The number of variables in the case can be controlled for learning level. Learner can make and learn from mistakes without fearing harm to real patient. Learner can practice integrating knowledge and skills in real time. SP can be trained to give constructive feedback from patient's point of view. SPs are an integral part of four of the 10 monthly seminars each year.
Faculty facilitate small groups in which the students interview SPs.
During time-outs the group participants brainstorm, discuss aspects of the case and make suggestions to the interviewing student on how to deal with specific patient issues. At the end of the encounter, the SP comes out of character and gives feedback to the group on what the patient experienced during that encounter. Another example of how students are learning clinical skills in interaction with SPs is in the ambulatory experience within the Internal Medicine Clerkship at San Diego Hospice during third-year. Before working with the actual patients at hospice, students learn, in a small group setting, how to give bad news to a terminally ill simulated patient, meet with her on a subsequent visit and work through pain assessment and management, family, psychological and spiritual issues. Future plans include developing scenarios in which students learn to interact with family members or significant others of the dying patient.