Creating a safe space: medical students’ perspectives on using actor simulations for learning communication skills | BMC Medical Education

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Creating a safe space: medical students’ perspectives on using actor simulations for learning communication skills | BMC Medical Education

This study centres on student perceptions regarding simulations and subsequent debriefing discussions. Out of 227 students, 208 (92%) took part in the study. 19 students declined to participate, and consequently, their answers were excluded from the dataset.

Students’ experiences of learning communication skills in simulations with actors as patients

The study explored students’ experiences while learning communication skills through simulated scenarios with professional actors portraying patients. Using content analysis, we identified eight overarching themes that encapsulate these experiences. Table 1 provides an overview of these themes, including categories, codes, and illustrative data samples. These themes highlight what students found significant during the simulations and subsequent feedback sessions. Our findings reveal both positive experiences associated with simulations and, critical reflections that shed light on the challenges inherent in this type of experiential learning.

The students’ experiences regarding learning communication skills in simulations revolved around eight themes: practising within a safe learning environment, getting feedback is crucial, gaining new perspectives, simulations are useful and fun, critical perspectives, building confidence, enhancing self-knowledge, and encountering authentic and exiting experiences. Further elucidation of these themes follows in the subsequent description.

The students described most frequently simulations as creating a safe learning environment for practising doctor-patient communication. This setting allowed them to gain experience handling diverse patient interactions, actively engage in simulated consultations and observe. Simulations created a safe space for exploring doctor-patient communication and learning from potential communication errors and setbacks without causing real harm to patients, thereby effectively preparing students for real-life patient consultations.

Students emphasised the crucial role of feedback following simulation practices in their learning process. They expressed a desire for honest, constructive feedback that helped them improve their communication skills. Even when their actions did not require correction, they appreciated suggestions for alternative communication approaches. Many students wanted more of this type of feedback during reflective debriefing sessions. Such feedback enriched their perspectives and provided deeper insights into doctor-patient interactions. The feedback from professional actors, offering the patients’ viewpoint, was highly valued.

Simulations also served as a platform for students to learn how to give and receive feedback. However, they found it challenging to provide constructive or corrective feedback to friends, as they wanted to avoid causing discomfort. They also acknowledged the difficulty in adjusting to feedback received. Despite these challenges, students valued the feedback and appreciated assessments of their communication skills. Overall, they considered feedback an indispensable component of the simulations.

Students perceived simulations as opportunities to gain new perspectives, particularly through analysing and discussing cases in reflective feedback sessions immediately after the exercises. They valued the insights provided by clinician teachers, who shared reflections on real patient encounters. Engaging in small group discussions following the cases was not only enjoyable for students but also crucial in addressing communication-related challenges. The intensity of the simulations encouraged students to reflect on the cases and debrief the thoughts evoked by the exercises. These reflections included discussions about their reactions, and exploring alternative approaches, which stimulated new ideas.

The theme that described simulations as both useful and fun captured students’ experiences, portraying simulations as the most engaging and informative method for learning communication skills. This positive disposition reflected students’ views of simulations as an effective learning method. They found simulations both rewarding and useful, with the reflective debriefing sessions complementing the learning process seamlessly.

Engaging in simulations allowed students to gain confidence in their professional communication skills. Overall, they expressed satisfaction with the simulated consultations and felt a sense of accomplishment. Their self-efficacy improved with recognition and encouragement, which supported their future endeavours, and their ability to manage uncertainties. Students faced exhilarating situations with a composed and independent demeanour, learning to navigate professional roles more effectively through these practices.

Students expressed critical perspectives regarding simulations, perceiving the practices as unrealistic and artificial. They voiced discomfort with role-playing and criticised the emphasis on communication skills rather than medical content. Additionally, the intensity and length of simulations and debriefings caused stress and discomfort for some students, hindering behavioural changes. Views on session duration varied, with some students finding them too long or too short. There were also differing opinions on the allocation of time between simulations and feedback. One area of criticism concerned the difficulty of patient scenarios. Some students felt that the exercises lacked novelty, while others wished for more challenging cases to enhance their practice.

During reflective debriefing sessions, students acknowledged that simulations enhanced their self-knowledge by revealing how others perceived their consultations. They recognized that much of the excitement and stress they experienced during simulations was not noticeable for observers. Additionally, reflecting on their own emotions and reactions to these encounters contributed to a deeper understanding of themselves, better preparing them for future interactions. In these scenarios, students identified their strengths and weaknesses, gaining insights into what worked well and areas for improvement.

Students described simulations with actors portraying patients as both authentic and exciting experiences. They felt that the actors played their roles realistically, eliciting genuine emotions and reactions from the students.

What the students learned in simulations

The students’ reflections on their learning from simulations revealed a depth of knowledge that surpassed the specific learning outcomes of the course, primarily addressing various facets of communication competence. In analysing students’ responses (Table 2), we identified five key themes encompassing learning outcomes expressed by students: patient-related issues, behavioural aspects, emotional aspects, and learning to deal with errors. Additionally, we recognised the perception of not learning anything new during the course.

The theme involving issues related to patient care encapsulated the students’ reflections on prioritising patient-centeredness in their interactions. This theme encompasses categories such as learning to encounter and collaborate with diverse patients, adeptly listening to and motivating patients, ensuring continuity of treatment, and addressing patients’ needs and emotions. Moreover, it included showing respect for patients and understanding their situations holistically, including the support offered by their families and significant others.

The theme of behavioural aspects covered students’ accounts of acting as a professional when interacting with patients. This theme was constructed based on categories such as acquiring practical guidance for handling challenging situations, employing clear and comprehensible communication, and exploring different approaches to behaviour during patient encounters. This includes, taking on the doctor’s role, preparing for consultations, and actively engaging in them.

Within simulations, students gained insights into the emotional aspects of patient encounters. They had the opportunity to cultivate and develop empathy and compassion while caring for patients, navigating moments of uncertainty and silence during consultations, building trust, and fostering a calm atmosphere. Additionally, students enhanced their self-knowledge by understanding their own reactions and emotions in challenging situations.

Simulations provided a secure environment for students to learn how to deal with errors.

However, some students expressed that the simulations did not offer them anything new, indicating that they were already familiar with the issues covered.

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