Letters to the Editor
To the Editor:
Recently, we presented Clever and colleagues’ report1 to our peers at Cardiff University Journal Club. It was met with enthusiasm and sparked much debate, as all of us had experienced communication skills training using simulated patients in our first year of medical school and had taken real patient histories during later clinical placements. Thus, our encounters were similar to those of the first-year students described by Clever et al, who had developed their skills by communicating with both outpatients and simulated patients.
All of us agreed that we would be more comfortable talking to real patients rather than actors in our first year, as the interaction is less artificial. This is particularly apparent when expressing empathy, which feels contrived when directed toward an actor. We also concluded that the histories we have taken from patients have been more representative of real clinical practice, as they are hugely varied and accompanied by real signs and symptoms.
However, there was a concern that volunteer outpatients used for such training may be less willing to provide constructive criticism for fear of upsetting students. Actors may therefore be more suitable, as they are particularly aware of what is expected of the student and, so, can tailor feedback accordingly. Furthermore, the use of patients is not always appropriate in certain pathologies and breaking bad news, for which a simulated patient is essential. Indeed, Cardiff University has recently made it possible for its medical students to practice procedures that are unsuitable for real patients on simulated patients.
In conclusion, we felt that whilst patients provide a more genuine and rewarding encounter, actors are also a vital resource for the development of communication skills. Consequently, we propose that patients be used by first-year medical students to begin learning communication skills in a comfortable environment, and that both patients and actors be used thereafter, since, ultimately, we will be treating patients, not actors.
Third-year medical student, Cardiff University, Cardiff, United Kingdom; firstname.lastname@example.org.
Third-year medical student, Cardiff University, Cardiff, United Kingdom.
1. Clever SL, Dudas RA, Solomon BS, et al. Medical student and faculty perceptions of volunteer outpatients versus simulated patients in communication skills training. Acad Med. 2011;86:1437–1442