spsim 2017 Bern

Short Presentations 1 – Simulated Patients – 17.03.2017 – 11.30 to 12.45 – Lecture hall A 003

Chair: Henrike Hölzer

Time Title
11:30 – 11:45 Competencies of standardized persons during role-play and feedback-discussion

Sibylle Matt Robert1, Petra Metzenthin1, Stephan Lichtensteiger2, Sibylle Heim2, Priska Gisler2, Wolfram Heberle2Dörte Watzek1
1Berner Fachhochschule, Gesundheit, Switzerland; 2Berner Fachhochschule, Hochschule der Künste, Switzerland; sibylle.matt@bfh.chdoerte.watzek@bfh.ch
Background: Actors are increasingly being employed in various social areas as standardised persons (SP) for educational sessions. An additional characteristic of advanced communication training is that actors are not only employed as standardised persons, but also as communication trainers (CT). They are responsible for the feedback session. At Berne University of Applied Sciences, Health Section lecturers are mostly not present during the trainings. Feedbacks given by standardised persons are effective, if they start with a short self-evaluation of students or if it is guided by a clear standard. This can be a checklist but it is not necessarily a structured aid (Bokken, Linssen, Scherpbier, Vleuten, & Rethans, 2009). The task is challenging and that’s why it is important to investigate the necessary competencies. The cooperation of a theatre and a health division gave the opportunity to have a look on communication trainings from both perspectives. The goal of the study is to describe artistic as well as communicational or other professional skills required by the actors for their different roles as communication trainers.
Research question: Which competencies do actors apply in their various roles as communication trainers?
Methods: A multi-method qualitative design with analyses of performances (participatory observation) and seven semi-structured focus group interviews with all involved parties, which are (a) communication trainers, (b) BSc and MSc students, (c) lecturers. Lecturers and students came from nursing, midwifery and physiotherapy. A deductive and an inductive approach were combined in a qualitative content analysis. Categories regarded the two main roles during communication training.
Results: Observational analysis of the theatre division results in the declaration, that there are more roleplays than the one during the first act as patient. The actor’s perspectives indicate a roleplay also during the feedback session.
The results of the focus group show, that theatre skills as well as skills from the field of communication and knowledge about health issues and health professional behaviour are needed in every stage. A good communication training performance has to be well prepared and reflected. An excellent roleplay is of no benefit without a good guided feedback session. Main theatrical competencies result from the categories (a) dealing with different roles and functions, (b) attentiveness on multiple layers (Directing on stage), (c) adaptation of theatre skills to diverse requests, (d) improvisation skills, (e) arranging the setting. Concerning all competencies lecturers, students and actors had similar points of view.
Discussion: To our knowledge this is the first investigation of competencies of SPs within these perspectives of health professionals and theatre professionals. Combination of analyses of performances and focus group interviews seems to be fruitful. In the focus groups all involved parties took part.
As the investigation took place within a specific setting of communication trainings generalizability is limited. One cannot completely exclude the aspects social desired behaviours or answers. This leads to future investigation within other settings.
Conclusion: We do ask the question, if there will once be created a profession of communication trainer that shows, how many competencies are essential for actors working with students and that intense instruction of these collaborators is inevitable. Our discussion leads us to a role model for communication trainers adapted from the CanMEDS-Model (Frank, 2005).
Bokken, L., Linssen, T., Scherpbier, A., van der Vleuten, C., & Rethans, J. J. (2009). Feedback by simulated patients in undergraduate medical education: a systematic review of the literature. Medical Education, 43(3), 202-210.
Frank, JR. (Ed). 2005. The CanMEDS 2005 physician competency framework. Better standards. Better physicians. Better care. Ottawa: The Royal College of Physicians and Surgeons of Canada. Retrieved 16.01.2014: http://www.ub.edu/medicina_unitateducaciomedica/documentos/CanMeds.pdf.

