Is it better to use teachers or patient support group volunteers as surrogate patients to train students in clinical problem solving?

Abstract

BACKGROUND: Recruiting and training actors to play simulated patients is costly, whilst using staff lacks authenticity. Patient support-groups are a potential source of volunteers who have illness experiences and who can be easily trained to role-play themselves. SUMMARY OF WORK: A mixed-method study was conducted to evaluate the effectiveness of role-play in clinical problem-solving training and to assess the impact of support-group volunteers as patient educators. MBBS III students participating in a Family Medicine workshop were randomly assigned into either the ‘intervention group’ with support-group volunteers or the ‘control group’ with teaching staff role-playing patients. Students were assessed on their completion of a pre- and post- workshop structured history-taking form of video-taped consultations, and on their Family Medicine OSCE performance. Qualitative feedback was obtained from both students and volunteers. SUMMARY OF RESULTS: Six groups of 30 students participated (response rate 100%). Students’ ability to complete the history-taking form improved after the workshop in both groups, although the intervention group had higher mean improvement. Students enjoyed the ‘real patient’ interaction, especially the constructive feedback on communication skills and their sharing of illness experiences. There was no difference in OSCE scores. DISCUSSION AND CONCLUSIONS: Role playing is an effective approach for problem-solving training. Use of patient-educators enhances the student learning experience. It fosters better student confidence and skill, and enhances awareness of interpersonal behaviors such as eye contact and empathy. Patients appreciate the opportunity to contribute to training future doctors. TAKE-HOME MESSAGES: Structured learning opportunities with patient educators can benefit both students and patients.