 2002: 95% of students anonymously evaluating the seminar from 2002 to 2010 agreed with the statement, "Studying improv could make me a better doctor," and 100% agreed with the statement, "I would recommend this class to other medical students." The author proposes a medical improv teaching model that other medical schools and hospitals could adapt and adopt.
The authors recognize the pressing need for teaching methods that encourage empathy in both undergraduate and postgraduate medical curricula. While the useful application of theatrical acting techniques in medical education has been reported in major medical journals, these reports present an incomplete picture of these techniques and their potential importance to physician competence. The authors propose a broader understanding of performance theories and practices and a more nuanced appreciation of the experience and knowledge acquired through working with standardized patients and acting exercises. The academic discipline of performance studies offers a paradigm not only for teaching doctors how to "act" in a more truly empathetic and compassionate manner but also for analyzing, and thus evaluating and improving, human interactions in the medical environment. A complex understanding of performance is essential to the development of an empathetic imagination, a cognitive faculty that allows physicians to generate unique responses to given situations rather than employing reactions learned by rote in "communications training." The authors recommend the inclusion of a wide range of performance theories and practices alongside the ubiquitous presence, in medical schools and other physician education forums, of actors performing as standardized patients.
How method actors create character roles387Y416. 220 Convention for Acting in Healthcare Simulation Simulation in Healthcare Copyright © 2013 by the Society for Simulation in Healthcare Unauthorized reproduction of this article is prohibited
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Bandelj N. How method actors create character roles. Sociol Forum 2003;18(3):387Y416. 220 Convention for Acting in Healthcare Simulation Simulation in Healthcare Copyright © 2013 by the Society for Simulation in Healthcare. Unauthorized reproduction of this article is prohibited.
Considering acting as epistemology and its use in teaching and teacher preparation
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Griggs T. Considering acting as epistemology and its use in teaching and teacher preparation. Teach Educ Q 2001;28:23Y37
The Philosophical Actor: A Practical Meditation for Practicing Theatre Artists
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The Stanislavski System Penguin Group
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