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SHORT COMMUNICATION
Year : 2022  |  Volume : 36  |  Issue : 1  |  Page : 36-38

Simulated patients in the training of medical students: Justifying the need and Points to ponder


1 Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission13-Nov-2020
Date of Decision17-Jul-2021
Date of Acceptance07-Aug-2021
Date of Web Publication02-Sep-2022

Correspondence Address:
Dr. Saurabh RamBihariLal Shrivastava
Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jms.jms_113_20

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  Abstract 


During the phase of medical training, patients are considered as the best teachers and it is strongly believed that exposure to patients helps medical students in both learning and practicing medicine. Nevertheless, the changing health dynamics has significantly affected the availability of patients in hospitals. This has led to the introduction of simulated patients in the delivery of medical education, initially for facilitating the acquisition of clinical skills and subsequently for the sake of assessment, including giving feedback to the learners. Any medical college, which is planning to initiate such curricular reforms within their setup, has to be aware of the standard practices to be adopted for recruitment, screening, and retention. In conclusion, the use of simulated patients in teaching and assessment in medical training has immense potential to improve the skills of medical students. It is the need of the hour for every medical college to explore their dynamics and then plan for the introduction of simulated patients within their setup and thereby improve multiple skills of future doctors.

Keywords: Clinical teaching, medical education, simulated patients


How to cite this article:
Shrivastava SR, Shrivastava PS. Simulated patients in the training of medical students: Justifying the need and Points to ponder. J Med Soc 2022;36:36-8

How to cite this URL:
Shrivastava SR, Shrivastava PS. Simulated patients in the training of medical students: Justifying the need and Points to ponder. J Med Soc [serial online] 2022 [cited 2022 Oct 4];36:36-8. Available from: https://www.jmedsoc.org/text.asp?2022/36/1/36/355574




  Introduction Top


Need of simulated patients

During the phase of medical training, patients are considered as the best teachers and it is strongly believed that exposure to patients helps medical students in both learning and practicing medicine.[1] Nevertheless, the changing health dynamics (namely rise in the incidence of daycare procedures, decline in the average time spent by patient in hospital, encouragement of management or rehabilitation of patients in community settings, reduction of the possibility of hospital-acquired infections, minimizing the scope of harm to patients through inexperienced learners, and better awareness among the general population about health services, etc.,) has significantly affected the availability of patients in hospital, who can be utilized for teaching and learning medicine.[1],[2]

Further, owing to the inherent limitations attributed to the assessment pattern in traditional examinations, concerns have been raised about bedside clinical assessments.[1],[2] These issues include reliability and validity of clinical exams (namely allocating different clinical cases to different studentslack of standardization/uniformity), interexaminer variability, and the ethical concerns linked with exposure to real patients.[1],[2] All these facts led to the introduction of simulated patients in the delivery of medical education, initially for facilitating the acquisition of clinical skills and subsequently for the sake of assessment, including giving feedback to the learners.[2],[3]

Simulated patients

A simulated patient is one who has been trained to simulate a real patient, not only with regard to clinical history but also with regard to the body language, emotional, and personality attributes.[1] The presence of such kinds of a patient for clinical training in a medical institution has multiple advantages, namely their availability whenever required, exposing the student to a wide range of clinical cases which is a distant possibility, in reality, readiness to give exposure to a large number of students without reducing their cooperation, and predictable behavior.[2],[4] In addition, such patients can be also used in those cases wherein involving real patients is a difficult task. Further, they can be trained depending on the level of the student and thus facilitate student-centered learning.[1]

Use of simulated patients

These cohorts of patients can be used to train medical students about initiating the discussion with the patient, building rapport, obtaining history, performing physical examinations for eliciting normal signs, improving communication skills, providing information to the patient (namely explanation of diagnosis or line of management, counseling, etc.,), and closing the interaction with the patient.[2] Another merit of using these patients is that they can also be trained to assess the performance of the student using a checklist and provide feedback to the medical student. There is a definite scope of using them in formative assessments (like in objective structured clinical examinations) and encourage the students to reflect upon and improve their overall learning.[1],[3]

Existing practice

Acknowledging the scope, many medical institutions across the world have introduced the concept of simulated patients within their settings and have even gone ahead with developing a bank of such patients. In fact, in two of the constituent colleges of Sri Balaji Vidyapeeth, Puducherry – Shri Sathya Sai Medical College and Research Institute and Mahatma Gandhi Medical College and Research Institute, the simulated patients have been used in medical training. Moreover, such patients are also used in the field of nursing, dentistry, physiotherapy, dietetics, and pharmacy.[2],[3],[4],[5]

Initiation of simulated patient program in a medical college

Any medical college, which is planning to initiate such curricular reforms within their setup, has to be aware of the standard practices to be adopted for recruitment, screening, and retention.[3] Any person with above-average intelligence, emotionally mature, and who is able to remember their roles over a period of time based on the script given can be enrolled as a simulated patient. In addition, the person should have a positive attitude and should be willing to play their part in the process of training future doctors. It is always better to select those individuals who will fit the given profile of a patient with regard to their age group so that students can relate to them clinically.[1],[4]

The process of recruitment of such patients can be decided based on the number of such patients required. If the requirement is small, the department of community medicine can be assigned the responsibility to identify from the field practice area or by discussing with the practicing physicians in the region or the housekeeping staff of the hospital. For more requirement, advertisement for the same can be done.[3] The identified individuals can be screened via face-to-face interview and it is good to have a protocol for the same, wherein we can explore about the interest and willingness of the person.[1],[2]

It is quite essential that steps should be taken to retain the trained simulated patients and this can be accomplished by involving them throughout the year, as it will not only improve their interest but also motivate them and refine their skills.[2],[3],[4] The administrators can also give financial remunerations to them for the same and this will definitely improve their retention. Even though the initiative to employ simulated patients in medical training could prove to be extremely useful, still, we have to be aware of the need to have a dedicated staff, supporting administration, and financial assistance to sustain the program for years and derive the intended benefits.[1],[4],[5]


  Conclusion Top


The use of simulated patients in teaching and assessment in medical training has immense potential to improve the skills of medical students. It is the need of the hour for every medical college to explore their dynamics and then plan for the introduction of simulated patients within their setup and thereby improve multiple skills of future doctors.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Cleland JA, Abe K, Rethans JJ. The use of simulated patients in medical education: AMEE Guide No 42. Med Teach 2009;31:477-86.  Back to cited text no. 1
    
2.
Jabeen D. Use of simulated patients for assessment of communication skills in undergraduate medical education in obstetrics and gynaecology. J Coll Physicians Surg Pak 2013;23:16-9.  Back to cited text no. 2
    
3.
Nestel D, Burn CL, Pritchard SA, Glastonbury R, Tabak D. The use of simulated patients in medical education: Guide supplement 42.1--Viewpoint. Med Teach 2011;33:1027-9.  Back to cited text no. 3
    
4.
Peters T, Sommer M, Fritz AH, Kursch A, Thrien C. Minimum standards and development perspectives for the use of simulated patients - A position paper of the committee for simulated patients of the German Association for Medical Education. GMS J Med Educ 2019;36:Doc31.  Back to cited text no. 4
    
5.
Sommer M, Fritz AH, Thrien C, Kursch A, Peters T. Simulated patients in medical education - A survey on the current status in Germany, Austria and Switzerland. GMS J Med Educ 2019;36:Doc27.  Back to cited text no. 5
    




 

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