11:45 – 12:00 Using Serious Games to Train Patient Observation
Claudia Schlegel, Uwe Weber
Berner Bildungszentrum Pflege, Switzerland; claudia.schlegel@bzpflege.ch
This is a Research In Progress RIP
Introduction: A key precondition to improve patient safety is, that clinical practitioners are able to identify everyday risks to patients. Patient safety is an important element in the training of nurses. Clinical practice feedback shows that second-semester nursing students are experiencing difficulties in assessing the overall situation presented by a patient and his environment using focused observation, and initiating the necessary measures. Focused patient observation is crucial, as it increases patient safety. In order for students to learn and train patient observation in their first semester, a serious game was developed. Serious games are conceptually aimed at conveying knowledge and allowing players to discover and learn. The question is whether serious games represent a lastingly instructive teaching method.
Method: In order to assess the efficacy of serious games as a teaching method, the study was designed as a static group comparison. Two groups of first-semester nursing students (n=86) took part in the study. The intervention group played a game with a video still of a patient room presenting risks for the patient. Students were asked to find 11 errors using a limited number of clicks. At each correct click, a text faded in explaining why this represented a potential hazard. When students did not achieve the required number of correct answers or when they exceeded the number of clicks allowed, they went back to reading about the topic before playing the game again. Once the game had been successfully completed, a reading assignment gave students the opportunity to deepen their knowledge of the topic.
The control group was given the same still image in paper form, was tasked to find the same 11 errors, and was also able to read why these errors represented potential risks. They were given the same reading assignment to deepen their knowledge of the topic.
The posttest was conducted as a formative OSCE station. Students from both groups were run through a ward presenting a re-enacted scene similar to the still they had seen. Students had to tell observers which measures they would initiate to improve patient safety. Observers were blinded and did not know which students belonged to which group.
Data analysis will take place in winter 2016.

12:00 – 12:15 SPs’ knowledge of and adherence to feedback standards – Results from feedback trainings and an observational study
Julia Freytag
Charité Universitätsmedizin Berlin, Germany; julia.freytag@charite.de
Background: Feedback trainings are an extremely important part of the instruction of Simulated Patients (SPs). As we make much effort to prepare our SPs adequately, giving feedback remains a very difficult task and its quality is often not as high as desired. But what are the causes for that? Do SPs not know or understand all standards? Or do they find it too just difficult to meet them all? Through different approaches we tried to gain more insight into SPs’ knowledge of our feedback standards on one hand and their adherence or non-adherence to this standards on the other hand.
Research question: Our main research questions were: Which of our standards for giving feedback do SPs know? And which of those standards do they meet? We wanted to know if it is possible to identify certain patterns of feedback rules that are hardly known, that are often missed out on and to examine potential connections between those two areas.
Methods: We held several “advanced” feedbacks trainings and asked SPs afterwards, which of the standards they had already known before. Additionally, we observed 34 SPs while giving feedback after a simulated encounter in a communication skills course. For the observations we used an assessment tool for SP-feedback, developed by the SP Committee of the German Association for Medical Education (GMA) which includes 21 feedback standards (e.g. SP uses specific examples in his/her feedback).
Results: 45 SPs took part in one of the feedback trainings. The overall knowledge level was high with 15 out of 21 standards that were known by at least 80% of SPs. Areas with low knowledge levels were for example connected to a well-balanced speaking time between learner and SP or the checking of students’ understanding of SP’s feedback. This results were supported by our observations (N=34), where we found low adherence rates in the same areas. We also found some discrepancies, e.g. that SPs adherence to using descriptive vocabulary in their feedback is rather low (50%), although almost all SP (86%) stated, they know this rule.
Discussion: The participants in our trainings and in the observational study are a representative sample of our SP pool (considering age, experience etc.), still 45, respectively 34 data sets, only have a limited explanatory power. Furthermore the data from the feedback trainings cannot be linked to the data from the observations on an individual level. Nonetheless the results show that many standards with low adherence levels are standards which a lot of SPs do not seem to know. Feedback trainings which focus on securing the knowledge and understanding of all standards therefore present a first step to an improved feedback quality. In a second step we must turn our attention to standards which are known, but not yet met.
Conclusion: Our research suggests that some deficits in the quality of SPs’ feedback are connected to SPs’ knowledge and understanding of the feedback standards. This problem can be easily approached in future trainings. Further research is needed to find out the reasons why some standards are known, but not met. Possibilities include that these standards are too difficult for some SPs or have not been trained well enough or that they are simply considered as not important by SPs.

