Simulation Training in Psychiatry for Medical Education: A Review

Abstract

Despite recognised benefits of Simulation-Based Education (SBE) in healthcare, specific adaptations required within psychiatry have slowed its adoption. This article aims to discuss conceptual and practical features of SBE in psychiatry that may support or limit its development, so as to encourage clinicians and educators to consider the implementation of SBE in their practice. SBE took off with the aviation industry and has been steadily adopted in clinical education, alongside role play and patient educators, across many medical specialities. Concurrently, healthcare has shifted towards patient-centred approaches and clinical education has recognised the importance of reflective learning and teaching centred on learners' experiences. SBE is particularly well-suited to promoting a holistic approach to care, reflective learning, emotional awareness in interactions and learning, cognitive reframing, and co-construction of knowledge. These features present an opportunity to enhance education throughout the healthcare workforce, and align particularly well to psychiatric education, where interpersonal and relational dimensions are at the core of clinical skills. Additionally, SBE provides a strategic opportunity for people with lived experience of mental disorders to be directly involved in clinical education. However, tenacious controversies have questioned the adequacy of SBE in the psychiatric field, possibly limiting its adoption. The ability of simulated patients (SPs) to portray complex and contradictory cognitive, psychological and emotional states has been questioned. The validity of SBE to develop a genuine empathetic understanding of patients, to facilitate a comprehensive multiaxial diagnostic formulation, or to develop flexible interpersonal skills has been criticised. Finally, SBE's relevance to developing complex psychotherapeutic skills is much debated, while issues such as symptom induction in SPs or patients involvement raise ethical dilemmas. These controversies can be addressed through adequate evidence, robust learning design, and high standards of practice. Well-designed simulated scenarios can promote a positive consideration of mental disorders and complex clinical skills. Shared guidelines and scenario libraries for simulation can be developed, with expert psychiatrists, patients and students involvement, to offer SPs and educators a solid foundation to develop training. Beyond scenario design, the nuances and complexities in mental healthcare are also duly acknowledged during the debriefing phases, providing a crucial opportunity to reflect on complex interpersonal skills or the role of emotions in clinicians' behaviour. Considered recruitment and support of SPs by clinical educators can help to maintain psychological safety and manage ethical issues. The holistic and reflexive nature of SBE aligns to the rich humanistic tradition nurtured within psychiatry and medicine, presenting the opportunity to expand the use of SBE to support a range of clinical skills and workforce competencies required in psychiatry.

Making It Real: From Telling to Showing, Sharing, and Doing in Psychiatric Education

“…Specifically, psychiatric education is ideally positioned to move from the prevailing use of standardized patients, to one in which actors, unencumbered by rigid scripts to adhere to, can be utilized as simulated patients instead. 21 Models such as CCPS that rely on actors' spontaneity can support reflective practice and innovative supervision by opening up a full range of realistic interactions with learners. Second, through their expertise in mental illnesses and the use of intersubjectivity as a means of understanding and healing, psychiatrists can advance the destigmatization of mental health conditions by sharing their own journeys.…”

“…19 The use of SPs in psychiatric education has been criticized as limited in its application and "most problematic for teaching psychotherapy and assessing complex interpersonal skills, such as empathic responsiveness". 20 However, a growing literature, as recently reviewed, 21 reveals that SP use can in fact be fruitfully applied as one potential remedy for the discipline's imaging woes. The unique strengths of SPs in psychiatry may in fact reside in the opportunity they provide to delve deeply into interpersonal complexity.…”

Mental Health Nursing Student’s Perception of Clinical Simulation about Patients at Risk of Suicide: A Qualitative Study

“…Extensive research has demonstrated the benefits of incorporating clinical simulation into psychiatric/mental health nursing curricula, emphasizing increased confidence and critical thinking to address the abovementioned difficulties [ 18 ]. Significant changes have occurred over the past decade, with many recent experiments and meta-analyses strongly supporting simulation-based mental health education for healthcare professionals [ 27 ].…”

Mental Health Nursing Student’s Perception of Clinical Simulation about Patients at Risk of Suicide: A Qualitative Study

“…[26] Extensive research has demonstrated the benefits of incorporating clinical simulation into psychiatric/mental health nursing curricula, emphasizing increased confidence and critical thinking to address the aforementioned difficulties. [18] Significant changes have occurred over the past decade, with a growing number of recent experiments and metaanalyses strongly supporting the use of simulation-based mental health education for health care professionals [27].…”