BackgroundShared decision making (SDM) involves the formation of a collaborative partnership between the patient and clinician combining both of their expertise in order to benefit decision making. In order for clinicians to be able to carry out this skilled task, they require practice. Virtual reality, in the form of a virtual patient, could offer a potential method of facilitating this.ObjectiveThe objective of this study was to create a virtual patient that simulated a primary care consultation, affording the opportunity to practice SDM. A second aim was to involve patients in the design of a virtual patient simulation and report the process of the design.MethodsWe employed a multistep design process drawing on patient and expert involvement.ResultsA virtual patient, following a narrative style, was built, which allows a user to practice and receive feedback; both clinical and communication skills are required for the simulation. The patient group provided multiple insights, which the academic team had overlooked. They pertained mostly to issues concerning the patient experience.ConclusionsIt is possible to design a virtual patient that allows a learner to practice their ability to conduct SDM. Patient input into the design of virtual patient simulations can be a worthwhile activity.

IntroductionSevere mental illness (SMI) is associated with significant morbidity and mortality. People living with SMI often receive complex medication regimens. Optimising these regimens can be challenging. Non-adherence is common and addressing it requires a collaborative approach to decision making. MEDIATE uses a realist approach with extensive engagement with experts-by-experience to make sense of the complexities and identify potential solutions.Realist research is used to unpack and explain complexity using programme theory/theories that contain causal explanations of outcomes, expressed as context–mechanism–outcome–configurations. The programme theory/theories will enable MEDIATE to address its aim of understanding what works, for whom, in what circumstances, to optimise medication use with people living with SMI.Method and analysisMEDIATE will be conducted over six stages. In stage 1, we will collaborate with our service user/family carer lived experience group (LEG) and practitioner stakeholder group (SG), to determine the focus. In stage 2, we will develop initial programme theories for what needs to be done, by whom, how and why, and in what contexts to optimise medication use. In stage 3, we will develop and run searches to identify secondary data to refine our initial programme theories.Stage 4 involves selection and appraisal: documents will be screened by title, abstract/keywords and full text against inclusion and exclusion criteria. In stage 5, relevant data will extracted, recorded and coded. Data will be analysed using a realist logic with input from the LEG and SG. Finally, in stage 6, refined programme theories will be developed, identifying causal explanations for key outcomes and the strategies required to change contexts to trigger the key mechanisms that produce these outcomes.Ethics and disseminationPrimary data will not be collected, and therefore, ethical approval is not required. MEDIATE will be disseminated via publications, conferences and form the basis for future grant applications.PROSPERO registration numberCRD42021280980.

BackgroundShared decision-making (SDM) involves a healthcare professional and a patient forming a congruent partnership, within which information is shared and decisions are made which align with the patient’s values. SDM does not occur to the extent it ought to; SDM requires practice. Virtual reality could help facilitate this practice.ObjectiveTo pilot an interactive, high-fidelity virtual patient (VP) who simulates SDM within a primary care consultation.MethodAcademic pharmacists and doctors were recruited from the Keele University. Participants completed prequestionnaires and postquestionnaires.Results18 participants (14 pharmacists and 4 medical doctors) completed the study. 89% (n=16) suggested the VP was ‘enjoyable’ or ‘highly enjoyable’ to use and 72% (n=13) suggested it was ‘very accessible’. There were diverse views about the way in which the user made their reply to the VP with ratings ranging from ‘very poor’ (n=2) to ‘very good’ (n=5); the modal rating was indifference (n=7). It seemed the multiple choice system caused the participants to feel restricted but it was unclear why those who liked the system did so.ConclusionsThe VP was found to be enjoyable and thought-provoking. The data suggest that this type of intervention could be useful at many different stages of a professional’s career although the multiple-choice conversation style may be too restrictive for more experienced consulters.

