The lived experience of clinical instructors as simulated patients: a qualitative study
Main Article Content
Abstract
Purpose: Simulated patients (SPs) during simulated learning experiences (SLEs) are typically played by a trained actor, potentially requiring significant training time and cost. The participating university’s physical therapist (PT) education program recruits clinical instructors (CIs) to play the SP role during SLEs that represent various learning environments (in and out patient). As there is limited literature exploring the SP experience, especially from a clinician perspective, the purpose of this qualitative inquiry was to describe the lived experience of CIs as SPs.
Methods: This qualitative inquiry used an inductive approach to identify the experiences of CIs as SPs. Eight CIs participated in an individual semi-structured interview to gather their perspectives about their experiences playing the SP role during SLEs. A constant-comparative approach was used to develop codes, which were further collapsed into categories and main themes. Member checks and peer review were conducted to establish trustworthiness of the findings.
Results: Qualitative analysis revealed four main themes: (1) Becoming the Patient, (2) A Window into the Student Experience, (3) We See It Every Day: Using Experience to Guide Performance, and (4) Giving Back Through Teaching.
Conclusion: Being an SP was an enjoyable experience that allowed CIs to participate in teaching and give back to their profession. Empathy gained for both patients and students through the SP experience influenced the CIs’ own clinical practice and may enhance CIs’ preparation for student clinical experiences and improve CI mentoring skills.
References
1. Lioce L, Lopreiato J, Downing D, et al. Healthcare simulation dictionary. 2nd ed. AHRQ Publication No. 20-0019. Rockville, MD: Agency for Healthcare Research and Quality; 2020. doi: 10.23970/simulationv2
2. Meakim C, Boese T, Decker S, et al. Standards of best practice: simulation standard I: terminology. Clin Simul Nurs (2013) 9(6S): S3–11. doi: 10.1016/j.ecns.2013.04.001
3. Mori B, Carnahan H, Herold J. Use of simulation learning experiences in physical therapy entry-to-practice curricula: a systematic review. Physiother Can (2015) 67(2): 194–202. doi: 10.3138/ptc.2014-40E
4. Silberman N, Litwin B, Panzarella K, et al. Student clinical performance in acute care enhanced through simulation training. J Acute Care Phys Ther (2016) 7(1): 25–36. doi: 10.1097/JAT.0000000000000021
5. Ohtake PJ, Lazarus M, Schillo R, et al. Simulation experience enhances physical therapist student confidence in managing a patient in the critical care environment. Phys Ther (2013) 93(2): 216–28. doi: 10.2522/ptj.20110463
6. Macauley K. Evaluating changes in clinical decision-making in physical therapy students after participating in simulation. Health Prof Educ (2018) 4(4): 278–86. doi: 10.1016/j.hpe.2018.06.001
7. Pritchard SA, Blackstock FC, Nestel D, et al. Simulated patients in physical therapy education: systematic review and meta-analysis. Phys Ther (2016) 96(9): 1342–53. doi: 10.2522/ptj.20150500
8. Cunningham S, Cunningham C. Exploration of a simulation-based learning experience in critical care: the use of standardized patients for early mobility training. Cardiopulm Phys Ther J (2020) 31: 74–85. doi: 10.1097/CPT.0000000000000114
9. Miale S, Silberman N, Kupczynski L. Classroom-based simulation participants and observers perceive high psychological fidelity and improved clinical preparedness. J Phys Ther Educ (2021) 35(3): 210–17. doi: 10.1097/JTE.0000000000000190
10. Paparella-Pitzel S, Edmond S, Chris DeCaro C. The use of standardized patients in physical therapist education programs. J Phys Ther Educ (2009) 23(2): 15–21. doi: 10.1097/00001416-200907000-00003
11. Barrows HS. An overview of the uses of standardized patients for teaching and evaluating clinical skills. Acad Med (1993) 68(6): 443–3. doi: 10.1097/00001888-199306000-00002
