Dual-phase standardised patient training: Merging content expertise with acting skills

Abstract

The increasing demand for standardised patients (SPs) use in medical education requires new SPs to be regularly trained. It is critical that SPs possess the ability to maintain consistency in their performance across multiple sessions, especially for high-stakes exam and simulation-based teaching and learning sessions. Very often, a gap exists between SPs' ability to portray clinical accuracy and their ability to maintain realistic and consistent patient scenario.¹ This discrepancy often produces performances that are either overly clinical or lack authenticity, hence reducing the effectiveness of the training experience for medical students.

A dual-phase training model was developed in our institution to better equip SPs for advanced communication scenarios. The training model is grounded in theoretical frameworks that incorporate Experiential Learning, Deliberate Practice, Cognitive Apprenticeship, and Fidelity in Simulation Theory.

In the first phase of content mastery training, the content experts who are clinicians read and review scripts of the scenarios together with the SPs (N = 21). By working through the scripts with content experts, this enabled detailed discussions on medical conditions and patient perspectives. Hence, SPs gained a deeper understanding of the clinical, ethical and emotional aspects of the roles they were assigned to portray.

In the second phase of performance skills development, professional SP educators focused on developing the trainee SPs' role-playing or acting skills. The trainee SPs were required to pair up with each other and perform role plays. They were coached on their acting techniques, content delivery and emotional expression through a two-way mirror which allows for real time feedback and immediate fine-tuning of their performance.

The lessons learned from the implementation of dual-phase training model in our institution offer valuable insights that can benefit other institutions aiming to improve their SP training. Trainee SPs provided feedback on their training using a 5-point Likert scale and reported that Phase 1 training improved their understanding of the patient's perspective (4.04 ± 0.74) and Phase 2 were found to be effective in enhancing their delivery of the scenario (4.33 ± 0.66). A total of 95.24% of trainee SPs would recommend this model for future training. Medical students and faculty reported improvements in SP performance with 80.65% of students and 72.73% of faculty noting enhanced performance, consistency and authenticity.

There are a few insights we have gathered from this implementation. Effective time management is crucial to allow training to be completed with optimised resource use. The varying backgrounds of the trainee SPs highlighted the need for tailored approaches to medical scenario scripts briefing by the content experts to the whole group. Prioritising Phase 1 ensured a solid mastery of the scenario by the SPs with a minimum of 1 hour is needed to be allocated to this effort. Doubling the phase 1 coaching time for phase 2 assisted deeper role exploration. Each scenario requires 3 hours of training for six trainee SPs, highlighting the need for institutions to budget appropriately when implementing similar models. A limitation is the lack of long-term follow-up on SP performance consistency and its impact on student learning.

Siaw Cheok Liew: Conceptualisation; data collection; resources; project administration; writing the original draft; review and editing. Tham Thi Phi: Methodology; resources; project administration; review and editing; data analysis.

The authors state no conflict of interest.

The SP training was conducted in a normal educational setting to improve educational practices. No ethical approval was required.