Widyandana’s Weblog

POSTER ABSTRACT

By: dr. Widyandana, MHPE
Simulated patient Coordinator in Skills Lab

Department of Medical Education
Gadjah Mada University

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Overview
The Skills Training Centre in the Faculty of Medicine of Gadjah Mada University (GMU) is developing simulated patient regarding the needs of early clinical exposure where students can learn clinical skills gradually and systematically, as preparation towards standardized clinical competence.
In the skills training program, innovative approach to enhance the realism is by combining the use of mannequins and standardized patients in the Skills Lab4.
Simulated Patients (SP) is only one term used to describe individuals trained to portray the history, physical findings and effects of an actual patient. They have also been called “programmed patients”, “pseudo patients”, “surrogate patients” or “standardized patient” 6.
SPs have so many advantages and several disadvantages2. The examples for advantages of SPs are: available at any time and any situation, available in a non clinical setting, SPs can be standardized (consistent content), provide clinical training for beginner’s medical students provides direct feedback about interpersonal skills and offers a flexible educational tool2. The disadvantages of SPs are: resource intensive and too complicated5, recruiting, training and organization SP’s is time consuming3 and high cost to pay SPs5.
Realizing the advantages and disadvantages of SPs, GMU are developing Simulated Patient Cycle for improving the use of SP in the Skills Lab Faculty of Medicine GMU.

The Cycle of Management SP in Skills Lab including;

Recruitment –> Training –> management role of SP –> Evaluation and Feedback

Evaluation and Feedback
Faculty of Medicine GMU adapts the Maastricht Assessment of Simulated Patients (MaSP) 8. SPs should be observed regularly and given detailed feedback, coaching and continued training1. Feedback for SPs comes from students and instructors8. In the survey to the students in GMU, shows that; the students still believe that SPs in GMU are not good enough. It still needs training for acting skills and giving constructive feedback to the students.

Training
There is no consensus or standard for SP’s training1. The techniques employed in the training are aimed at helping the SP actually take on the real patient problem as a believable self role6. Application of 4C/ID model in training of SP could be ideal. 4 components for Instructional Design are; Learning tasks, Supportive information, Just in time information, Part task practice7 .

The Role of SP
Ideally for quality assurance purpose, SP face students not more than 3-4 consecutive times (10-20 minutes/session) 1. Develop SP handbook, training protocol and case material template are important for SPs1. SP have to be well paid and manage.

Recruitment
Adamo (2003) give several criteria on recruiting SPs; age, language, gender, body habits, findings on physical examination, including scars, stretch marks, physical functionality, etc.

Summary
- SPs are very useful tools for the skills training program and the application of Simulated Patient Cycle for managing SP could be a good choice.
- Considering the quality assurance and standardization of SPs, the SPs should be observed, evaluated and trained regularly.
- Using simulated patients combined with other resources in Skills Lab offer high quality skills training program towards standardized clinical competence and assessment.

References
1. Adamo G, 2003. Simulated and standardized patients in OSCE’s: achievements and chalanges 1993-2003. Jurnal Medical Teacher, vol 25: 262-270
2. Barrow, H.S., 1987. Simulated (Standardized) Patients and other human simulations. Chapel Hill: Health Sciences Consortium.
3. Collins, J.P. and Patel, V.J., 1986. AMEE Medical Education Guide No. 13: Real Patients, Simulated Patients and simulator in clinical examinations. Medical Teacher, 20 (6), 508-521.
4. Good, M.L., 2003. Patient simulation for training basic and advanced clinical skills. Journal Medical Education, vol 37: 14-21
5. Kassebaum, D.G., 1993. On standardized patients and clinical skills assessment. Academic Medicine, 65, 5, 307.
6. Neuffeld, V.R. and Norman, G.R., 1991. Assessing Clinical Competence. Springer Publishing Company: New York.
7. Van Marrienboer JJG, Clark RE, de Croock MBM., 2002. Blueprints for complex learning: The 4C/ID-model. ETR&D., vol 50: 39-64
8. Wind, Lidewij A., et.al., 2004. Assessing simulated patients in an educational setting: the MaSP (Maastricht Assessment of Simulated Patients). Jurnal Medical Education, vol 38: 39-44

This Poster was published on PEPKI III Conference in Bali, 2005
Further discussion, contact: widyandana@yahoo.com