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Policy and procedures

It's important to establish a policy and procedure document when you are establishing a simulated patient program. It's advised that you update the content regularly.

This documentation was adapted for La Trobe University Rural Health School.  It was based on the a Simulation Center Policy and Procedure Manual developed by the Society for Simulation in Healthcare (SSH) in 2012.

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Case study: Recruiting nursing students as simulated patients

The use of Simulated Patients (SPs) to portray a patient scenario with the aim of providing nursing students realistic clinical experiences followed by feedback has been well documented.

At our regional campus in Mildura we have a wonderful group of SPs who regularly assist us with Simulations for the undergraduate nurses.

During Semester 2 last year, an SP simulation was planned for the first year students. However it turned out that none of our regular SPs were available.  In desperation I decided to ask the second year students if they would be willing to help me out.

Recruitment occurred via a group email to the second year students and I was overwhelmed with the response. The second year students were very keen to help, and I ended up having a ‘waiting list’ of participants.

The scenario was very simple: During a routine Medical Assessment at a Community Clinic the student nurses are asked by the supervising RN to complete a Subjective & Objective Respiratory Assessment on a patient.

The intended learning outcomes for this simulation were that by the end of the simulation the student would be able to apply the skills required to collect subjective and objective data whilst undertaking a respiratory assessment on a patient, and to apply formal communication techniques with both patients and members of the health team.

The simulation ran beautifully. The first year students were not aware that their ‘patients’ were actually second year students. The students don’t often cross paths on campus, so for them the SPs were just some young people who were acting in the role.

The first year students were able to practice their respiratory assessments and ISBAR handovers.  During debrief they were provided with some insightful and constructive feedback on their assessment skills and communication techniques. They left for the day, feeling that they had achieved the intended learning outcomes.

 The real surprise was the learning experience that occurred for the second year students.  Firstly, they were surprised at how much knowledge they had. They were able to easily identify strengths in the first year student’s skills and areas in need of improvement. They could then articulate this easily during debrief.  Many of the SPs were excited to realise that they knew the content well enough to be able to provide constructive feedback.

Secondly, it provided the second year students with the ‘patient’ experience.  This was especially timely as they were about to begin their clinical practicum for the semester.  Some of the comments they made in regard to this included ‘I felt powerless, lying in the bed with someone hovering over me, who obviously was not confident with what they were doing’ and ‘I will be making sure when I am on placement that I will be telling my patients exactly what I am doing and why’.

While our experience here is merely anecdotal, I believe that it was worthwhile for both groups, and we will run the simulation again this year using the current first and second year cohorts in the same roles.

Sandy Connor

Nursing Lecturer

LaTrobe Rural Health School

Mildura Campus

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Sample materials for recruitment

Here are some sample documents that La Trobe University used for their recruitment strategy for simulated patients.  This documentation could be used as a guide to start your own simulated patient bank or add further SP's to your network.

 

Sample Powerpoint presentation for information evening

Sample A4 double sized brochure

Sample print advertisement for newspaper

 

If you have a great resource or document that could be shared with others, contribute to SimEd.

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Interview questions

Here are some great interview questions to determine whether or not your candidate would be a suitable simulated patient.

This was originally adapted from the University of Toronto online resources

 

Simulated Patient (SP) Interview Questions

Name ……………………………………….

Contact ph.: ………………………………

Email: ……………………………………….

Do you have any previous acting experience or acting training?

Not necessary, but important to note

Do you have a health background or an interest in health?

Not necessary, but important to note. If they have a health background, it’s important for them to acknowledge and understand that they are not to comment on their medical/health knowledge when giving feedback to students.

If SP’s start talking about their own experiences with health professionals, it’s to ascertain if they have any prejudices or biases towards health professionals.

Do you have any previous teaching experience?

Not necessary, but important to note

What is your availability? (Days/ Nights/ Weekends)

The most flexible SP’s are the easiest to schedule.  Generally retired SP’s are the easiest to book; people who are working 3-5 days per week may not be suitable.

