Simulation-based learning is an important part of physiotherapy education.

It allows students to practise their communication, decision making and hands-on skills in an environment closer to a clinic than a classroom.

And while traditionally the ‘patients’ in simulation-based education have often been actors, non-student volunteers or even real patients, it has become increasingly common for students—peers—to portray the patient role in such scenarios.

In these simulations, it’s not simply a matter of the student jumping up onto the examination table so that another student can examine their knee or do a respiratory assessment, as typically happens in student practical classes.

Instead, simulations are usually held in an environment that simulates a clinical setting such as a private practice, hospital room or aged care facility.

The ‘patient’ wears clothing that matches the case, may have appropriate injuries replicated with moulage, such as bruising and may even wear a mask to help the portrayal of an elderly person.

‘Peer simulation these days goes far beyond pretending.

‘It can be considered an evolution of role-play,’ says Narelle Dalwood MACP, a senior lecturer and researcher in Monash University’s Department of Physiotherapy.

‘Here at Monash, we emphasise the structured, repeated practice of skills with a clear framework for patient role preparation so it’s not improvised.

‘We also put a strong emphasis on accurate patient portrayal to ensure that the students honour the patient’s story and portray the patient as accurately as they can for their colleague.

‘It’s quite different from the old days of role-play.’

Narelle Dalwood is teaching students to portray patients for clinical simulations.

Narelle is interested in whether taking part in peer simulation scenarios—where students not only practise their clinical skills but also portray the role of the patient—has an impact on their developing skills as a physiotherapist.

She says that a recent systematic review by her team has shown that peer simulation in a healthcare setting has a positive impact on both communication skills and the development of empathy and that this can be observed in the students taking part in peer simulations at Monash University.

‘An unanticipated but fairly significant benefit of our peer simulation program has been what our students learn when they portray the patient role when they figuratively step into the patient’s shoes,’ Narelle says.

But while it’s clear that peer simulation is a valuable approach to learning, there is no consensus on the best way to teach students to portray the patient role.

‘We have a method that we use here at the university to train our students to portray the patient role, but we have no evidence to support it.

‘Is it enough to just give a student a general outline of the patient case and a script and say this is your patient and off you go?

‘Or does the training need to be more extensive?’ says Narelle.

She has recently been awarded a Physiotherapy Research Foundation Seeding Grant to determine the impact of two different training approaches for patient role portrayal during peer simulation on third-year physiotherapy student preclinical learning outcomes.

The randomised controlled trial will also explore whether the patient portrayal training provided to physiotherapy students during peer simulation affects the accuracy of patient role portrayal and the development of empathy.

These results will be supported by qualitative data to explore the impacts of the two different training approaches.

The proposed study will be run this year during the nine-week peer simulation unit that all third-year Bachelor of Physiotherapy students take at Monash in semester one.

In this unit, pairs of students do two simulation scenarios each week, switching roles between patient and physiotherapist for each scenario.

While students can opt out of participating in the trial, they will still take part in the assigned simulations.

The students taking part in the trial will be randomised into two groups—the intervention and the control group.

Both groups will be provided with scripts for their roles as patients but the intervention group will get additional resources, including videos, and will have the opportunity to practise their portrayal of the patient, receiving feedback from the facilitators.

A variety of outcome measures will be collected and compared between the two groups at baseline and at the end of the nine- week trial, including the students’ Objective Structured Clinical Examination scores in the semester prior to and after completing the study, patient portrayal ratings—not just by the students rating themselves and their partner, but by a blinded independent observer—and empathy development.

The students will also participate in focus groups to capture their perspectives and the impacts of the different approaches.

Narelle says that the findings of the study will be applied directly to the ongoing curriculum in both the Bachelor and Doctor of Physiotherapy programs at Monash University and she hopes the results will guide the implementation of peer simulation in physiotherapy programs and other healthcare programs more widely.

COURSE OF INTEREST: Learning and teaching for physiotherapy-Part A here.