Andrés Martin1,2,3, Indigo Weller4, Doron Amsalem5,6, Ayodola Adigun1,6, Debbie Jaarsma3, Robbert Duvivier3,7, Marco Antonio de Carvalho-Filho3,8. 1. Child Study Center, Yale School of Medicine, New Haven, CT, United States. 2. Standardized Patient Program, Teaching and Learning Center, Yale School of Medicine, New Haven, CT, United States. 3. Center for Educational Development and Research in Health Sciences (CEDAR), LEARN, University Medical Center Groningen, Groningen, Netherlands. 4. Bioethics Program, Harvard University, Cambridge, MA, United States. 5. Tel-Aviv University Faculty of Medicine, Ramat-Aviv, Israel. 6. Mental Health Services, Columbia University Irving Medical Center, New York, NY, United States. 7. Parnassia Psychiatric Institute, The Hague, Netherlands. 8. School of Medical Sciences, University of Minho, Braga, Portugal.
Abstract
Objectives: Co-constructive patient simulation (CCPS) is a novel medical education approach that provides a participatory and emotionally supportive alternative to traditional supervision and training. CCPS can adapt iteratively and in real time to emergent vicissitudes and challenges faced by clinicians. We describe the first implementation of CCPS in psychiatry. Methods: We co-developed clinical scripts together with child and adolescent psychiatry senior fellows and professional actors with experience performing as simulated patients (SPs). We conducted the simulation sessions with interviewers blind to the content of case scenarios enacted by the SPs. Each hour-long simulation was followed by an hour-long debriefing session with all participants. We recorded and transcribed case preparation, simulation interactions, and debriefing sessions, and analyzed anonymized transcripts through qualitative analysis within a constructivist framework, aided by NVivo software. Results: Each of six CCPS sessions was attended by a median of 13 participants (range, 11-14). The first three sessions were conducted in person; the last three, which took place during the COVID-19 pandemic, via synchronized videoconferencing. Each of the sessions centered on clinically challenging and affectively charged situations informed by trainees' prior experiences. Through iterative thematic analysis we derived an alliterating "9R" model centered on three types of Reflection: (a) in action/"while doing" (Regulate, Relate, and Reason); (b) on action/"having done" (Realities, Restraints, and Relationships); and (c) for action/"will be doing" (with opportunities for Repair and Reaffirmation). Conclusions: CCPS is an experiential approach that fosters autonomous, meaningful, and individually tailored learning opportunities. CCPS and the 9R model for reflective practice can be effectively applied to psychiatry and have the potential to contribute uniquely to the educational needs of its trainees and practitioners.
Objectives: Co-constructive patient simulation (CCPS) is a novel medical education approach that provides a participatory and emotionally supportive alternative to traditional supervision and training. CCPS can adapt iteratively and in real time to emergent vicissitudes and challenges faced by clinicians. We describe the first implementation of CCPS in psychiatry. Methods: We co-developed clinical scripts together with child and adolescent psychiatry senior fellows and professional actors with experience performing as simulated patients (SPs). We conducted the simulation sessions with interviewers blind to the content of case scenarios enacted by the SPs. Each hour-long simulation was followed by an hour-long debriefing session with all participants. We recorded and transcribed case preparation, simulation interactions, and debriefing sessions, and analyzed anonymized transcripts through qualitative analysis within a constructivist framework, aided by NVivo software. Results: Each of six CCPS sessions was attended by a median of 13 participants (range, 11-14). The first three sessions were conducted in person; the last three, which took place during the COVID-19 pandemic, via synchronized videoconferencing. Each of the sessions centered on clinically challenging and affectively charged situations informed by trainees' prior experiences. Through iterative thematic analysis we derived an alliterating "9R" model centered on three types of Reflection: (a) in action/"while doing" (Regulate, Relate, and Reason); (b) on action/"having done" (Realities, Restraints, and Relationships); and (c) for action/"will be doing" (with opportunities for Repair and Reaffirmation). Conclusions: CCPS is an experiential approach that fosters autonomous, meaningful, and individually tailored learning opportunities. CCPS and the 9R model for reflective practice can be effectively applied to psychiatry and have the potential to contribute uniquely to the educational needs of its trainees and practitioners.
Authors: Linda Drozdowicz; Elisabeth Gordon; Desiree Shapiro; Sansea Jacobson; Isheeta Zalpuri; Colin Stewart; A Lee Lewis; Lee Robinson; Myo Thwin Myint; Peter Daniolos; Edwin D Williamson; Richard Pleak; Ana Soledade Graeff Martins; Mary Margaret Gleason; Cathryn A Galanter; Sarah Miller; Dorothy Stubbe; Andrés Martin Journal: Front Psychiatry Date: 2020-11-17 Impact factor: 4.157