To determine if the type of patient portrayal training provided to students during peer simulation impacts students’ accuracy of patient portrayal, development of empathy, and pre-clinical learning outcomes. Students’ experiences and perspectives of patient portrayal training approaches were also explored.
A randomized controlled trial comparing two training approaches for patient portrayal during peer simulation was conducted. One training approach (intervention) was based on best available evidence for training SPs for patient role portrayal, and the alternative training approach (control) reflected ‘role-play’. Outcomes measured included accuracy of patient portrayal (Peer-Patient Portrayal Rating Tool), empathy (Jefferson Scale of Physician Empathy and The Consultation and Relational Empathy Measure), and pre-clinical learning outcomes (examination grades). Focus groups explored students’ perspectives of how they prepared for patient portrayal, perceived value of this preparation, and characteristics of a well-performing peer patient. Group differences were examined using one-way analysis of covariance, and linear regression models identified factors associated with pre-clinical learning outcome grades. An interpretivist approach was adopted for qualitative analysis of focus group transcriptions.
Fifty-seven third-year, undergraduate physiotherapy students (mean age 21 years; SD 2.6) were randomised into the intervention or control group. After controlling for all baseline scores, there were no significant differences between training approaches on pre-clinical learning outcomes, i.e. written (p=0.512) and practical (p=0.783) examination grades. There were also no significant differences in accuracy of patient portrayal (self-rated, therapist-rated and observer-rated) and empathy levels (self-rated and patient-rated). However, blinded, observer-rated accuracy of patient portrayal was significantly associated with written (β=0.3; 95% CI 0.1, 0.3) and practical (β=0.4; 95% CI 0.2, 0.7) pre-clinical learning outcome grades. Themes from the qualitative analysis indicated that preparing for and engaging in accurate patient portrayal, including committing to and staying in character, were important for student learning.
Qualitative findings highlight the importance of preparing and training students during peer simulation to ensure that they can accurately portray the patient role for each other. Although the type of training approach did not impact accuracy of patient portrayal, empathy level or achievement of pre-clinical learning outcomes, accuracy of patient portrayal during peer simulation was associated with enhanced pre-clinical learning outcome grades. This aligns with students’ perspectives on the importance of training for, and accuracy of, patient portrayal on their learning.
Accuracy of patient portrayal during peer simulation is important for student learning, and can be optimised by a training program to guide performance. The training can be conducted in groups, and may include the use of written material outlining patient characteristics, with tutor presence and time to prepare; or video and written resources, tutor assistance and guided rehearsal with feedback.
simulated patient
patient portrayal training
