The Role of Simulated Patients in SL
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Transcript of The Role of Simulated Patients in SL
8/12/2019 The Role of Simulated Patients in SL
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The r ol e of si mul at edpat i ent
i n t he ski l l s l abor at or ypr ogr amsGandes Retno Rahayu
Department of Medical EducationGadjah Mada University
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The simulated patienta normal person who has been carefully coached toaccurately portray a specific actual patient whengiven the history and physical examination (Barrows1987, 1993)
simulation of reality
Standardized patientspeople, with or without actual diseases, who havebeen trained to portray a medical case in a consistentfashion. These people may portray their ownproblem(s) or ones based on those of other patients(RCSA, 1993; Collins and Harden, 1998)
consistency of presentation
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Role Player
allows students to learn about roles and
interpersonal professional interactions,but relies on their understanding of whatthat role is rather than the understanding
of the actual patient or physician.
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Subject
People on whom students practice
interview and physical examinationtechniques, or observe and probe as aliving body. These subjects are normal
people and they are not portraying anyparticular patient problem.
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Practical Instructor
They are carefully educated to teachmedical students in the techniques ofphysical examination on themselves.
Practical instructors may or may not be
SPs.
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Patient Instructor
patients with stable abnormal physicalfindings who have been educated about
their own illnesses and the specificquestions and examination techniques thatshould be carried out to discover their
symptoms and signs. The use of patients inthis way is more common in North America
(Ledingham and Harden, 1998).
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Mythological patient
simulations prepared out of the
imagination, patients who never reallyexisted or a compilation of a number
of real patients
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Ski l l s t r ai ni ng
1. Arouse motivation2. Preparation stage3. Teacher-guided training session in a group
4. Practice without teacher to develop a stableautomatic reaction scheme5. Working with simulated patients
6. Working with real patients
Assessment at certain points
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The use of standardized patients
For supporting learning processFor assessment
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Number of medical schools used standardized patients in instruction of medical students in thefollowing skills:
- history-taking (106 schools)- doctor-patient communication skills (104)- general physical examination skills (93)- specialized physical exam skills, such as the
gynecologic or urologic exam (114)Liaison Committee on Medical Education(LCME), 2000-2001)
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Real Pat i ent vs Si mul at edPat i ent
Aspect of physicalexamination or historytaking is easily simulated
Physical signs to beassessed are not easilysimulated
Simulation
Simulated patientexpensive
Real patient inexpensiveCost
Formal examination inarranged setting
Assessment on the job,in practice
Context
Continuous examinationsOccasional or intermittentclinical examination
Frequency
Standardization essentialStandardization lessimportant
Standardization
Simulated patientsreadily available
Real patients do notalways available
Availabil ity
Simulated patientReal PatientFactors
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Fact or s f or choosi ng SPs
The role expected of the patientThe level of standardization requiredLocal logistics including experience of using
the different approaches, availability of thedifferent options and costThe context for the assessmentThe requirement for realism or authenticity(Collins and Harden, 1998 )
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I ssues r el at ed t o SPsRecr ui t ment
Recruit SPs from community volunteers,students, colleagues, acting groups or othergroups such as teachersRecruit SPs by word of mouth, throughexisting patients, from personal contacts andby advertising in the local paper Select individuals who have the ability toportray the important clinical features of apatient’s problem. The characteristic of theindividual are as important.
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Personal characteristic of goodSP
intelligence, appropriate motivation, flexible workschedule, stamina, emotional and geographic stability
an appropriate match between case and individual
variables, including age, ethnic origin, gender, andpersonal characteristics such as weight, height andphysical features
Good attitude to medical profession
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SPs Tr ai ner
Recruit trainers of SP from healthcareprofessionals, particularly those with aninterest in education
Trainers themselves should receiveappropriate training an will benefit fromobserving experienced trainers in action.