A realist evaluation exploring simulated patient role-play in pharmacist undergraduate communication training

Abstract

Background Effective communication between pharmacists and patients is essential and improves health outcomes. Simulated patients (SPs) are trained to reproduce real-life situations and can help pharmacy students to develop and adapt their communication skills in a safe, learner-centred environment. The aim of this research was to explore how SP and pharmacy student role-play supports communication training. Methods A mixed methods realist evaluation approach was adopted to test an initial theory relating to SP role-play for pharmacy students. The intervention tested involved complex communication cases in a men’s and women’s health module in year three of a new MPharm programme. This SP session was the first such session, of the programme which exclusively focused on complex communication skills for the students. Data collected comprised video-recordings of both training and mock OSCE sessions, and from student focus groups. Communication videos were scored using the Explanation and Planning Scale (EPSCALE) tool. Scores from SP and mock OSCE sessions were compared using the Wilcoxon-signed rank test. Focus groups were conducted with students about their experience of the training and analysed thematically, through a realist lens. Data was analysed for Context-Mechanism-Outcome configurations to produce modified programme theories. Results Forty-six students (n = 46/59, 78 %) consented to their video-recorded interactions to be used. Students identified contextual factors relating to the timing within the course and the setting of the intervention, the debrief and student individual contexts. Mechanisms included authenticity, feedback, reflection, self-awareness and confidence. Negative responses included embarrassment and nervousness. They distinguished outcomes including increased awareness of communication style, more structured communication and increased comfort. However quantitative data showed a decrease (p < 0.001) in communication scores in the mock OSCE compared with scores from training sessions. Modified programme theories relating to SP training for pharmacy students were generated. Conclusions SP role-play is a valuable communication skills training approach. Emphasis should be placed on multiple stakeholder feedback and promotion of reflection. Time limits need to be considered in this context and adjusted to meet student needs, especially for students with lower levels of communication comfort and those communicating in languages different to their first language.

Non-virtual simulation training and patient simulation existing for pharmacy students: A scoping review

“…The cases included chronic role-reversal simulation (in which each student took the role of a pharmacist and/or a patient) (Chen et al, 2015a). Sensitive and difficult patient topics of conversation (Westberg et al, 2006;Schultz & Marks, 2007;Marken et al, 2010;Eukel et al, 2021) included: suicide risk (Boukouvalas et al, 2018;El-Den et al, 2018;Willson et al, 2020), cancer (Serag-Bolos et al, 2018), vaccination (Vyas et al, 2018), risk of opioid abuse (Thakur et al, 2019), teratogenic drugs (Haddad, 2010), pregnancy, erectile dysfunction (Kerr et al, 2021b), pharmacogenetics (Powers et al, 2019), and end of life palliative care (Efstathiou & Walker, 2014;Thomas et al, 2021). The skills worked on included social competencies, attitude toward elderly patients, cultural competence, assertiveness (Luiz Adrian et al, 2015), leadership, verbal and non-verbal behaviour (Barker et al, 2018), communication skills (Rickles et al, 2009), social competence (Galal et al, 2012), empathy and holistic care (Gülpınar & Özçelikay, 2021;Thomas et al, 2021).…”

“…Pharmacy Education 24(1) 91 -145 103 needs, especially for students with a lower level of communication (including those who had to communicate in a language that was not their mother tongue), is paramount if they are to fully develop and retain communication skills (Grice et al, 2013a;Cobb et al, 2019;Kerr et al, 2021b). However, it is also necessary to develop education regarding the discussion of sensitive topics, as students found these more demanding and were embarrassed and reluctant to discuss them during the activity (Bajis et al, 2019;Thakur et al, 2019).…”