In a university setting, ideally people would be available during semesters or the peak exam periods. Therefore, students may not be ideal depending on their workload.

Please describe any limitations in terms of travel/transportation?

Transport could be an issue if they need to travel for a simulation, or if they need a reliable means of transport to get to sessions in a timely manner.

Are you comfortable with the student touching your body to practice an assessment? (Neck, leg, back, stomach, etc.)

This wouldn’t exclude someone from being a simulated patient; it would limit their roles however.

If a simulation requires you to disrobe and/ or wear a hospital gown, what would be your comfort level with this? Please describe any limitations.

This wouldn’t exclude someone from being a simulated patient; it would limit their roles however.

Some of the simulations that we conduct would require your feedback about the simulation (for example, how you felt the clinician gained your rapport, communication style of the clinician etc.). Do you feel that you could give honest feedback to a participant about their communication style?

Feedback is one of the hardest things an SP can do, and it’s very hard to give constructive feedback. This is one area you will have to train the SP’s in extensively, so it's important that they are comfortable with this concept.

Would you have any concerns being filmed/recorded while participating in a simulation?

A media consent form would have to be signed by the SP, and generally a higher rate is paid. The video might be reviewed by other students who might critic the session, placed on a web page or kept in case a student disputes their mark in an assessment.

Do you have any scars or have you had any broken bones etc. in the past?

If the SP had an appendix scar, they might not be suitable for a scenario where they have appendices for example. Some injuries or broken bones might need to be written into past history in case studies when dealing students. For example; disciplines such as physiotherapy or occupational therapy

The SP selection process has quite a few steps, including training. What is your availability to complete the next step if you are selected?

Important to know if they would like to pursue the opportunity further after finding out more about the program.

Being a Simulated Patient takes energy, memorization, discipline, concentration, excellent communication skills, and a high level of comfort with your own health. Please describe why you would be a good SP?

Great question to ask to understand their motives and learn more about them.

 

Share your interview tips/questions with the global simulation community by contributing to SimEd

 

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Case Study: How to recruit simulated patients

Case study contributed by La Trobe University, Rural Health School

As our simulated learning sessions developed, it became apparent that simulated patients could enhance the student's learning experience by increasing fidelity and realism.  Some disciplines were using their own recruits or volunteers, but there was no central database or training provided for Simulated Patients (SPs).

The team at La Trobe Rural Health School decided to pilot a simulated patient program to improve and standardise the use of SPs within the School.

Our recruitment strategy 

We employed the following methods to attract a wide range of potential simulated patients;

  • A traditional print advertisement was placed in our local newspaper. 
  • Social media was utilised to display the advertisement on the University home page. 
  • The La Trobe University Careers page was used to advertise the positions.
  • Online job pages were used to advertise for simulated patients.
  • Hard copies of the advertisement were also placed around the university noticeboards and at numerous community groups such as Rotary and sporting groups. 
  • A group email was sent out to health science academics and the La Trobe social email distribution.  They were asked to pass on to their social networks if applicable.

recruiting-advertisement

Figure 1: The advertisement that was produced by our marketing department

Prospective Sim Patients were told that no acting or medical experience would be required.  A desire to be a participant in health care education, the ability to learn case studies and dependability were essential characteristics for the position. 

We also looked for people who had flexible schedules, and aim to achieve a good mix of ages, races, ethnic groups, religions, genders, etc. so that they might be able to play a range of characters.

Information Session

An hour long information session was set up  in our simulation labs.  Attendees were given a tour of the facilities and the Simulation Educator gave an outline on what it’s like to be a simulated patient and what our expectations would be.   A brief simulation was demonstrated for the attendees and a YouTube video demonstrating a high stakes assessment was shown.

At the end of the session those who were interested in applying for a casual Simulated Patient position were invited to do so.   All applicants were invited to interview for the position.

