Minding the gap between communication skills simulation and authentic experience

Abstract

CONTEXT Concurrent exposure to simulated and authentic experiences during undergraduate medical education is increasing. The impact of gaps or differences between contemporaneous experiences has not been adequately considered. We address two questions. How do new undergraduate medical students understand contemporaneous interactions with simulated and authentic patients? How and why do student perceptions of differences between simulated and authentic patient interactions shape their learning?METHODS We conducted an interpretative thematic secondary analysis of research data comprising individual interviews (n = 23), focus groups (three groups, n = 16), and discussion groups (four groups, n = 26) with participants drawn from two different year cohorts of Year 1 medical students. These methods generated data from 48 different participants, of whom 17 provided longitudinal data. In addition, data from routinely collected written evaluations of three whole Year 1 cohorts (response rates 88%, n = 378) were incorporated into our secondary analysis dataset. The primary studies and our secondary analysis were conducted in a single UK medical school with an integrated curriculum.RESULTS Our analysis identified that students generate knowledge and meaning from their simulated and authentic experiences relative to each other and that the resultant learning differs in quality according to meaning created by comparing and contrasting contemporaneous experiences. Three themes were identified that clarify how and why the contrasting of differences is an important process for learning outcomes. These are preparedness, responsibility for safety, and perceptions of a gap between theory and practice.CONCLUSIONS We propose a conceptual framework generated by reframing common metaphors that refer to the concept of the gap to develop educational strategies that might maximise useful learning from perceived differences. Educators need to 'mind' gaps in collaboration with students if synergistic learning is to be constructed from contemporaneous exposure to simulated and authentic patient interactions.The strategies need to be tested in practice by teachers and learners for utility. Further research is needed to understand gaps in other contexts.

Learning patient-centred communication: The journey and the territory

“…Detachment, as a protective mechanism, risks being reinforced if students do not see clinicians explore and discuss the patient's perspectives (33,34). Without providing strategies and discussing how to manage difficult situations, which could otherwise overwhelm students and further distress patients, students will perhaps quite wisely stay within the safer biomedical territory.…”

“…The actual experience of patients and their unpredictable responses and agendas provide learners the opportunity to derive meaning (31,33,34). The apparent contradiction in contrived practice with simulated patients may understandably make it difficult for students to engage fully.…”

What’s in a name? A discussion of what medical students and junior doctors call their senior colleagues, and why it matters

“…Discussing differences they notice, working out why they exist and deciding what meaning and action they will take as a result can train the students to do their own reflecting in future. (Yardley, Irvine, & Lefroy, 2013) Having discussed and reviewed the use of names and titles in the complex 'swampy lowlands' (Schon, 1991) of medical school classroom and placement etiquette from the perspective of the clinician tutors, the authors have been struck by the lack of detailed information from the student perspective, which is arguably the most important perspective of all. We don't really know how big a problem this inconsistency and complexity is for students, how much of a barrier it poses to their learning, how much of their emotional energy it consumes or even how students actually deal with it on a practical level on a daily basis.…”

Pacientes simulados en la formación de los profesionales de salud: el lado humano de la simulación

“…Sin embargo, hay un llamado a "cuidar la brecha" entre la experiencia simulada y la no-simulada (con pacientes reales), especialmente en el aprendizaje de empatía, profesionalismo y en el caso del trabajo con pacientes con enfermedades psiquiátricas [37][38][39] . Se recomienda usar casos "simples" en los primeros encuentros de los estudiantes con PS, y luego incluir situaciones que sea difícil que los estudiantes las enfrenten en el mundo real: situaciones de emergencia o de poca frecuencia; entregar una mala noticia o discutir temas delicados como disfunción sexual; entregar un plan de manejo en común acuerdo con el paciente; ayudar a un paciente a un cambio en su estilo de vida, entre otras 40 .…”