Learning how to portray the patient role for peer simulation: a mixed methods study on training approaches and impacts

Background: Peer simulation is a method of simulation-based education whereby students are trained to portray patient scenarios for peers. There is little evidence to guide practice in student training methods for peer simulation. This study aimed to determine if patient portrayal training type impacts patient portrayal accuracy, student empathy development and academic performance. Students’ perspectives of training approaches were explored.
Method: A semester-long randomized controlled trial compared two training approaches for patient portrayal during peer simulation. One approach was based on evidence for training paid actors for patient role portrayal as simulated patients, the alternative reflected traditional, unstructured preparation or ‘role-play’. Patient portrayal accuracy (assessed by blinded observers, peers and self), empathy (rated by peers and self) and academic grades were examined. Focus groups explored students’ perspectives of training approaches. Group differences were examined using one-way analysis of covariance, and linear regression models identified factors associated with academic grades. An interpretivist approach was adopted for focus group analysis.
Results: Fifty-seven third-year, undergraduate physiotherapy students were randomised into two groups. There were no significant differences between training approaches on patient portrayal accuracy, empathy or academic grades. However, blinded, observer-rated accuracy of patient portrayal was significantly associated with overall subject (β=0.3; 95% CI: 0.1, 0.3) and practical skill (β=0.4; 95% CI: 0.2, 0.7) grades. All participants’ self-rated empathy increased from baseline to post-intervention. Qualitative analysis suggested preparing for, and engaging in, accurate patient portrayal were important components.
Discussion: Training method did not impact accuracy of patient portrayal, empathy or academic grades. However, greater accuracy of patient portrayal, achieved via any training method, was associated with enhanced academic grades. Qualitative findings indicated the importance of formal training of students during peer simulation to improve patient portrayal for their peers. This reflects students’ perspectives on the importance of training for, and accuracy of, patient portrayal on their learning.