Comments on “The pillars of well-constructed simulated patient programs: A qualitative study with experienced educators”

We read the recent article by Pritchard et al. (2017) regarding the best practice for simulated patients in the teaching of health professionals with keen interest. Being final-year medical students at Cardiff University, we undergo SP teaching regularly to develop our clinical and communication skills and so to consider how our educators support SPs to provide effective SP-based education for our learning is very insightful. The four themes identified that represent the key structural components to optimizing SP programs are echoed by many of our cohort. Although as a student it is difficult to comment on the administrative and logistical issues outlined in theme 1, theme 2 “selecting SPs” highlighted some important factors that students may not have previously considered but are vital to our education. When participating in SP education as a learner, it is highly important that the SP reacts to particular scenarios in the most appropriate way for their character and that their feedback is not influenced by their prior experiences in the NHS. Therefore, having nonbiased SPs with no ulterior motives is the most effective way for students to prepare for real-life situations. In addition, we feel it is imperative for SPs to be capable of delivering constructive and relevant feedback to the learners from the perspective of the patient – gaining information about how a student’s body language, tone, and content of speech made the SP feel when in character is invaluable and unique to SP-based education. This information, complemented by feedback from educators allows a more complete evaluation of performance. At Cardiff University, we also receive written feedback from both the SP and examiner in our integrated structured clinical examinations, which is a great way to evaluate our communication and professionalism skills from both a clinical and a patient point of view under stressful conditions. From the perspective of the medical student theme three, “preparing SPs”, is seen as a vital part of the teaching process. Convincing and realistic portrayal of a character is key for the development of the communication skills required in the healthcare setting. At Cardiff, the SPs are professional actors often with years of experience in SP education with medical students. In addition, they often play the same character in a scenario year-on-year and thus are extremely authentic. This allows us to react naturally to new situations in an environment where it is safe to make mistakes, identify them – either by self-identification or via the educator/SP – and adjust our approach. Advising on how much information the SP should divulge, especially in challenging scenarios, forces students to carefully consider the phrases and body language that suits the patients’ needs best in order to gain their trust and subsequently the important information from them. The involvement of the educator is also emphasized in theme four, “Directing SP’s”, another aspect that greatly increases the effectiveness of these sessions for the learner. The presence of an educator to guide the session, not only allows for the safety of the SP as described, but also greatly increases the comfort and confidence of the learner in the situation. Students appreciate that they have support not only in a theory and knowledge capacity but also in an emotional capacity, especially when faced with particularly challenging sessions and scenarios. What we find particularly useful in sessions at Cardiff University is when educators have identified that the learner is struggling in a scenario and pauses the session. This allows the learner to verbalize their strengths and weaknesses, allows the rest of the learners observing to give constructive criticism and the educator to steer the learner in the right direction again. We feel this is vital in the development of communication skills, especially in more challenging scenarios. The combination of these factors makes SP-based education an unrivaled tool in the development of students and healthcare professionals, and with the continued evaluation of its practice the value of this teaching will only increase.