Simulated medical consultations with standardized patients: In-depth debriefing based on dealing with emotions

Abstract

In general, students have few opportunities to address their emotions under the guidance of an experienced physician, which can undermine their self-confidence to deal with real patients in stressful situations. Emotional detachment and cynicism are defense mechanisms, which can emerge as a consequence. The consolidation of a professional identity committed to patients’ interests can become a challenge when medical students are not comfortable in their role as caregivers. In general, we consider that the undergraduate medical curriculum has been insufficient in providing appropriate environments for students to reflect on professional identity formation and on the future challenges of their profession. Objective: To develop an in-depth debriefing to address students’ emotions and professional identity formation in the context of a simulation activity with simulated patients at a medical school in Brazil. Methods: The authors conducted a simulated medical consultation activity using standardized patients (SPs) with an in-depth debriefing based on the feelings of the patient and the student. During each encounter the formation and consolidation of professional identity was discussed. Fourth- and sixth-year medical students (n=551) participated and answered a questionnaire about the activity and the learning outcome. Results: The students felt comfortable during the activity, due to "openness to dialogue", "proximity with colleagues and teachers" and the "judgment-free environment". More than 90% reported that what they had learned would be useful in their professional and personal lives, providing a greater "understanding of emotions", "empathy", "ability to listen" and "ability to deal with conflicts". More than half of them were motivated to study, especially "doctor-patient relationship", "treatment", "common diseases" and "medicine in general". Students considered the activity important for retrieving the initial reasons that had led them to embarking on the medical profession in the first place. Conclusions: Reflecting on disease and its impact on patients’ daily life may motivate learning in medicine, allowing for the recovery of the personal and social meaning of its practice. In-depth debriefing was important to nurture professional identity committed to empathy and patients’ interests. Activities planned to discuss the influence and importance of emotions in medical practice can help students to reconcile personal and professional identities.

Recomendações para a educação com a simulação de paciente no ensino superior

“…Quanto à identidade, autores propõem que podem ser leigos, professores, estudantes ou atores profissionais que disponham de vontade e tempo para participar (Cantillon et al, 2010;Baig et al, 2014) (Schwelle et al, 2018).…”

“…Assim como o tom de voz e a linguagem corporal deve estar de acordo com o caso, por exemplo voz de ansiedade por medo de um infarto. O PS deve identificar as características pessoais e familiares para dar veracidade ao caso (Schwelle et al, 2018).…”

“…Autores recomendam promover o treinamento do PS, aplicado antes da seleção final, para perceber qual candidato se adequará melhor ao trabalho (Cantillon et al, 2010;Schwelle et al, 2018). Após serem selecionados os PS devem ser capacitados para interpretar um papel típico do paciente e interagir com os alunos/aprendizes (Pritchard et al, 2017).…”

Examining the effect of non-specialised clinical rotations upon medical students’ Thanatophobia and Self-efficacy in Palliative Care: a prospective observational study in two medical schools

“…Also, students have access to training sessions with simulated patients to develop communication skills (including breaking bad news) and emotional competence. 22 23 As such, students have several opportunities to acquire the knowledge, skills and attitudes required to care for dying patients, and reflexive learning is stimulated throughout the rotation by the supervisors. Nevertheless, most of the discussions during the rotation are about emergency medicine and critical care, and the activities around the topic of PC are complementary.…”

Simulação em saúde para ensino e avaliação: conceitos e práticas

“…A situação precisa incluir a complexidade das relações e da prática em saúde, mostrando a fragilidade dos pacientes, dos profissionais e as dificuldades que a equipe enfrenta ao realizar escolhas ou determinados tratamentos. As reflexões, como, por exemplo, "que médico eu gostaria de ser" ou "que medicina eu gostaria de praticar" frente a situações complexas e desafiadoras ajudam a reflexão frente a essas situações (SCHWELLER et al, 2018).…”