Paediatrics requires diverse, adaptable, age and developmentally appropriate communication and clinical skills which HCPs can find challenging, negatively impacting paediatric care. The involvement of simulated patients (SPs) could be used to bridge this gap and bring patient perspectives. To create authentic, high-fidelity paediatric simulations it makes sense that young people should have a role. As a paediatric registrar in a district general hospital, I considered how to involve adolescent SPs in teaching by performing a literature review.
On 2 February 2021, an advanced title and abstract search on PubMed: ‘paediatric’/’children’/’adolescent’ AND ‘simulated patient’/’simulated patients’/’standardized patient’/’standardized patients’. In total, 196 results returned which I filtered as per the inclusion and exclusion criteria (Table 1) leaving five articles.
| Inclusion criteria | Exclusion criteria |
|---|---|
| 1. Real-time encounters with SPs | -SPs >18 years old -Parental SPs only |
| -SPs 12–18 years old | -Adult playing child or young person |
| -Available in English | -Not available in English |
Findings 1.
Recruitment: SPs were recruited from theatre groups [1], schools [2,3] or by word of mouth [4,5]. One group ran sessions at a local school which were included in the curriculum [2].
2.Training: some authors ran didactic teaching about conditions, rehearsals or video training [4]. A lack of training was found to be troublesome.
3.Scenarios: standards of best practice state that simulated patients should be involved in resource writing and evaluation. However, while one group personalized scenarios [5] no SPs collaborated in writing. One study felt that it was unkind to ask SPs to draw upon potentially negative personal experiences [1].
4.Feedback: honest feedback from SPs is central to optimizing learning which SPs found challenging. Training to feedback with ‘I’ statements or using ‘the character’ to feedback was useful [1,5]. Some studies paired SPs with parents for feedback [1].
5.Positive impact: SPs felt the experience was positive and would be involved again. Positive impacts include: increased trust in HCPs [1,2], increased confidence [1], learning about illnesses and reduced stigma around mental illness [2,4]. I also note the future benefits of having well-trained and competent HCPs who communicate effectively.
6.Negative impact: exhaustion, boredom and potential for exploitation (missed schooling) [5]. Mental health roles fostered anxiety and depressive symptoms which were underestimated by the SPs themselves [4]. Some parents were debriefing their own children in the absence of a formal debrief [1].
7.Student learning: real children challenged students’ interpersonal skills and rendered encounters realistic.
Implications for practice 1.
‘Do no harm’ remains paramount in medical education. The benefit to society must be weighed against the risks to the child and their best interests must be kept central in educational processes.
2.When planning teaching I will:
3.Run monthly simulation sessions consolidating weekly didactic teaching
4.Limit sessions to 1 hour
5.Recruit young people within the hospital to minimize school absence
6.Invite collaboration between SPs and students to create scenarios around self-identified learning needs while maintaining psychological safety, allowing for complexity and fidelity that would be impossible if written by faculty
7.Train SPs to feedback using ‘I’ statements
8.Collaborate with the Child and Adolescent Mental Health Team prior to mental health scenarios to consider training and debriefing
9.Keep the SPs voice central to the debrief and feedback
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4 Departmental Paediatric Simulation Teaching: How Can we Best Involve Adolescents as Simulated Patients?
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