12. Black B, Marcoux BC. Feasibility of using standardized patients in a physical therapist education program: a pilot study. J Phys Ther Educ (2002) 16(2): 49–56. doi: 10.1097/00001416-200207000-00008
13. Cleland JA, Abe K, Rethans JJ. The use of simulated patients in medical education: AMEE Guide No. 42. Med Teach (2009) 31: 477–86. doi: 10.1080/01421590903002821
14. Abe K, Roter D, Erby LH, et al. A nationwide survey of standardized patients: who they are, what they do, and how they experience their work. Patient Educ Couns (2011) 84: 261–4. doi: 10.1016/j.pec.2010.07.017
15. Pritchard SA, Denning T, Keating JL, et al. ‘It’s not an acting job ... don’t underestimate what a simulated patient does’: a qualitative study exploring the perspectives of simulated patients in health professions education. Simul Healthc (2020) 15(1): 21–9. doi: 10.1097/SIH.0000000000000400
16. Jacobs AC, van Jaarsveldt DE. ‘The character rests heavily within me’: drama students as standardized patients in mental health nursing education. J Psychiatr Ment Health Nurs (2016) 23(3–4): 198–206. doi: 10.1111/jpm.12302
17. Mandrusiak AM, Isles R, Chang AT, et al. Senior physiotherapy students as standardised patients for junior students enhances self-efficacy and satisfaction in both junior and senior students. BMC Med Educ (2014) 14: 105. doi: 10.1186/1472-6920-14-105
18. Recker-Hughes C, Dungey J, Dougherty M, et al. A win-win model for use of a standardized patient examination to promote student readiness and develop clinical instructor teaching skills for clinical experiences. 2015. Available from: https://aptaeducation.org/abstract-archive/view.cfm?id=2288274 [cited 30 August 2021].
19. Creswell JW, Poth CN. Qualitative inquiry and research design: choosing among five approaches. 4th ed. Thousand Oaks, CA: Sage Publications; 2018.
20. Thomas DR. A general inductive approach for analyzing qualitative evaluation data. Am J Eval (2006) 27(2): 237–46. doi: 10.1177/1098214005283748
21. INACSL. Standards of best practice: simulation. Simulation design. Clin Simul Nurs (2016) 12: S5–12. doi: 10.1016/j.ecns.2016.09.005
22. Dreifuerst KT. Using debriefing for meaningful learning to foster development of clinical reasoning in simulation. J Nurs Educ (2012) 51(6): 326–33. doi: 10.3928/01484834-20120409-02
23. Rudolph JW, Simon R, Rivard P, et al. Debriefing with good judgement: combining rigorous feedback with genuine inquiry. Anesth Clin (2007) 25: 361–37. doi: 10.1016/j.anclin.2007.03.007
24. Riopel M, Litwin B, Silberman N, et al. Utilizing standardized patient feedback to facilitate professional behavior in physical therapist students: a pilot study. Internet J Allied Health Sci Pract (2018) 16(3): 4. doi: 10.46743/1540-580X/2018.1734
25. Silberman N, Litwin B, Fernandez-Fernandez A, et al. Development and evaluation of a simulation-based acute care course in a physical therapist education program. J Phys Ther Educ (2020) 34(1): 76–85. doi: 10.1097/JTE.0000000000000122
26. Lincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills, CA: Sage Publications, 1985; p. 314.
27. Saunders B, Sim J, Kingstone T, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant (2018) 52(4): 1893–907. doi: 10.1007/s11135-017-0574-8
28. Creswell JW, Miller DL. Determining validity in qualitative inquiry. Theory Pract (2000) 39(3): 124–30. doi: 10.1207/s15430421tip3903_2
29. Hojat M. A definition and key features of empathy in patient care. In: Empathy in health professional education and patient care. Cham: Springer; 2016: 71–78. doi: 10.1007/978-3-319-27625-0_6
30. Bearman M, Palermo C, Allen LM, et al. Learning empathy through simulation: a systematic literature review. Simul Healthc (2015) 10(5): 308–19. doi: 10.1097/SIH.0000000000000113
31. Hojat M, Louis D, Maio V, et al. Empathy and health care quality. Am J Med Qual (2013) 28(1): 6–7. doi: 10.1177/1062860612464731
32. Core values for the physical therapist and physical therapist assistant. Available from: https://www.apta.org/siteassets/pdfs/policies/core-values-endorsement.pdf [cited 1 June 2020].