12:15 – 12:30 Patient simulation in neurology : choosing sensory and attention cueing for patient with Parkinson’s disease and teaching its use in everyday life

Sylvie Ferchichi, Isabelle Chebil Dobbi, Corinne Gaudin, Nicolas Perret
Haute Ecole de Santé Vaud, Switzerland; sylvie.ferchichi-barbey@hesav.ch
Background: Most of the student have difficulties in understanding and getting a correct representation of the OFF phase phenomena in Parkinson’s disease (PD). They do not realise how challenging it can be to teach motor strategies to patients. They also have minimal concern about how to teach a patient to use these tools -the cues- in everyday life. We reached the limits with traditional teaching methods (ie: videos, clinical description, clinical vignette). Therefore, we came to simulation in order to offer an authentic experience: a real interaction with a simulated patient (SP) in a secure environment. We decided to teach experienced SP to portray the physical signs (akinetic, lack of mimic, lack of motricity), non-verbal behaviours (slowed treatment of information, slowed flow of word) and emotional response to a situation (augmented tremor with stress) of a patient with PD in OFF phase. The students received theoretical teaching about pathophysiology, medical and physiotherapeutic treatment, including the use of sensory and attention cueing. They worked on two different clinical cases, watched videos of the typical signs and effect of cueing on patient in OFF phase. Before the simulation, the case description and simulation modalities have been exposed. During the simulation, they had ten minutes, either to try a cue or to teach a cue to make the patient independent in its use in everyday life. After each performance, the students gave their impressions and ideas of improvement for a next treatment. Then, they received feedback from the other students and the teacher about their technical and communication skills. After a group of five students, the simulation ended and the SP left his role to give specific feedback on predefined points from a patient perspective.
Research question: We wanted to know if the simulation is a good way of improving the skills of choosing and teaching cues for patient with PD. We also wanted to know the degree of satisfaction of the students with the simulation on different points.
Methods: We asked the student to fill in a twelve-questions questionnaire directly after the simulation. Some were open questions, others were based on a Likert scala (“not at all”, “rather not”, “rather”, “absolutely”, “not applicable”).
Results: We received 43 questionnaires on 43. Forty-two students indicated that the simulation was educative, enriching, rewarding, interesting and playful. Twenty-one quoted the real-life situation positively. The latter were particularly interested in the feedback of the patient and the confrontation with the patient; the reason “knowing his own limits and strengths” was first mentioned.
93% of the responders felt they had enough tools and knowledge to take benefit from the simulation. 100% of the student considered the simulation a good means to acquire the targeted skills.
100% of them thought to have extended their tools to integrate in their practice, especially exercises ideas, strategy integration and clearer communication.
The degree of satisfaction (quoted on 4) with the credibility was 3.9, the realism 3.7, the difficulty of the scenario 3.4, the lay out of the room 3.1, the feedback from the SP 3.7 and the others feedback 3.8. To receive a feedback was very important for 93% of the students, particularly because it’s an external point of view (SP). Finally, though it was the first experience for these students with the simulation, they felt comfortable with the patient for 96% of them. They wished for 100% of them to use simulation for upcoming courses on other neurologic disease.
Discussion: The results show that the simulation was an appropriate method to achieve our pedagogic objectives. The real-life situation and the feedback from the SP was highly rewarded, showing that the external point of view is sometimes better considered than the feedback from peer or teacher. It’s an interesting point as this could also support the teacher’s point of view, meaning the external view doesn’t differ from the “internal” view.
The simulation in this situation helped them to improve their skills in choosing and teaching the cues, from the communication and technical view. We could observe that the students were more implicated in the situation than with a “traditional” way of teaching.
The credibility was not a concern as most of the students ended up asking if the SP was really suffering from the disease.
Conclusion: We can conclude that the simulation is a good way to teach the use of cues with patient with PD, that the play was credible and that the students will use tools learned in the simulation in their future practice. We could also think of developing new situation of simulation with neurological disease, keeping in mind that particular neurological deficiency as spasticity or ataxia cannot be simulated by neurologically intact people.

