REVIEW Volume 11 Issue 3 2019 DOI: 10.21315/eimj2019.11.3.2 Experience towards Simulated Patient-based ARTICLE INFO Simulation Session: An Integrative Literature Submitted: 04-03-2019 Review Accepted: 01-07-2019 Online: 31-10-2019 Goh Lay-Khim1, Yee Bit-Lian2 1Clinical Skills and Simulation Centre, International Medical University Malaysia, Kuala Lumpur, MALAYSIA 2Cluster of Applied Science, Open University Malaysia, Kuala Lumpur, MALAYSIA To cite this article: Goh L-K, Yee B-L. Experience towards simulated patient-based simulation session: an integrative literature review. Education in Medicine Journal. 2019;11(3):5–21. https://doi. org/10.21315/eimj2019.11.3.2 To link to this article: https://doi.org/10.21315/eimj2019.11.3.2 ABSTRACT Simulated patient (SP) is defined as a layperson who simulates to portray the role of a patient with health-related conditions based on varying levels of training. SP allows students to practice various skills under guided experience in a realistic, safe, and controlled setting. The purpose of this integrative review is to examine original research relating to the experience towards simulated patient-based simulation session. A rapid review included three electronic databases search of articles published between 2008 to 2018 with inclusive and exclusive criteria. Seventeen articles were eventually selected for inclusion in the review. These articles were subjected to basic thematic analysis. Descriptive analysis of the study design, study location, professional area, and study variables were reported. Six themes were identified: SP’s perspective, evaluation of SP’s performance, euthenticity of SP role play, SP feedback, student’s development, and evaluation of student’s performance. SP methodology has been widely used to train healthcare students in the development of medical knowledge, clinical skills, as well as important soft skills. SPs, students, and facilitators play a role to ensure the success of an SP-based simulation session. The outcome of the training with SP was examined through an assessment of either the student’s performance or the SP’s performance. The outcome of the review concluded that SPs’ development indirectly influences students’ development. Keywords: Experience, Simulated patient, Simulated patient programme, Simulation CORRESPONDING AUTHOR Yee Bit-Lian, Open University Malaysia, Jalan Tun Ismail, Kuala Lumpur, 50480 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia | E-mail: [email protected] BACKGROUND (1–3). Combining these descriptions, SP can be defined as a layperson who simulates Simulated patient (SP) is defined as a to portray the role of a patient with health- trained individual who portrays the role related conditions based on varying levels of of a patient with various health associated training. conditions. The term SP also refers to a healthy individual trained to portray a SP can be interchangeably used with role patient. Another definition has described player, trained patient, patient instructor, SP as a layperson who simulates as a real and actor-patient. SP can also play a variety patient based on differing levels of training of roles along the educational path for Malaysian Association of Education in Medicine and Health Sciences and 5 Penerbit Universiti Sains Malaysia. 2019 This work is licensed under the terms of the Creative Commons Attribution (CC BY) (http://creativecommons.org/licenses/by/4.0/). Education in Medicine Journal 2019; 11(3): 5–21 health sciences students as well as training SP has been reportedly used in addressing of hospital staffs, such as clinical teaching communication skills, physical examination associate, incognito or unannounced skills, safe manual handling and personal patient, volunteer patient, hybrid patient, care assistance, and hybrid simulation and confederate (2). for invasive procedures (4). By practicing with SPs, students have the opportunity There are nine roles of SP: (a) role player; to develop various skills such as patient (b) trained patient; (c) patient instructor; interview skills, assessment skills, team (d) actor patient; (e) clinical teaching collaboration, professionalism, patient associate; (f) incognito or unannounced education skills, interpersonal skills, clinical patient; (g) volunteer patient; (h) hybrid skills, ethical decision making, patient safety, patient; and (i) confederate. Role player and communication skills. SP can portray refers to the individuals who portray as both physical and behavioural issue with and the patient who often are medical, nursing without the presence of medical conditions or health professional students. Trained for the students to learn under guided patient concerns a person who may or experience in a realistic, safe, and controlled may not use their experience of certain setting rather than ‘practicing on’ potentially diseases to play his/her role. The Patient distressed and vulnerable patients in real- instructor is commonly used in the medical life consultations (3–5). The purpose of this programme and means the individual is a article is to review research relating to the real patient and can be directed to use his/ experience of the simulated patient-based her own history and physical exam findings simulation session. to portray a patient. Actor patient refers to a professional actor acting as a patient. Clinical teaching associate are SPs trained to METHOD teach specific physical examination such as breast, rectal, and vaginal. The teaching Data Selection focus is on supporting the students to develop psychomotor, communication, and Search strategy other professional skills. SP who pretend as a real patient and enter the real clinical The researcher began the search process setting with permission to judge clinical with mind-mapping of research keywords performance are addressed as Incognito or – simulated patient, simulated patient unannounced patient. Volunteer patient is programme, and simulated patient the person who is insufficiently healthy to programme experience – with the aim attend teaching sessions. The role of this to analyse available research related patient usually involves role-play activities in to simulated patient programme and Objective Structured Clinical Examination experience towards simulated patient (OSCE). The patient involved in the use of or simulated patient programme. These a combination of real human and simulator three keywords were searched within three mimicking a real environment for the electronic databases, i.e. Google Scholar, practice of procedural and operative skills Open University Library, and BioMed is a hybrid patient. Lastly, confederate means Central (BMC). The search initially an individual other than the patient who returned a high volume of articles; therefore, is scripted to provide realism, additional an advanced search was performed by challenges or additional information for filtering the year and keyword search in title the students. For example, paramedic, only. receptionist, family member, laboratory technician, and the voice of manikins (2). 6 www.eduimed.com REVIEW | Experience towards Simulated Patient Programme Study selection the title for relevant articles. After the initial scanning of title, 56 articles were selected This review considered multiple research for the next screening, which was reading methods, including pilot study, descriptive abstract through the application of inclusion qualitative, descriptive quantitative, and exclusion criteria as shown in Table 1. correlation, regression analyses, and This resulted in 44 studies selected for literature and systemic review. Articles the full-text reading. Full review of these written in English, peer-viewed, and 44 studies resulted in 17 articles that was associated to SP based simulation session included in the present review. The study related to education training were included and selection process flow chart is illustrated from 2008 to 2018 (10 years) to explore a in Figure 1. wider range of data. Legend: A total of 344 papers were Data extraction identified through three electronic databases, i.e. BMC, Google Scholar, and Initially, a high volume of results was Open University Library. Six articles were achieved within the BMC search. The excluded due to duplication. Next, 338 researcher then did manual screening of papers were screened for title and abstract Table 1: Inclusive and exclusive criteria Inclusive criteria Exclusive criteria 1. Study focuses on SP based simulation 1. Study focuses on SP based simulation session session related to education training. not related to education training. 2. Peer reviewed. 2. Duplication. 3. Year 2008 to year 2018. 3. Concept paper. 4. All study design including reviews. 4. Non-English language. 5. English language. Potential papers identified through Identification database searches using keyboards n = 344 6 duplicate papers excluded Screening of title and abstract for Screening relevance n = 338 294 papers excluded Full text review Eligibility n = 44 27 papers excluded Papers included in literature review Included n = 17 Figure 1: Study and selection process flow chart www.eduimed.com 7 Education in Medicine Journal 2019; 11(3): 5–21 relevance and 294 studies were excluded Study Variable due to content not focused on SP based simulation session related to education Most of the studies focused on SP (10 out training and duplication. Finally, 44 of 17), while the rest on students (three) and papers were eligible for full-text review and lecturer (one). Three articles had more