33. Lewis KL, Bohnert CA, Gammon WL, et al. The association of standardized patient educators (ASPE) standards of best practice (SOBP). Adv Simul Lond Engl (2017) 2: 10–14. eCollection. doi: 10.1186/s41077-017-0043-4
34. Berenson LD, Goodill SW, Wenger S. Standardized patient feedback: making it work across disciplines. J Allied Health (2012) 41(1): 27E–31E.
2. Meakim C, Boese T, Decker S, et al. Standards of best practice: simulation standard I: terminology. Clin Simul Nurs (2013) 9(6S): S3–11. doi: 10.1016/j.ecns.2013.04.001
3. Mori B, Carnahan H, Herold J. Use of simulation learning experiences in physical therapy entry-to-practice curricula: a systematic review. Physiother Can (2015) 67(2): 194–202. doi: 10.3138/ptc.2014-40E
4. Silberman N, Litwin B, Panzarella K, et al. Student clinical performance in acute care enhanced through simulation training. J Acute Care Phys Ther (2016) 7(1): 25–36. doi: 10.1097/JAT.0000000000000021
5. Ohtake PJ, Lazarus M, Schillo R, et al. Simulation experience enhances physical therapist student confidence in managing a patient in the critical care environment. Phys Ther (2013) 93(2): 216–28. doi: 10.2522/ptj.20110463
6. Macauley K. Evaluating changes in clinical decision-making in physical therapy students after participating in simulation. Health Prof Educ (2018) 4(4): 278–86. doi: 10.1016/j.hpe.2018.06.001
7. Pritchard SA, Blackstock FC, Nestel D, et al. Simulated patients in physical therapy education: systematic review and meta-analysis. Phys Ther (2016) 96(9): 1342–53. doi: 10.2522/ptj.20150500
8. Cunningham S, Cunningham C. Exploration of a simulation-based learning experience in critical care: the use of standardized patients for early mobility training. Cardiopulm Phys Ther J (2020) 31: 74–85. doi: 10.1097/CPT.0000000000000114
9. Miale S, Silberman N, Kupczynski L. Classroom-based simulation participants and observers perceive high psychological fidelity and improved clinical preparedness. J Phys Ther Educ (2021) 35(3): 210–17. doi: 10.1097/JTE.0000000000000190
10. Paparella-Pitzel S, Edmond S, Chris DeCaro C. The use of standardized patients in physical therapist education programs. J Phys Ther Educ (2009) 23(2): 15–21. doi: 10.1097/00001416-200907000-00003
11. Barrows HS. An overview of the uses of standardized patients for teaching and evaluating clinical skills. Acad Med (1993) 68(6): 443–3. doi: 10.1097/00001888-199306000-00002
12. Black B, Marcoux BC. Feasibility of using standardized patients in a physical therapist education program: a pilot study. J Phys Ther Educ (2002) 16(2): 49–56. doi: 10.1097/00001416-200207000-00008
13. Cleland JA, Abe K, Rethans JJ. The use of simulated patients in medical education: AMEE Guide No. 42. Med Teach (2009) 31: 477–86. doi: 10.1080/01421590903002821
14. Abe K, Roter D, Erby LH, et al. A nationwide survey of standardized patients: who they are, what they do, and how they experience their work. Patient Educ Couns (2011) 84: 261–4. doi: 10.1016/j.pec.2010.07.017
15. Pritchard SA, Denning T, Keating JL, et al. ‘It’s not an acting job ... don’t underestimate what a simulated patient does’: a qualitative study exploring the perspectives of simulated patients in health professions education. Simul Healthc (2020) 15(1): 21–9. doi: 10.1097/SIH.0000000000000400
16. Jacobs AC, van Jaarsveldt DE. ‘The character rests heavily within me’: drama students as standardized patients in mental health nursing education. J Psychiatr Ment Health Nurs (2016) 23(3–4): 198–206. doi: 10.1111/jpm.12302
17. Mandrusiak AM, Isles R, Chang AT, et al. Senior physiotherapy students as standardised patients for junior students enhances self-efficacy and satisfaction in both junior and senior students. BMC Med Educ (2014) 14: 105. doi: 10.1186/1472-6920-14-105
18. Recker-Hughes C, Dungey J, Dougherty M, et al. A win-win model for use of a standardized patient examination to promote student readiness and develop clinical instructor teaching skills for clinical experiences. 2015. Available from: https://aptaeducation.org/abstract-archive/view.cfm?id=2288274 [cited 30 August 2021].
