case study

Simulation training changes real-world behavior

Discover how RCSI is increasing patient consultation performance of their trainees through the use of virtual patient simulations.

Interaction with virtual patients through training simulations

Changing behavior

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Company

The Royal College of Surgeons in Ireland (RCSI)

Challenge

Add additional communication skills training to the curriculum without further overburdening the teaching staff, who are themselves working doctors.

Solution

Virtual Patient Simulations (VPS) were added to support the development of patient-centered consulting skills.

Results

  • A 7% increase in trainees' communication skills when conducting a patient consultation.

Communication
skills at scale

The Royal College of Surgeons in Ireland (RCSI) is a multi-national institution providing medical courses to 3000+ trainees annually. RCSI wished to create a supplemental training opportunity focusing on communication skills in early trainees. Early exposure to communication skills is known to be beneficial (Berman & Snyder, 2015) and so supporting learning by early exposure for medical trainees is important in terms of inculcating this essential skill.

Delivery of learning opportunities is becoming increasingly challenging due to:

  • Larger classes of trainees
  • Decreasing access to patients
  • Increasing concerns over patient safety and exposure (Ramani, 2008).

Therefore, the challenge is to add additional communication skills training to the curriculum without further overburdening the teaching staff, who are themselves working doctors.

Virtual Patient Simulations

Virtual Patient Simulations (VPS) were added to the first-year training curriculum on an opt-in basis to aid in up-scaling while providing a meaningful high-quality learning opportunity to support the development of patient centered consulting skills. Virtual Patients are interactive computer simulations of real-life clinical scenarios for the purpose of medical training, education or assessment (Ellaway, 2014). Training in a simulated environment creates a safe and private space for the trainee to gather patient information and make decisions on how to communicate (Edelbring, Dastmalchi, Hult, Lundberg & Dahlbren, 2011).

ETU’s proprietary platform enables VPS with multi-branching interactions that model patient-centered dialogues. Patient scenarios of a variety of common conditions were developed into VPS and the novice trainee interacted as the doctor. The virtual patients were designed in collaboration with general practitioners and derived from real patient histories. One patient ‘entered’ the virtual waiting room per week and was available for anytime, anywhere interaction and was device agnostic. Each interactive simulation provided the student with personalised feedback. Simulations supplemented lectures on theory (consultation models), small group work, and community placements for first-year trainees.

Simulation effectiveness was evaluated based on trainees’ class performance and their scores on the Objective Structured Clinical Examination (OSCE), an internationally recognized assessment standard. In the OSCE, a trainee takes a medical history from a Standardized Patient, an actor trained to portray an individual with a particular disease or condition, while a certified doctor observes their behavior and evaluates their communication skills using a checklist (Setyonugroho, Kennedy & Kropmans, 2015).

Real-world performance improvement

In both cohorts, overall course performance and in-class assessments of communication skills were better for those who completed simulations. In addition, trainees who completed simulations performed better on the OSCE (see Figure 1).

In other words, completing training simulations changed behavior both in class and while performing a clinical evaluation under real-life conditions. Overall, patient consultation performance was 7% better for trainees who completed simulations.Figure1-average-scores-for-OSCE-performanceInteraction with virtual patients through training simulations provides valuable experiential learning and personalized feedback which improves performance in essential patient-centered consultation skills of novice trainees, including behavior during a standard clinical evaluation of a patient.

By completing simulations, trainees experienced a 7% increase in their communication skills when conducting a patient consultation. These behavioral changes have real implications for the trainees’ futures, as doctors perform more than 200,000 medical consultations in their careers (Silverman, 2013).

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