Training and standardization of simulated patients for multicentre studies in clinical pharmacy education
Keywords:Patient Simulation, Simulation Training, Education, Pharmacy, Pharmacists, Clinical Competence, Clinical Decision-Making, Educational Measurement, Reproducibility of Results, Brazil
Objective: To evaluate the training and standardization methods of multiple simulated patients (SPs) performing a single scenario in a multicenter study.
Methods: A prospective quasi-experimental study, using a multicenter approach, evaluated the performance of five different individuals with the same biotype during a simulation session in a high-fidelity environment. The SPs training and standardization process consisted of four steps and six web or face-to-face mediated: Step 1: simulation scenario design and pilot test. Step 2: SPs selection, recruitment and beginning training (Session 1: performance instructions and memorization request.) Session 2: check the SPs’ performances and adjustments). Step 3 and session 3: training role-play and performance’s evaluation. Step 4: SPs' standardization and performances’ evaluation (Sessions 4 and 5: first and second rounds of SPs' standardization assessment. Session 6: Global training and standardization evaluation. SPs performance consistency was estimated using Cronbach's alpha and ICC.
Results: In the evaluation of training results, the Maastricht Simulated Patient Assessment dimensions of SPs performances "It seems authentic", "Can be a real patient" and "Answered questions naturally", presented “moderate or complete agreement” of all evaluators. The dimensions "Seems to retain information unnecessarily", "Remains in his/her role all the time", "Challenges/tests the student", and "Simulates physical complaints in an unrealistic way" presented “moderate or complete disagreement” in all evaluations. The SPs "Appearance fits the role" showed “moderate or complete agreement” in most evaluations. In the second round of evaluations, the SPs had better performance than the first ones. This could indicate the training process’s had good influence on SPs performances. The Cronbach's alpha in the second assessment was better than the first (varied from 0.699 to 0.978). The same improvement occurred in the second round of intraclass correlation coefficient that was between 0.424 and 0.978. The SPs were satisfied with the training method and standardization process. They could perceive improvement on their role-play authenticity.
Conclusions: The SPs training and standardization process revealed good SPs reliability and simulation reproducibility, demonstrating to be a feasible method for SPs standardization in multicenter studies. The Maastricht Simulated Patient Assessment was regarded as missing the assessment of the information consistency between the simulation script and the SPs provision.
Vyas D, Bray BS, Wilson MN. Use of simulation-based teaching methodologies in US colleges and schools of pharmacy. Am J Pharm Educ. 2013;77(3):53. https://doi.org/10.5688/ajpe77353
Eukel HN, Frenzel JE, Skoy ET, Focken RL, Fitz AL. An introductory pharmacy practice experience using simulated patient care activities in a pharmaceutical care laboratory environment. Curr Pharm Teach Learn. 2014;6(5):682-669. http://dx.doi.org/10.1016/j.cptl.2014.05.007
Smithson J, Bellingan M, Glass B , Mills J. Standardized patients in pharmacy education: An integrative literature review. Curr Pharm Teach Learn.2015;7(6):851-863. https://doi.org/10.1016/j.cptl.2015.08.002
Seybert AL. Patient simulation in pharmacy education. Am J Pharm Educ. 2011;75(9):187. https://doi.org/10.5688/ajpe759187
Alinier G. Developing high-fidelity health care simulation scenarios: a guide for educators and professionals. Simul Gaming. 2011;42(1) 9-26. https://doi.org/10.1177%2F1046878109355683
Ibrahim IR, Palaian S, Ibrahim MI. Assessment of diarrhea treatment and counseling in community pharmacies in Baghdad, Iraq: A simulated patient study. Pharm Pract (Granada). 2018;16(4):1313. https://doi.org/10.18549/pharmpract.2018.04.1313
Ibrahim MI, Palaian S, Al-Sulaiti F, El-Shami S. Evaluating community pharmacy practice in Qatar using simulated patient method:acute gastroenteritis management. Pharm Pract (Granada). 2016;14(4):800. https://doi.org/10.18549/pharmpract.2016.04.800
Schneider CR, Gudka S, Fleischer L, Clifford RM. The use of a written assessment checklist for the provision of emergency contraception via community pharmacies: a simulated patient study. Pharm Pract (Granada). 2013;11(3):127-131. https://doi.org/10.4321/s1886-36552013000300001
Elayeh ER, Hammad EA, Tubeileh RH, Basheti IA. Use of secret simulated patient followed by workshop based education to assess and improve inhaler counseling in community pharmacy in Jordan. Pharm Pract (Granada). 2019;17(4):1661. https://doi.org/10.18549/pharmpract.2019.4.1661
Mobark DM, Al-Tabakha MM, Hasan S. Assessing hormonal contraceptive dispensing and counseling provided by community pharmacists in the United Arab Emirates: a simulated patient study. Pharm Pract (Granada). 2019;17(2):1465. https://doi.org/10.18549/pharmpract.2019.2.1465
Medical Subject Heading (Mesh). High Fidelity Simulation Training. Available at: https://www.ncbi.nlm.nih.gov/mesh/?term=High-fidelity+simulation (accessed Oct 12, 2020).
