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      Cost-effectiveness of peer role play and standardized patients in undergraduate communication training

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          Abstract

          Background

          The few studies directly comparing the methodological approach of peer role play (RP) and standardized patients (SP) for the delivery of communication skills all suggest that both methods are effective. In this study we calculated the costs of both methods (given comparable outcomes) and are the first to generate a differential cost-effectiveness analysis of both methods.

          Methods

          Medical students in their prefinal year were randomly assigned to one of two groups receiving communication training in Pediatrics either with RP ( N = 34) or 19 individually trained SP ( N = 35). In an OSCE with standardized patients using the Calgary-Cambridge Referenced Observation Guide both groups achieved comparable high scores (results published). In this study, corresponding costs were assessed as man-hours resulting from hours of work of SP and tutors. A cost-effectiveness analysis was performed.

          Results

          Cost-effectiveness analysis revealed a major advantage for RP as compared to SP (112 vs. 172 man hours; cost effectiveness ratio .74 vs. .45) at comparable performance levels after training with both methods.

          Conclusions

          While both peer role play and training with standardized patients have their value in medical curricula, RP has a major advantage in terms of cost-effectiveness. This could be taken into account in future decisions.

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          Most cited references31

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          Systematic review of the literature on assessment, feedback and physicians' clinical performance: BEME Guide No. 7.

          Jon Veloski, James R. Boex, Margaret Grasberger … (2006)
          There is a basis for the assumption that feedback can be used to enhance physicians' performance. Nevertheless, the findings of empirical studies of the impact of feedback on clinical performance have been equivocal. To summarize evidence related to the impact of assessment and feedback on physicians' clinical performance. The authors searched the literature from 1966 to 2003 using MEDLINE, HealthSTAR, the Science Citation Index and eight other electronic databases. A total of 3702 citations were identified. Empirical studies were selected involving the baseline measurement of physicians' performance and follow-up measurement after they received summaries of their performance. Data were extracted on research design, sample, dependent and independent variables using a written protocol. A group of 220 studies involving primary data collection was identified. However, only 41 met all selection criteria and evaluated the independent effect of feedback on physician performance. Of these, 32 (74%) demonstrated a positive impact. Feedback was more likely to be effective when provided by an authoritative source over an extended period of time. Another subset of 132 studies examined the effect of feedback combined with other interventions such as educational programmes, practice guidelines and reminders. Of these, 106 studies (77%) demonstrated a positive impact. Two additional subsets of 29 feedback studies involving resident physicians in training and 18 studies examining proxy measures of physician performance across clinical sites or groups of patients were reviewed. The majority of these two subsets also reported that feedback had positive effects on performance. Feedback can change physicians' clinical performance when provided systematically over multiple years by an authoritative, credible source. The effects of formal assessment and feedback on physician performance are influenced by the source and duration of feedback. Other factors, such as physicians' active involvement in the process, the amount of information reported, the timing and amount of feedback, and other concurrent interventions, such as education, guidelines, reminder systems and incentives, also appear to be important. However, the independent contributions of these interventions have not been well documented in controlled studies. It is recommended that the designers of future theoretical as well as practical studies of feedback separate the effects of feedback from other concurrent interventions.
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            The use of simulated patients in medical education: AMEE Guide No 42.

            Keiko Abe, Jennifer Cleland, Jan Rethans (2009)
            Medical training has traditionally depended on patient contact. However, changes in healthcare delivery coupled with concerns about lack of objectivity or standardization of clinical examinations lead to the introduction of the 'simulated patient' (SP). SPs are now used widely for teaching and assessment purposes. SPs are usually, but not necessarily, lay people who are trained to portray a patient with a specific condition in a realistic way, sometimes in a standardized way (where they give a consistent presentation which does not vary from student to student). SPs can be used for teaching and assessment of consultation and clinical/physical examination skills, in simulated teaching environments or in situ. All SPs play roles but SPs have also been used successfully to give feedback and evaluate student performance. Clearly, given this potential level of involvement in medical training, it is critical to recruit, train and use SPs appropriately. We have provided a detailed overview on how to do so, for both teaching and assessment purposes. The contents include: how to monitor and assess SP performance, both in terms of validity and reliability, and in terms of the impact on the SP; and an overview of the methods, staff costs and routine expenses required for recruiting, administrating and training an SP bank, and finally, we provide some intercultural comparisons, a 'snapshot' of the use of SPs in medical education across Europe and Asia, and briefly discuss some of the areas of SP use which require further research.
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              The Calgary-Cambridge Referenced Observation Guides: an aid to defining the curriculum and organizing the teaching in communication training programmes.

              Andrew Silverman, S L Kurtz (1996)
              Effective communication between doctor and patient is a core clinical skill. It is increasingly recognized that it should and can be taught with the same rigour as other basic medical sciences. To validate this teaching, it is important to define the content of communication training programmes by stating clearly what is to be learnt. We therefore describe a practical teaching tool, the Calgary-Cambridge Referenced Observation Guides, that delineates and structures the skills which aid doctor-patient communication. We provide detailed references to substantiate the research and theoretical basis of these individual skills. The guides form the foundation of a sound communication curriculum and are offered as a starting point for programme directors, facilitators and learners at all levels. We describe how these guides can also be used on an everyday basis to help facilitators teach and students learn within the experiential methodology that has been shown to be central to communication training. The learner-centred and opportunistic approach used in communication teaching makes it difficult for learners to piece together their evolving understanding of communication. The guides give practical help in countering this problem by providing: an easily accessible aide-mémoire; a recording instrument that makes feedback more systematic; and an overall conceptual framework within which to organize the numerous skills that are discovered one by one as the communication curriculum unfolds.
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                Author and article information

                Contributors
                Hans Martin Bosse: +49 (0) 211 81 17687 , HansMartin.Bosse@med.uni-duesseldorf.de
                Martin Nickel: martin.nickel@med.uni-heidelberg.de
                Sören Huwendiek: soeren.huwendiek@iml.unibe.ch
                Jobst Hendrik Schultz: jobst-hendrik.schultz@med.uni-heidelberg.de
                Christoph Nikendei: Christoph.Nikendei@med.uni-heidelberg.de
                Journal
                Journal ID (nlm-ta): BMC Med Educ
                Journal ID (iso-abbrev): BMC Med Educ
                Title: BMC Medical Education
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-6920
                Publication date (Electronic): 24 October 2015
                Publication date PMC-release: 24 October 2015
                Publication date Collection: 2015
                Volume: 15
                Electronic Location Identifier: 183
                Affiliations
                [ ]Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children´s Hospital´, University Clinic Düsseldorf (UKD), Moorenstrasse 5, 40225 Duesseldorf, Germany
                [ ]Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany
                [ ]Department of Assessment and Evaluation, Institute of Medical Education in Bern, Bern, Switzerland
                [ ]Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Heidelberg, Germany
                Article
                Publisher ID: 468
                DOI: 10.1186/s12909-015-0468-1
                PMC ID: 4619415
                PubMed ID: 26498479
                SO-VID: ea2da22d-fe41-47ff-8b3c-459ba7701e47
                Copyright © © Bosse et al. 2015
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 5 May 2015
                Date accepted : 16 October 2015
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2015

                ScienceOpen disciplines: Education
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                ScienceOpen disciplines: Education

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