Involvement of Expert Patients in Simulation Courses to Train Residents on Communication of Bad News
Authors: Lambert Juliette , Roux Paul , Bouguet Guy , Sicre de Fontbrune Flore , Rousselot Philippe , Besson Caroline 
Published: December 2024

Introduction: Patients and their associations want to get involved in developing their relationship with caregivers towards more partnership. In France, the 2019 health law favored patient participation in practical and theoretical training. We have set up and evaluated training workshops for breaking bad news in simulation labs involving expert patients and dedicated to residents and medical students.

Residents in clinical hematology from Ile de France, and medical students in 6th year participated in these workshops in the simulation laboratory. They included a course on breaking bad news according to the French recommendation and to the SPIKES protocol and four role plays, each followed by a debriefing. These workshops were supervised by two teachers, one of whom has a simulation teaching certificate.

Methods: The workshops were carried out in collaboration with expert patients from the ELLYE association and the “League against cancer”. ELLYE association is a patient association dedicated to lymphoma and chronic lymphocytic leukemia. The “League” association is dedicated to the fight against cancer, and works for prevention, patient support and research. Expert volunteer patients from both associations have benefited from specific training.

ELLYE volunteers participated by collaborating on the scenarios and by playing the role of patients in the role plays with the hematology residents. They also participated in debriefings. League volunteers were involved in the form of two testimonies supervised by a “League against cancer” employee during the workshops dedicated to medical students. In this second case, student volunteers played the patients in the role plays.

Student satisfaction was measured by a satisfaction questionnaire, on the one hand, and by the MAASTRICHT questionnaire for the evaluation of simulated patients (MaSP), on the other hand. The questionnaires were administered at the end of the workshop. The responses to the satisfaction questionnaires were analyzed qualitatively, based on responses to open questions, and quantitatively. The responses to the MaSP questionnaire were compared between the two teaching modalities using the Mann-Whitney rank test.

Results: Overall, these workshops were very appreciated by residents and medical students. The evaluation was carried out with 8 hematology residents (one workshop) and 27 medical students (two workshops of 16 and 11 students). The overall score was maximum for the 8 residents and for 25/27 medical students. The comments encourage us to continue these workshops: “it should be mandatory”, “very enriching experience in very realistic conditions”.

The comparison of the two modalities of simulated patients (expert patients or student volunteers) showed that the expert patients had higher performances than the students on all the items evaluated, and significantly, for “seems authentic” and “could be a real patient”. The expert patients from both associations also reported a high degree of satisfaction from these experiences.

Conclusion: This educational experience illustrates that collaboration with patient associations in teaching is enriching for residents and medical students. It is not a question of patients competing with the academic knowledge of professionals but of sharing their health journeys, their lifestyle habits, their representations and their “experiential knowledge”. Expert patients also performed better in role play than students. Patient engagement could transform medical training.