Roberts F, Cooper K. Effectiveness of high fidelity simulation versus low fidelity simulation on practical/clinical skill development in pre-registration physiotherapy students: a systematic review. JBI Database System Rev Implement Rep. 2019;17(6):1229-1255. https://doi.org/10.11124/jbisrir-2017-003931
Brata C, Schneider CR, Marjadi B, Clifford RM. The provision of advice by pharmacy staff in eastern Indonesian community pharmacies. Pharm Pract (Granada). 2019;17(2):1452. https://doi.org/10.18549/pharmpract.2019.2.1452
Campbell JL, Carter M, Davey A, Roberts MJ, Elliott MN, Roland M. Accessing primary care: a simulated patient study. Br J Gen Pract. 2013;63(608):e71-e76. https://doi.org/10.3399/bjgp13x664216
Nicholson J, Kalet A, van der Vleuten C, de Bruin A. Understanding medical student evidence-based medicine information seeking in an authentic clinical simulation. J Med Libr Assoc. 2020;108(2):219-228. https://doi.org/10.5195/jmla.2020.875
Schlegel CAB. Simulated and standardized patients in health profession education: the impact of quality improvement. Maastricht: Maastricht University;2016. ISBN: 978 94 6159 525 6.
MacLean S, Geddes F, Kelly M, Della P. Simulated patient training: Using inter-rater reliability to evaluate simulated patient consistency in nursing education. Nurse Educ Today. 2018;62:85-90. https://doi.org/10.1016/j.nedt.2017.12.024
MacLean S, Kelly M, Geddes F, Della P. Use of simulated patients to develop communication skills in nursing education: An integrative review. Nurse Educ Today. 2017;48:90-98. https://doi.org/10.1016/j.nedt.2016.09.018
Wind LA, Van Dalen J, Muijtjens AM, Rethans JJ. Assessing simulated patients in an educational setting: the MaSP (Maastricht Assessment of Simulated Patients). Med Educ. 2004;38(1):39-44. https://doi.org/10.1111/j.1365-2923.2004.01686.x
Howley L, Szauter K, Perkowski L, Clifton M, McNaughton N; Association of Standardized Patient Educators (ASPE). Quality of standardised patient research reports in the medical education literature: review and recommendations. Med Educ. 2008;42(4):350-358. https://doi.org/10.1111/j.1365-2923.2007.02999.x
Instituto Brasileiro de Geografia e Estatística. [City and states]. Available at http: https://ibge.gov.br/ (accessed Jul 27, 2020).
Meier RS, Perkowski LC, Wynne CS. A method for training simulated patients. J Med Educ. 1982;57(7):535-540. https://doi.org/10.1097/00001888-198207000-00005
Wallace P. Coaching standardized patients: for use in the assessment of clinical competence. New York: Springer; 2006. ISBN: 9780826102249
Furman G. The role of standardized patient and trainer training in quality assurance for a high-stakes clinical skills examination. Kaohsiung J Med Sci. 2008;24(12):651-655. https://doi.org/10.1016/S1607-551X(09)70031-2
Nestel D, Fleishman C, Bearman M. Preparation: developing scenarios and training for role portrayal. In: Nestel D, Fleishman C, Bearman M, eds. Simulated patient methodology: theory, evidence and practice. Chichester: Wiley-Blackwell; 2014. ISBN: 9781118761007.
