Experiences of simulated patients in providing feedback in communication skills teaching for undergraduate medical students.

BACKGROUND: Simulated Patients (SPs) are commonplace in the teaching of communication skills in medical education and can provide immediate feedback to students from the patient's perspective. The experiences of SPs and their perspective on providing feedback is an under-studied area. This study aims to explore SP experiences and views on feedback, factors influencing their feedback and implications for training. METHODS: Using a constructivist grounded theory approach, we conducted six focus groups with 30 SPs. Participants included experienced simulated patients from a London-based actor agency, used in undergraduate teaching programmes of communication skills. Consistent with the principles of grounded theory, data was collected and analysed in an iterative process to identify themes. RESULTS: Five over-arching themes were identified: 1.) Feedback processes, 2.) Challenges in providing feedback, 3.) Cumulative experiences, 4.) Web of interpersonal relationships and dynamics and 5.) Portraying the character and patient representations. DISCUSSION: These SPs regarded the sharing of the emotions they experienced during the consultation as the focus of their feedback. Their preference was for giving a 'sandwich style' of feedback and 'out-of-role' approach. The relationship with facilitators and students and politeness conventions emerged as significant factors when providing feedback. Sensitivity to the social dynamics of groups and implicit facilitator expectations were challenges they experienced as was divergence in views of student performance. CONCLUSION: This study explored SP experiences and perspectives on providing feedback. Findings reveal complex social and structural dynamics at play in providing feedback which have not been reported so far in the literature. It is recommended that these issues should be addressed in training of both SPs and facilitators, in addition to feedback guidelines.

Twelve Tips for teaching clinical and communication skills online.

This article was migrated. The article was marked as recommended. Teaching and learning online is a long-established pedagogical approach in medical education. However, the Covid-19 pandemic has escalated the use and development of online teaching and with it have come a number of benefits and challenges. In this article the authors consider these benefits and challenges in relation to the teaching and learning of clinical and communication skills, drawing on up-to-date evidence and their extensive experience of using online learning before and during the Covid-19 pandemic. The authors have identified twelve tips to support others in constructing and developing online clinical and communication skills for medical students taking into account educational vision and curriculum, the educational multi-disciplinary team, feedback and evaluation, and what to do when things go wrong. This article provides a practical guide to teaching clinical and communication skills in a new learning environment, which is likely to be a much more prominent feature of medical education in the future.

Refocusing on physical health: Community psychiatric nurses' perceptions of using enhanced health checks for people with severe mental illness.

In the present qualitative, descriptive study, we explored Hong Kong community psychiatric nurses' (CPN) perceptions of using comprehensive physical health checks for service users diagnosed with severe mental illness (SMI). Research interviews were conducted with a purposive sample of 11 CPN in order to explore their perceptions about the use of the Health Improvement Profile (HIP) over a 1-year period. Interview data were analysed using inductive thematic analysis. The analysis revealed that the majority of CPN appreciated the comprehensive focus on the physical health of their clients and reported positive changes in their clinical practice. Many of them observed an increase in the motivation of their clients to improve their physical health, and also noted observable benefits in service users' well-being. The use of the HIP also helped the CPN identify implementation barriers, and highlighted areas of the tool that required modifications to suit the local cultural and clinical context. To our knowledge, this is the first study conducted in an Asian mental health service that explores nurses' views about using comprehensive health checks for people with SMI. The findings suggest that such approaches are viewed as being acceptable, feasible, and potentially beneficial in the community mental health setting.

The effects of medication-management training on clinicians' understanding and clinical practice in Hong Kong.

Medication management training programmes for mental health clinicians have been shown to improve clinical outcomes for service users. These studies do not explore from a clinician's perspective how the knowledge and skills learnt during training have been applied in clinical practice and if similarly positive results are observed in differing cultural settings. This study used individual concept mapping series to explore changes in understanding and to aid self-prompted qualitative interviews following a medication management course in Hong Kong. Qualitative interview data shows clinicians developed a systematic but pragmatic approach towards delivering interventions which is in response to perceived implementation barriers. This paper highlights the importance of the cultural and clinical context when using evidence-based medication management interventions; the training may benefit from the addition of specific teaching content and support to help clinicians deal with these issues.

A concept mapping exploration of social workers' and mental health nurses' understanding of the role of the Approved Mental Health Professional.

This study uses concept mapping and participant interviews to explore how differing professional viewpoints and levels of knowledge held by social workers and mental health nurses affect perceptions of the Approved Mental Health Professional (AMHP) role during an interprofessional training programme. The results suggest that social workers entering the programme had a greater understanding of the role in comparison to mental health nurses; however, on completion of the programme, both professional groups demonstrated similar levels of learning. The study challenges assumptions that nurses may be inherently disadvantaged by their professional background in terms of learning about a role that is traditionally associated with social work practice. Study participants valued the concept mapping process and felt that the approach may be a valuable tool for clinical supervision.