PSYCH SIM Developing Therapeutic Communication Skills Amanda Redvers – Consultant Psychiatrist / Simulation Lead Amanda.redvers@sabp.nhs.uk
1. Setting the scene. 2. Project aims. 3. Show you it in action. 4. Feedback. 5. Future.
What is Psych Sim? Who’s doing it and how is it currently done? SLaM /BSUH/ Kent &Medway – ACTORS SABP – Virtual Patients
CONTEXT - National Our NHS is changing and how we learn is changing. Education now aligned with NHS strategy (NHS mandate, 5 yr forward view) Compassion and integrated health and social care. Quality of patient experience Framework for Technology Enhanced Learning (DoH 2011)
CONTEXT - Local Health Education Kent Surrey & Sussex Technology Enhanced Learning Strategy and Plan (2013 – 2016) Appropriate and responsive to the changing environment Team based learning improved patient safety through • skills • attitudes • collaborative behaviours • appreciation of human factors
Link with KSS Strategic Priorities Compassionate care Primary care Dementia Children and young people Learning disability
SABP TEL PROJECT Creating safe learning environments where adult learners can pursue a curiosity driven approach. Skills rehearsed in ‘almost real life’ settings. Development of self- awareness and peer feedback. Coaching skills = creating thinking environments (Kline, 1999) where learners develop from trainee to professional (Miller, 1990; Bloom 1956).
Goals Improve skills & confidence eg: communication in tricky situations or with vulnerable people. Core communication and therapeutic skills for all staff Role specific specialist skills ASPH FY1 doctors (& psych attached medical students) Scenarios provide situations of increasing complexity • rapport building / risk assessment / alcohol and drug history/ mental status assessment, • discussing trauma / discussing involuntary admission / capacity assessment / conversations about safeguarding
Virtual Patients vs Actors Actor : Complex; not necessarily consistent; requires ongoing sourcing of actors and funding. Spontaneous, flexible (our system involves the trainer in the response loop – avoids need for AI) VP : Safe place to practise repeatedly; Consistent, thorough; Available round the clock; Simplified to begin learning and can be graded and scripted to match learning needs. Virtual patients may be cheaper in the long run. The consistency makes it easier for supervisors to support learning. Portable kit and one facilitator can run sessions. (adapted from Brown and Eagles, 2011)
The model:
Video link http://www.youtube.com/watch?v=Bqj9qWNu6lM
See it in action
Feedback 91% ASPH FY1 doctors Content / speaker / subject – very satisfactory.
Style – approx. 50/ 50 split for virtual patient vs actor.
Feedback comments: “Good scenarios which offered provocative discussions…Very helpful in identifying personal targets. Great use of technology and comparisons between various situations. Worthwhile analytical discussions”. “Excellent scenarios, very good learning chance. Having done scenarios with actors before, I still believe it is a more realistic experience with actors. I’m not convinced it will replace real actors”. “Valued the opportunity to practice dealing with difficult patients and scenarios that are directly relevant to working as a doctor”
Distillation of feedback comments: Valued the learning opportunity re: difficult communications with patients. A gap in FY1 formal training? Some learners find it more challenging to interact with VP We need to be clearer about how to use the sim patients effectively.
What have we learnt? Iterative process, actively using feedback from learners + facilitators. Maximise cross reactivity within scenarios for multiple playback permutations. Conventional feedback structures don’t work well – Guided development of themes (Mishra, 2015; Kurz 1998) Longer scenarios (16 utterances) Engaging actors / patients Continuity errors!
What next? Film remaining scripts Other clinical settings (dementia) Integrate with local innovations eg: tracking learner experiences / cost effectiveness / measure attitude change? Vision – HEKSS wide PSYCH SIM programme that uses VPS and Actors; coordinated and accessible; making best use of resources.
‘Challenges’ Staff release Sustaining the investment in faculty development. Employer commitment and engagement across disciplines eg: incentivising / job plans. Ongoing collaboration with industry partner (Xenodu). Collaboration with other psych and sim units within / outside HEKSS
Contact Details Amanda Redvers: 07917 173941 amanda.redvers@sabp.nhs.uk
Local infrastructure: SABP: ACUTE KSS Education TRUST Department QA / networks KSS Funding Train TEL FY Doctors / / strategy ing PROJECT med students SimFact Develop (BSUH) local faculty
MODELS OF GIVING FEEDBACK A common model for giving feedback in clinical education settings that you may have come across was developed by Pendleton (1984). Pendleton’s rules: 1. Check the learner wants and is ready for feedback. 2. Let the learner give comments/background to the material that is being assessed. 3. The learner states what was done well. 4. The observer(s) state what was done well. 5. The learner states what could be improved. 6. The observer(s) state how it could be improved. 7. An action plan for improvement is made. Although this model provides a useful framework, there have been some criticisms of its rigid and formulaic nature and a number of different models have been developed for giving feedback in a structured and positive way. These include reflecting observations in a chronological fashion, replaying the events that occurred during the session back to the learner. This can be helpful for short feedback sessions, but you can become bogged down in detail during long sessions. Another model is the ‘feedback sandwich’, which starts and ends with positive feedback.
When giving feedback to individuals or groups, an interactive approach is deemed to be most helpful. This helps to develop a dialogue between the learner and the person giving feedback and builds on the learners’ own self -assessment, it is collaborative and helps learners take responsibility for their own learning. A structured approach ensures that both trainees and trainers know what is expected of them during the feedback sessions. Walsh (2005) and Vassilas and Ho (2000) describe a model adapted from Kurtz et al . (1998), summarising the key points for problem-based analysis in giving feedback to groups as follows. Start with the trainee’s agenda; Look at the outcomes that the interview is trying to achieve; Encourage self -assessment and self-problem solving first ; Involve the whole group in problem solving; Use descriptive feedback; Feedback should be balanced (what worked and what could be done differently); Suggest alternatives. Rehearse suggestions through role-play. Be supportive. The interview is a valuable tool for the whole group. Introduce concepts, principles and research evidence as opportunities arise. At the end, structure and summarise what has been learnt. Vassilas and Ho (2000) identify that medical educationalists claim that using this method for groups and individuals is more likely to motivate adults, in particular, to learn. Initially, grasping this different way of working can be more difficult for trainers than using the traditional didactic approach, but research into using this method supports its effectiveness in clinical settings. The widely used Calgary-Cambridge approach to communication skills teaching (Silverman et al ., 1996) is referred to by Walsh (2005) in his summary of ‘agenda -led, outcomes- based analysis’: ‘Teachers start with the learners’ agenda a nd ask them what problems they experienced and what help they would like. Then you look at the outcomes that they are trying to achieve. Next you encourage them to solve the problems and then you get the trainer and eventually the whole group involved. Feedback should be descriptive rather than judgmental and should also be balanced and objective.
Alignment with the Framework for Technology Enhanced Learning (DoH 2011) This project aligns with the 6 key principles: Patient – centred and service-driven : skills are developed and practised 1) safely in the simulation environment. Service user input is a goal in real time teaching. 2) Educationally coherent: Educational theory underpins the delivery of this training. It develops knowledge and competence in communication skills, to increase expertise in clinical practice (Miller, 1990). It can be used to help staff develop understanding of safer systems and complex clinical situations using local incident data in scenarios (NPSA, 2010)
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