There are various ways in which simulation is used within training and education in healthcare, some include human patient simulation, virtual human/patient simulation, the use of mannequins, and more. A study was conducted in the U.S. where 206 second year medical students practiced communication skills using virtual human (VH) based simulation and an objective structured clinical examination (OSCE) [now5(was4)]. Students were asked to complete a reflective essay summarising their thoughts about both experiences with regards to understanding verbal communication and human interactions, amongst others. Identified themes included Learning Awareness of Nonverbal Skills, Gaining Useful Communication Skills suggesting an overall beneficial experience with both interventions. However, on comparison between VH and OSCE simulation it was mentioned that “Your true response can only come from human to human interaction…program is much stronger at allowing a person to think about their verbal responses” .
In a simulation study, standardised patients were used to train medical students in breaking bad news. The sample size consisted of 28 medical students and the control group included 38 medical residents. The intervention was carried out in the style of OSCEs with standardised breast and colon cancer patients . As expected, results showed that residents were significantly better at showing rapport to standardised patients than students were (p = 0.015) . However, there was no significant difference between the actual breaking of bad news or communication related to patients’ emotions between the two groups (p = 0.100, p = 0.828 respectively) . The fact that students and residents showed no significant difference in communication skills relating to patient’s emotions, suggests that using standardised patients can be just as effective as having in-person experience with cancer patients.
Saiva et al. , carried out an immersive simulation intervention with a convenience sample of 15 medical residents at a Canadian mental health Hospital . The aim was to provide medical residents insight into the struggles of geriatric patients. This was carried out by giving participants a suit to wear to emulate physical restrictions, ear plugs which played an audio to simulate hallucinations and difficulty in hearing. Goggles and gloves were worn to simulate dexterity problems and difficulty in seeing. During the simulation, participants were patients invited to a consultation with a pharmacist about their medicines and starting the use of Dossett boxes. Participants reported struggling to understand and hear everything that was said and felt limited as to how much they could engage and be a part of the consultation . The voices in the audio caused great distress and anxiety which made the participants self-conscious. Before and after participating, residents completed a 7-point Likert scale test, which used the Jefferson scale of empathy to measure and compare levels of empathy before and after the experience. With 7 being extremely empathetic, both mean scores were compared, showing that empathy was significantly increased after the experience, p = 0.02, t = 2.65 . A similar approach was used at the Department of Physical Medicine and Rehabilitation, Taipei Municipal Wanfang Hospital, China . Thirty Physiotherapist interns participated in a simulation experience which involved completing tasks whilst wearing suits, to understand the struggles faced by older adults and those with disabilities . Some tasks included; putting on and taking off clothes while wearing a hemiplegia simulation suit, using the nondominant hand to pick up beans with chopsticks, and drinking water while wearing a simulation suit. Interns completed tests before and after the intervention, which measured their empathy, knowledge, and attitude with the use of various scales. Results showed that interns had more empathy (p = 0.001), knowledge (p = 0.005), improved attitudes (p = 0.002) toward older adults and individuals with disabilities after the intervention .
Usually the majority of simulation education research is focused on the learner simulating the role of a future HCP. However, being put in the position of a patient through role reversal simulation (RRS), has rarely been done. Simulation of this nature is of growing interest as learners can better relate to the thoughts and emotions of patients, as well as have a better perception of how care is received. A Life in a Day is an application (app) created by The Method, a healthcare education company who uses theatre techniques to create realistic situations which elicit emotion and empathy . It incorporates immersive RRS to teach HCPs about a particular patient group or chronic condition and what patients experience on a day-day basis . This is a simulation experience where the individual becomes the patient for a day rather than simulating a future HCP role. Participants engage with stimuli in the form of app notifications and phone calls from actors who role play various characters. To create a heightened sense of reality, participants receive a kit with a range of items. Examples of these are red dye capsules to create the effect of haematuria when thrown into the toilet, or the wearing of a belt around the lower chest to simulate shortness of breath. The participant is required to carry on with their daily activities and work commitments whilst partaking in the experience to help participants appreciate the challenges faced by patients.
The ‘A Life in a day’ experience undertaken in this study was based on Renal Cell Carcinoma (RCC). RCC is the most common type of Kidney Cancer with a high 5-year survival rate of 70–80% . Patients living with RCC can have different experiences, but many will experience fatigue, weight loss, haematuria, pain and a decrease in appetite .
The aim of this study was to investigate the experience of pharmacy staff and nurses with the ‘A Life in a Day’ simulation experience.