Making it Real: A Practical Guide to Experiential Learning of Communication Skills

Abstract

You would never guess it from the title, but this is a marvellous guide to setting up a simulated patient program for teaching and assessing communication skills in health-care settings. 'A standardized patient (SP) is a non-physician trained to accurately and consistently portray a patient in a simulated clinical situation for teaching or testing purposes.'1 Although there are many journal articles about working with simulated or standardized patients in health professions education, I could not find another book on the subject except the one by Barrows2 and chapters in a few texts on interviewing.3,4 This is puzzling as SPs have been involved in communication skills training since the 1960s. Thus, this book fills an important gap in the literature especially now that working with SPs has become commonplace in communication training. To those sceptics of this educational technique, I ask whether they would be comfortable flying with a pilot who had never been in a flight simulator.The first chapter provides an overview of working with SPs in communications training and a cursory review of Kolb's experiential learning cycle. The second chapter is a goldmine of practical advice about working with SPs including tips on recruitment, training, achieving realism, portraying emotions and 'letting go' of the role when the session is over. Chapters 3 and 4 provide practical suggestions about planning and conducting sessions involving SPs including examples of different teaching formats, a typical schedule for running a session with several SPs and suggestions for facilitators. There are individual chapters on specific communication skills: information gathering, information sharing and shared decision making, risk communication and informed consent, breaking bad news, difficult interactions and communication among health professionals. Each chapter outlines the key communication skills to be learned, suggestions for facilitators and sample SP scenarios. The scenarios provide enough information to get started with each SP role including age, setting, medical and personal history, as well as ideas, expectations and concerns of the patient. But the subtleties of the roles - e.g. when and how much to divulge to the interviewer - will need to be fleshed out in more detail before using them.Additional chapters cover special situations. There is a valuable chapter on developing scenarios to meet the specific needs of the participants, either based on a needs assessment ahead of time, or based on topics generated from a group of learners on the spot. Another chapter reviews the role of SPs in assessment using the Objective Structured Clinical Examination format. Two detailed examples of an SP scenario are provided along with marking sheets. The thorny measurement issues (validity, reliability and standard setting) are briefly mentioned and readers are referred to the excellent references at the end of the chapter for further information. The final chapter reviews a few new developments in communication skills training. Clinical teaching associates (CTAs) are 'lay women from the community who are trained to provide teaching and feedback to health professionals and students about the technical and interpersonal skills required in intimate female examinations, while they (the CTAs) are being examined'.5 Only enough information is provided to get the reader interested. Similarly, there is a brief overview of how to set up experiential learning sessions with overseas-trained doctors.For anyone starting a communications programme, or responsible for a course on interviewing skills, working with SPs, this will be a useful guide. Although much of the advice will be 'old hat' to those with experience in this field, this book will provide a good refresher and will probably stimulate some new ideas. It is a perfect book for anyone wondering about introducing SPs into their programmes on communication skills. The reader will gain a good understanding of the exciting potential of working with SPs. Because this book is short (136 pages) and covers a wide range of topics it is necessarily superficial. If the book goes into a second edition I hope the authors can add more information about the nitty-gritty of training SPs and provide advice about how to simulate abnormalities on physical examination. For more information about SPs, see Standardized Patient Program of the University of Toronto (http://spp.utoronto.ca/index.php?option=com_frontpageItemid=1) and Standardized Medical Students Website (http://www.uic.edu/orgs/facdevel/main.html).