CONTEXT: Most medical doctors are likely to work with patients experiencing mental health conditions. However, there are often limited educational opportunities for medical doctors to achieve professional development in the field of psychiatry. Simulation training in psychiatry may be a useful tool to foster this development. OBJECTIVES:To assess the effectiveness of simulation training in psychiatry for medical students, post-graduate trainees, and medical doctors. METHODS:For this systematic review and meta-analysis, we searched 8 electronic databases and trial registries up to August 31, 2018. We manually searched key journals and the reference lists of selected studies. We included randomised and non-randomised controlled studies and single group prepost-test studies. Our main outcomes were based on Kirkpatrick levels. We included data only from Randomised Controlled Trials (RCTs) using random-effects models. RESULTS:From 46 571 studies identified, we selected 163 studies and combined 27 RCTs. Interventions included simulation by role-play (n=69), simulated patients (n=72), virtual reality (n=22), manikin (n=5) and voice simulation (n=2). Meta-analysis found significant differences at immediate post-test for simulation compared with active and inactive controls on attitudes (SMD=0.52 (95%CI 0.31; 0.73; I 2 = 0%) and 0.28 (95%CI 0.04; 0.53; I 2 = 52%), respectively); on skills (SMD=1.37 (95%CI 0.56; 2.18; I 2 =93%) and 1.49 (95%CI 0.39; 2.58; I 2 = 93%), respectively); on knowledge (SMD=1.22 (95%CI 0.57; 1.88; I 2 = 0%) and 0.72 (95%CI 0.14; 1.30; I 2 = 80%), respectively); and on behaviours (SMD= 1.07 (95%CI 0.49; 1.65; I 2 =68%) and 0.45 (95%CI 0.11; 0.79; I 2 =41%), respectively. Significant differences were found at three-month follow-up for patient benefit and doctors' behaviours and skills. CONCLUSIONS: Despite heterogeneity in methods and simulation interventions, our findings demonstrate the effectiveness of simulation training in psychiatry training.

Purpose The purpose of this paper is to discuss the role of education and training in addressing health inequalities in intellectual disabilities, before examining innovative approaches to healthcare education. Preliminary findings of a simulation training course to support healthcare professionals to work with people with intellectual disability are then presented. Design/methodology/approach This study employed a mixed methods design to assess the impact of the simulation course. Quantitative data were collected using the Healthcare Skills Questionnaire and a self-report confidence measure; qualitative data were collected using post-course survey with free text responses to open questions. Findings Healthcare skills and confidence showed statistical improvements from pre- to post-course. Qualitative analyses demonstrated that participants perceived improvements to: attitudes, communication skills, reasonable adjustments, interprofessional and multi-disciplinary working, knowledge of key issues in working with people with intellectual disabilities. Practical implications Encouraging findings imply that simulation training to address health inequalities in intellectual disabilities is a valuable resource that merits further development. This training should be rolled out more widely, along with ongoing longitudinal evaluation via robust methods to gauge the impact on participants, their workplaces, and people with intellectual disabilities. Originality/value The authors believe this paper to be the first to assess an interprofessional, high-fidelity simulation course, using actors as simulated patients to address the mental and physical health needs of people with intellectual disabilities. The rigorous use of co-production and co-delivery, alongside promising findings for this training method, represent a useful contribution to the literature.

Aims Mental disorders constitute one of the main causes of disease and disability worldwide. While nurses are often at the frontline of mental health care, they have limited access to dedicated psychiatric training opportunities. Simulation training may foster the development of the appropriate competencies required when supporting people with mental disorders. To evaluate the effectiveness of simulation training in psychiatry for nursing students, nurses and nurse practitioners. Design Systematic review and meta‐analysis. Data sources Eight electronic databases, trial registries, key journals and reference lists of selected studies were searched from inception to August 20, 2020 without language restriction. Review Methods We included randomized and non‐randomized controlled studies and single group pre/post studies. Cochrane Risk of Bias tool 2.0 was used for randomized controlled study appraisal, and the Medical Education Research Study Quality instrument was completed for all other studies. Meta‐analysis was restricted to randomized controlled studies. The other studies were synthesized narratively. The main outcomes were based on Kirkpatrick levels. Results A total of 118 studies (6738 participants) were found. Interventions included simulated patients (n = 55), role‐plays (n = 40), virtual reality (n = 12), manikins (n = 9) and voice simulations (n = 9). Meta‐analyses based on 11 randomized controlled studies found a significant large effect size on skills at immediate post‐test for simulation compared with active control; and a small and medium effect size on learners’ attitudes for simulation compared with inactive control, at immediate post‐test and at three‐month follow‐up respectively. Three quarters of non‐randomized controlled studies and pre/post‐tests assessing attitudes and skills showed significant differences, and three quarters of participants in randomized controlled studies and pre/post‐tests showed significant differences in behaviours. Among the few studies assessing people with mental health outcomes, almost all reported significant differences. Conclusion These findings support the effectiveness of simulation training in psychiatric nursing throughout professional development grades, despite heterogeneity in methods and simulation interventions.