12:30 – 12:45 Can death be simulated? Using simulation to teach nursing students about End-of-Life Care

Anna Christine Steinacker
University of Applied Sciences Fulda, Germany; anna.steinacker@pg.hs-fulda.de
Background: In Germany 46% of all adults are dying in hospitals. Nurses are the primary caregivers of these patients and therefore it is necessary that they are thoroughly trained to meet the specific needs of this group. The results of many studies suggest that nursing students are inadequately prepared to care for dying patients. Possible reasons are a lack of theoretical knowledge as well as unsatisfactory mentoring during clinicals. If these problems aren’t addressed it could lead to anxiety and nervousness in students. Simulation proved itself to be an effective learning and teaching tool and could help to close the theory- practices gap, especially concerning end-of-life care.
Objectives: In this small study it was questioned how students perceive the use of simulation to learn about end-of-life care.
Methods: Five second and third year nursing students at the University of Applied Sciences Fulda went through a simulated experience with a dying patient and a family member. They were asked to perform oral care and assess the patient. During simulation they were asked questions about end-of-life care by the family member concerning spiritual care and improving the quality of life at this stage. Debriefing sessions were performed after each simulation.
A qualitative design was chosen for this research project. After the simulation and debriefing sessions, semi-structured interviews were conducted. The results were written into memos and analyzed using the Grounded Theory approach according to the sociologists Glaser and Strauss.
Results: Through the process of theoretical coding five results were discovered: Simulation revealed to be a good method the teach end-of-life care (1), simulation focused on communication (2), a lack of theoretical knowledge was reported (3), the importance of spiritual care was questioned (4) and the high-fidelity patient simulator seemed too unrealistic (5).
Discussion: There are no publications on the subject of simulation in end-of-life care training in Germany yet. But the results of this study are similar to studies published in other countries. The nursing students reported a lack of theoretical input about caring for dying patients. This concerns the physiological and psychological stages of dying as well as the spiritual needs of these patients. Some of the students were unsure how to address spiritual issues and if spiritual care was even part of the nursing profession. Communication was seen as the most important aspect of the simulation for the students. They especially approved of the family member, who was played by an amateur actress. Oral care and patient assessment happened in the background. The students also criticized that the high-fidelity simulator didn’t seem realistic enough. Especially since there were no changes in skin color. During the simulation the vital sign were programmed to reflect a patient at the end of life. But for the students the appearance of the patient was more important than signs on a monitor.
Conclusion: Simulation was found to be a valuable tool in the teaching of end-of-life-care especially as a communication exercise.
References: Corvetto, Marcia A.; Teakman, Jeffrey M. (2013): To die or not to die? A Review of Simulated Death. In: Simulation in Healthcare 2013 (8), S. 8–12.
Grote-Westrick, Marion; Volbracht, Eckhard (2015) Palliativversorgung. In Spotlight Gesundheit 10 (2015)
Gillan, Pauline C.; van der Riet, Pamela J; Jeong, Sarah (2014): End of life care education, past and present: a review of the literature. In: Nurse education today 34 (3), S. 331–342.
Hamilton, Cam A. (2010): The Simulation Imperative of End-of-Life Education. In: Clinical Si- mulation in Nursing 6 (4), S. e131-e138.
Kopp, Wendy; Hanson, Melissa A. (2012): High-Fidelity and Gaming Simulations Enhance Nursing Education in End-of-Life Care. In: Clinical Simulation in Nursing 8 (3), S. e97- e102.
Leighton, Kim (2009): Death of a Simulator. In: Clinical Simulation in Nursing 5 (2), S. e59- e62.
Leighton, Kim; Dubas, Jenna (2009): Simulated Death. In: Clinical Simulation in Nursing 5 (6), S. e223-e230.

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