19. Creswell JW, Poth CN. Qualitative inquiry and research design: choosing among five approaches. 4th ed. Thousand Oaks, CA: Sage Publications; 2018.
20. Thomas DR. A general inductive approach for analyzing qualitative evaluation data. Am J Eval (2006) 27(2): 237–46. doi: 10.1177/1098214005283748
21. INACSL. Standards of best practice: simulation. Simulation design. Clin Simul Nurs (2016) 12: S5–12. doi: 10.1016/j.ecns.2016.09.005
22. Dreifuerst KT. Using debriefing for meaningful learning to foster development of clinical reasoning in simulation. J Nurs Educ (2012) 51(6): 326–33. doi: 10.3928/01484834-20120409-02
23. Rudolph JW, Simon R, Rivard P, et al. Debriefing with good judgement: combining rigorous feedback with genuine inquiry. Anesth Clin (2007) 25: 361–37. doi: 10.1016/j.anclin.2007.03.007
24. Riopel M, Litwin B, Silberman N, et al. Utilizing standardized patient feedback to facilitate professional behavior in physical therapist students: a pilot study. Internet J Allied Health Sci Pract (2018) 16(3): 4. doi: 10.46743/1540-580X/2018.1734
25. Silberman N, Litwin B, Fernandez-Fernandez A, et al. Development and evaluation of a simulation-based acute care course in a physical therapist education program. J Phys Ther Educ (2020) 34(1): 76–85. doi: 10.1097/JTE.0000000000000122
26. Lincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills, CA: Sage Publications, 1985; p. 314.
27. Saunders B, Sim J, Kingstone T, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant (2018) 52(4): 1893–907. doi: 10.1007/s11135-017-0574-8
28. Creswell JW, Miller DL. Determining validity in qualitative inquiry. Theory Pract (2000) 39(3): 124–30. doi: 10.1207/s15430421tip3903_2
29. Hojat M. A definition and key features of empathy in patient care. In: Empathy in health professional education and patient care. Cham: Springer; 2016: 71–78. doi: 10.1007/978-3-319-27625-0_6
30. Bearman M, Palermo C, Allen LM, et al. Learning empathy through simulation: a systematic literature review. Simul Healthc (2015) 10(5): 308–19. doi: 10.1097/SIH.0000000000000113
31. Hojat M, Louis D, Maio V, et al. Empathy and health care quality. Am J Med Qual (2013) 28(1): 6–7. doi: 10.1177/1062860612464731
32. Core values for the physical therapist and physical therapist assistant. Available from: https://www.apta.org/siteassets/pdfs/policies/core-values-endorsement.pdf [cited 1 June 2020].
33. Lewis KL, Bohnert CA, Gammon WL, et al. The association of standardized patient educators (ASPE) standards of best practice (SOBP). Adv Simul Lond Engl (2017) 2: 10–14. eCollection. doi: 10.1186/s41077-017-0043-4
34. Berenson LD, Goodill SW, Wenger S. Standardized patient feedback: making it work across disciplines. J Allied Health (2012) 41(1): 27E–31E.
Article Details
Keywords:
Simulated patients, Clinical Instructor, Physical therapist, Clinical education, Empathy
Issue
Section
Original Research Articles
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
How to Cite
Silberman, N., Casella, C., Lam, M., & Lin, F. (2022). The lived experience of clinical instructors as simulated patients: a qualitative study. The Journal of Clinical Education in Physical Therapy, 4. https://doi.org/10.52214/jcept.v4.8614