Purpose People with intellectual disabilities experience poorer health outcomes than the general population, and a significantly increased risk of mental health comorbidity. Their access to healthcare has been consistently shown as inadequate, and their access to mental health support is still largely wanting. Adequate training and education should improve these shortcomings but there is limited evidence available as to the best way to achieve this. The paper aims to discuss these issues. Design/methodology/approach This paper reports on the co-production and co-delivery of a simulation training course to support healthcare professionals to provide care for people with intellectual disabilities, with a particular focus on their mental health needs. This training was designed with actors with intellectual disabilities, who participated as simulated patients in scenarios during the course and subsequently provided feedback on their experience. Findings This paper focusses on the positive experiences of the simulated patients, reporting on and interpreting their direct feedback on their experience of contributing to the development and delivery of the course and being involved as co-educators. Originality/value It is highlighted that the co-production and delivery of this simulation training with people with intellectual disabilities has the potential to realise some of the key principles called upon when attempting to improve how they are treated, by illustrating concrete participation, independence, and access to fulfilling lives. The value and benefits of interprofessional education to achieve these educational aims is further highlighted, particularly for the potential to generate a sense of shared responsibility within mainstream services in caring for people with intellectual disabilities.

Despite recognised benefits of Simulation-Based Education (SBE) in healthcare, specific adaptations required within psychiatry have slowed its adoption. This article aims to discuss conceptual and practical features of SBE in psychiatry that may support or limit its development, so as to encourage clinicians and educators to consider the implementation of SBE in their practice. SBE took off with the aviation industry and has been steadily adopted in clinical education, alongside role play and patient educators, across many medical specialities. Concurrently, healthcare has shifted towards patient-centred approaches and clinical education has recognised the importance of reflective learning and teaching centred on learners' experiences. SBE is particularly well-suited to promoting a holistic approach to care, reflective learning, emotional awareness in interactions and learning, cognitive reframing, and co-construction of knowledge. These features present an opportunity to enhance education throughout the healthcare workforce, and align particularly well to psychiatric education, where interpersonal and relational dimensions are at the core of clinical skills. Additionally, SBE provides a strategic opportunity for people with lived experience of mental disorders to be directly involved in clinical education. However, tenacious controversies have questioned the adequacy of SBE in the psychiatric field, possibly limiting its adoption. The ability of simulated patients (SPs) to portray complex and contradictory cognitive, psychological and emotional states has been questioned. The validity of SBE to develop a genuine empathetic understanding of patients, to facilitate a comprehensive multiaxial diagnostic formulation, or to develop flexible interpersonal skills has been criticised. Finally, SBE's relevance to developing complex psychotherapeutic skills is much debated, while issues such as symptom induction in SPs or patients involvement raise ethical dilemmas. These controversies can be addressed through adequate evidence, robust learning design, and high standards of practice. Well-designed simulated scenarios can promote a positive consideration of mental disorders and complex clinical skills. Shared guidelines and scenario libraries for simulation can be developed, with expert psychiatrists, patients and students involvement, to offer SPs and educators a solid foundation to develop training. Beyond scenario design, the nuances and complexities in mental healthcare are also duly acknowledged during the debriefing phases, providing a crucial opportunity to reflect on complex interpersonal skills or the role of emotions in clinicians' behaviour. Considered recruitment and support of SPs by clinical educators can help to maintain psychological safety and manage ethical issues. The holistic and reflexive nature of SBE aligns to the rich humanistic tradition nurtured within psychiatry and medicine, presenting the opportunity to expand the use of SBE to support a range of clinical skills and workforce competencies required in psychiatry.