Background Shared decision-making (SDM) is a process in which clinicians and patients work together to select tests, treatments, management, or support packages based on clinical evidence and the patient’s informed preferences. Similar to any skill, SDM requires practice to improve. Virtual patients (VPs) are simulations that allow one to practice a variety of clinical skills, including communication. VPs can be used to help professionals and students practice communication skills required to engage in SDM; however, this specific focus has not received much attention within the literature. A multiple-choice VP was developed to allow students the opportunity to practice SDM. To interact with the VP, users chose what they wanted to say to the VP by choosing from multiple predefined options, rather than typing in what they wanted to say. Objective This study aims to evaluate a VP workshop for medical students aimed at developing the communication skills required for SDM. Methods Preintervention and postintervention questionnaires were administered, followed by semistructured interviews. The questionnaires provided cohort-level data on the participants’ views of the VP and helped to inform the interview guide; the interviews were used to explore some of the data from the questionnaire in more depth, including the participants’ experience of using the VP. Results The interviews and questionnaires suggested that the VP was enjoyable and easy to use. When the participants were asked to rank their priorities in both pre- and post-VP consultations, there was a change in the rank position of respecting patient choices, with the median rank changing from second to first. Owing to the small sample size, this was not analyzed for statistical significance. The VP allowed the participants to explore a consultation in a way that they could not with simulated or real patients, which may be part of the reason that the VP was suggested as a useful intervention for bridging from the early, theory-focused years of the curriculum to the more patient-focused ones later. Conclusions The VP was well accepted by the participants. The multiple-choice system of interaction was reported to be both useful and restrictive. Future work should look at further developing the mode of interaction and explore whether the VP results in any changes in observed behavior or practice.

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Background Programme changes due to the COVID-19 pandemic have impacted variably on preparation for practice of healthcare professional students. Explanations for such variability in outcomes between institutions and healthcare professions have yet to be explored. The aim of our study was to understand what clinical learning, whilst under socially distanced restrictions, worked and why (or why not). Methods We conducted a realist evaluation of the undergraduate healthcare programmes at one UK university in 2020-21. The initial programme theories to be tested in this study were derived from discussions with programme leads about the changes they implemented due to the pandemic. Study participants were students and teaching faculty. Online interview transcripts were coded, identifying why the interventions in the programme had worked or not. This resulted in a set of ‘context-mechanism-outcome’ (CMO) statements about each intervention. The initial programme theories were refined as a result. Results and discussion 29 students and 22 faculty members participated. 18 CMO configurations were identified relating to clinical skills learning and 25 relating to clinical placements. Clinical skills learning was successful whether in person, remote or hybrid if it followed the steps of: demonstration – explanation – mental rehearsal – attempt with feedback. Where it didn’t work there was usually a lack of observation and corrective feedback. Placements were generally highly valued despite gaps in experience. Being useful on placements was felt to be good preparation for practice. Participant explanations from junior students about the value of various modes of induction to clinical workplace activity may also be relevant post-pandemic.

Background: Shared decision making involves the formation of a collaborative partnership between the patient and clinician, combining both of their expertise in order to benefit decision making. In order for clinicians to be able to carry out this skilled task, they require practice. Virtual reality, in the form of a virtual patient could offer a potential method of facilitating this.

BACKGROUND Shared decision-making (SDM) is a process where clinicians and patients work together to select tests, treatments, management or support packages, based on clinical evidence and the patient’s informed preferences. Like any skill, SDM requires practice to improve. Virtual Patients (VPs) are simulations that allow one to practice their communication skills. VPs could be used to help professionals and students practice the communication skills required to engage in SDM, but this specific focus has not received much attention within the literature. OBJECTIVE To evaluate a VP workshop for medical students aimed at developing the communication skills required for SDM. METHODS A pre and post-intervention questionnaire followed by semi-structured interviews. RESULTS The interviews and questionnaires suggested that the VP was enjoyable and easy to use. When the participants were asked to rank their priorities in a consultation both pre and post-VP, there was a statistically significant change in the rank position of “respecting patient choices” (P = 0.038) with the median rank changing from 2nd to 1st. The VP allowed the participants to explore a consultation in a way that they could not with simulated or real patients; this may be part of the reason that the VP was suggested as a useful intervention for bridging from the early, theory focused years of the curriculum to the more patient focused ones later on. CONCLUSIONS The VP was well accepted by the participants. The multiple choice system of interaction was reported as both useful but also restrictive. Future work should look at further developing the mode of interaction and explore whether the VP results in any changes in observed behaviour or practice.