Cleland JA, Abe K, Rethans JJ. The use of simulated patients in medical education: AMEE Guide No 42. Med Teach. 2009;31(6):477-486. https://doi.org/10.1080/01421590903002821
Lubarsky S, Dory V, Duggan P, Gagnon R, Charlin B. Script concordance testing: from theory to practice: AMEE guide no. 75. Med Teach. 2013;35(3):184-193. https://doi.org/10.3109/0142159x.2013.760036
INACSL Standards Committee. INACSL Standards of Best Practice: SimulationSM Outcomes and objectives. Clin Simul Nurs. 2016;12(suppl):S13-S15. https://doi.org/10.1016/j.ecns.2016.09.006
INACSL Standards Committee. INACSL standards of best practice: SimulationSM Participant evaluation. Clin Simul Nurs. 2016;12(suppl):S26-S29. http://doi.org/10.1016/j.ecns.2016.09.009
INACSL Standards Committee. INACSL standards of best practice: SimulationSM Simulation glossary. Clin Simul Nurs. 2016;12(suppl):S39-S47. http://doi.org/10.1016/j.ecns.2016.09.012
INACSL Standards Committee. INACSL standards of best practice: SimulationSM Professional integrity. Clin Simul Nurs. 2016;12(suppl):S30-S33. http://doi.org/10.1016/j.ecns.2016.09.010
Lewis KL, Bohnert CA, Gammon WL, Hölzer H, Lyman L, Smith C, Thompson TM, Wallace A, Gliva-McConvey G. The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP). Adv Simul (Lond). 2017;2:10. https://doi.org/10.1186/s41077-017-0043-4
Perera J, Perera J, Abdullah J, Lee N. Training simulated patients: evaluation of a training approach using self-assessment and peer/tutor feedback to improve performance. BMC Med Educ. 2009;9:37. https://doi.org/10.1186/1472-6920-9-37
Matos DAS. [Reliability and agreement among evaluators: applications in the educational area]. Est Aval Educ. 2014;25(59):298-324.
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(3):Doc27. https://doi.org/10.3205/zma001235
Veettil SK, Rajiah K. Use of simulation in pharmacy practice and implementation in undergraduate pharmacy curriculum in India. Int J Pharm 2016;8(7):1-5.
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(3):Doc31. https://doi.org/10.3205/zma001239
Yang HX, Xu Y, Liang NX, Chen W, Yan XM, Yang P, Guan ZY, Pfeiffer CA, Li Q, Zhao J, Pan H. Standardized patient methodology in mainland China: a nationwide survey. BMC Med Educ. 2019;19(1):214. https://doi.org/10.1186/s12909-019-1630-y
[Cuts in CNPq: uncertainty about future of research in Brazil]. https://desafiosdaeducacao.grupoa.com.br/cortes-no-cnpq/ (accessed Oct 12, 2020).
[Motion dificulties in Brazil]. https://www.projetoredacao.com.br/temas-de-redacao/a-crescente-crise-da-mobilidade-urbana-brasileira/as-dificuldades-de-locomocao-no-brasil/51331 (accessed Oct 12, 2020).
Oliveira R. [Field trips go into the uncertainty]. http://www.jornaldocampus.usp.br/index.php/2016/09/viagens-de-campo-passam-por-incertezas/ accessed Oct 12, 2020).
Jug R, Jiang XS, Bean SM. Giving and Receiving Effective Feedback: A Review Article and How-To Guide. Arch Pathol Lab Med. 2019;143(2):244-250. https://doi.org/10.5858/arpa.2018-0058-ra
Hammoud MM, Morgan HK, Edwards ME, Lyon JA, White C. Is video review of patient encounters an effective tool for medical student learning? A review of the literature. Adv Med Educ Pract. 2012;3:19-30. Published 2012 Mar 22. https://doi.org/10.2147/amep.s20219
Gehringe EF. Self-Assessment to Improve Learning and Evaluation. 2017 ASEE Annual Conference & Exposition. Columbus, OH, Jun 2017. https://doi.org/10.18260/1-2--28816
Bouter S, van Weel-Baumgarten E, Bolhuis S. Construction and validation of the Nijmegen Evaluation of the Simulated Patient (NESP): assessing simulated patients' ability to role-play and provide feedback to students. Acad Med. 2013;88(2):253-259. https://doi.org/10.1097/acm.0b013e31827c0856
How to Cite
Copyright (c) 2020 Pharmacy Practice and the Authors
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.