Interview

Three case studies were emailed to the applicant in advance of the interview with instructions to choose the case study that appealed to them the most and to learn the role. Interview times were staggered, 15-20 minutes apart and took place in a classroom or small simulation suite. 

Dear <Name>,

Thanks for your interest in taking part in our simulated patient program.

What’s next?

In the attached document, there are 3 case histories; please read over them and chose the one role that you feel the most comfortable portraying (learning)

Below is a list of expectations for our simulated patients. Simulated patients should:

  • Be comfortable with their health and dealing with health professionals
  • Be an excellent listener
  • Be reliable and punctual
  • Be nonjudgmental about students and faculty gender, race, religion, national origin, physical characteristics, etc.
  • Conduct themselves professionally, showing respect for all students, faculty members and staff
  • Consistently portray the role or scenario, as trained by staff
  • Remember what the student who examined you did and then record it, if asked
  • Have strong written and verbal communication skills
  • Keep all information regarding the case, students and other patients confidential
  • Want to contribute to the training process of excellent health care professionals

Here are the details of your interview.

Date:                           Wednesday 2nd of April

Time:                           3pm

Where:                       Clinical Teaching Building RECEPTION

                                    <address here>

Park:                           Car Park access is from Willow Street, Security have a list of people attending the interviews (see map attached)

Meet:                          <contact name>

Before your interview: please review one of the 3 case studies so we can ask you questions in character.

Any questions, or changes to interview times, please do not hesitate to contact me.

Regards,

<name>

<phone>

<email>

Figure 2: Sample email with the details for the interview including 3 case studies

The interview started with introductions, and then we launched into taking the case history from the prospective SP to see what they had remembered and how they went in character.  It was important that they took the task seriously and had made the effort to learn and retain the information. 

Some prospective SP’s were discounted because they hadn’t bothered to learn the role, broke character too easily or embellished medical information.  During all interviews, a question was asked that wasn’t in the case materials provided, to test the applicant’s ability to improvise. Some examples of additional questions might be;

  • What are your grandchildren’s names?
  • Have you been to any good restaurants lately?
  • What football team do you follow?

Interview Questions

After the role play, we asked a few more questions to see if they would be a good fit for the program.

  • How they learnt the role for the interview
  • Why they chose that particular role.
  • Discuss the requirement for confidentiality to protect the students who are learning
  • Discuss the fact that they might be video recorded in particular sessions
  • If they have any previous acting experience or acting training?
  • What is their availability? (Days/ Nights/ Weekends if applicable)
  • Any travel limitations?
  • Are they comfortable with the student touching your body to practise an assessment? (Neck, leg, back, stomach, etc.)
  • If a simulation requires you to disrobe and/ or wear a hospital gown, what would their comfort level be with this? Please describe any limitations.
  • Ask if there are any roles/scenarios that they might be uncomfortable participating in.  For instance, if they had a close relative or friend who died from a stroke, they might want to steer clear of stroke scenarios as it may be too upsetting for them.
  • Would they feel that they could give honest feedback to a participant/student about their performance after a simulation session?
  • Ask them to describe why they think they would make a good SP.
  • Would they be able to attend further training sessions?
  • Discussion of wage/timesheets/contracts

Notification of successful applicants

Successful SPs were notified via phone or email that they had been selected for the program and were then provided with small group training and induction. Case-specific follow up training and other training opportunities have been provided to all SPs in our program.

 

Thank you for your interest in the La Trobe Rural Health School Simulated Patient Program.

We had a fantastic response and interviewed a large number of potential participants. 

It was decided that we would keep our bank of simulated patients at a manageable level so that we could provide them with enough support, training and ultimately hours of simulation.

We would love you to partake in some further training. Training will take place at the clinical teaching building and will take approx. 1 hour (group training sessions)

I will be in contact to discuss a suitable time.

We have spoken about further resources for simulated patients in most of the interviews.  Here are some web pages you might like to visit for further information;

<insert links here>

Once again, please do not hesitate to contact me if you should have any questions.

Thanks again.

Regards,

<your name>

Figure 3: Sample email for successful SP’s

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HEAL - Simulated patient training program

I came to the HEAL training with no experience in acting as a simulated patient (SP) in health care education. However, I had had some experience in role plays related to IT education. The one day HEAL training was an excellent introduction to doing this kind of work in health education.  The training was well structured and professionally delivered.

There was good mix of theory and practical exercises. On the theoretical side it covered what an SP is, why SPs are used, the responsibilities of an SP and the different types of SP work in health education. On the practical side a structured 4 stage model for preparation for role portrayal was introduced and the first stage of the model was completed for a sample scenario as a group exercise. This was an excellent way to become familiar with the patient role. A one-on-one role rehearsal activity followed. There was an opportunity to role play both the patient and the health professional.

An important part of SP work involves giving feedback. The HEAL feedback framework was introduced. The presenter role-played giving different types of feedback. This was to emphasise the type of communication required for giving feedback and was a very effective way of getting information across. We were given opportunities to practice giving feedback both in the role of patient and as health professional.

Printed material covering the main aspects of the training was provided for participants to take away. This included the 4 stage model for role preparation, the HEAL feedback framework and sample questions the health professional may ask.

Some aspects of the training were especially valuable. We were encouraged to act out the roles in a realistic manner.  I found the session on learning to analyse the patient role and provide a backstory to a case study to be very helpful and an essential part of preparation for a role. The opportunities to get feedback on my performance in various roles was also very useful.

Overall the training was well designed and very effective. It was apparent that a lot of thought had gone into the training techniques and methods used. I would recommend the HEAL training for everyone who will be involved in SP work.

You can find out more about the HEAL Simulated Patient training sessions here - www.heal.edu.au

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How to prepare a simulated patient for their role

It is vital to the success of a simulation that the Simulated Patient (SP) is well prepared for their role. They should be made aware of nature of the scenario when they are first approached about the role, and then provided with a full copy of the scenario to allow them to prepare for the role.

It is also important that you have a briefing session with the SP.

This should include a rehearsal or demonstration of scenario events and should also include a discussion of:

  • what the learning objectives are
  • the character background
  • how long they will be in role
  • how and when to redirect the scenario if required
  • the feedback (if any) they will need to provide to participants
  • what to do in a time-out (look down, close eyes) and when to re-engage
  • risks
  • a time-out signal that they can use if they feel unsafe

In the rehearsal, make sure you demonstrate any assessments or examinations that the participants may perform on the SP, and coach the SP to provide the desired response.

You should also demonstrate any equipment that may be used with the SP in the scenario.

Try to anticipate as many of the participant questions/actions as you can. You will need to rehearse all of these with the SP so that they are prepared for all possibilities in the scenario.

Finally, ask the SP how they are feeling about the role, do they have any concerns about the role and do they have any questions.

Hopefully they will already have addressed this during the brief but it never hurts to ask again just to be certain that your SP is confident and well prepared for their role. 

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Simulated patient session evaluation form

 

In order for the simulated patient program to gain feedback, La Trobe University adminsters a quick questionnaire to the simulated patients (SPs) asking them for advice and thoughts on how the session ran.  On completion, this gives the educator and administrators more information about the session that the SPs participated in, and what might be improved upon in subsequent simulations.

The below information is generally emailed out within 24 hours after each simulation.

 

•  What do you think worked well in the session?

• What did not work well in the session?

• What role did you play (today)?

• Did you need any further information in the SP brief? 

            Yes/No.

             If yes, please outline

• What aspects of the role were challenging to play?

• Did the participants have any particular challenges in the scenario?

            Yes/No

            If yes, please outline

• Please make comments or suggestions about any other aspect of the session

Thanks for your feedback. 

This helps us tailor future sessions and make amendments if necessary.

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