Board #101 - Research Abstract Simulation in Undergraduate Psychiatry Education

Hypothesis Undergraduate medical education is increasing the use of simulation-based methodologies to expand students’ exposure to complex clinical scenarios.1-2 While a review of the literature was conducted in 2008 looking at the role of simulation within psychiatric education, emphasis on this review was placed more broadly on all areas of psychiatric education and primarily the role of standardized patients and role play.3 The hypothesis of this paper was to see if additional and potentially more promising approaches to simulation were influencing curriculum development within undergraduate psychiatric education. This paper will review the existing literature on simulation methodologies used specifically within undergraduate psychiatry education and provide an overview of most commonly used approaches to date. The goal is to identify innovative and useful simulations and potential gaps in the use of simulation within the undergraduate psychiatry curriculum. Methods The authors searched the MEDLINE, ERIC, and PsychINFO databases to 2014 using multiple search terms, including simulation, standardized patients, psychiatry, undergraduate education and medical student. A manual refined search of the yielded results specifically including medical students, a range of simulation methodologies (e.g., use of standardized patients, virtual reality, and e-learning simulation modules) was conducted. Literature that indirectly related to the defined search parameters was also included. The authors reviewed each paper manually to determine the type of simulation used and to determine the appropriateness of the use of simulation as a learning modality to enhance teaching, medical student learning and/or assessment. The psychiatry area of focus for the simulation learning was also ascertained. Results The refined search criteria yielded a total of 352 articles examining the use of simulation-based methodologies within undergraduate psychiatry education. Areas of focus included the use of simulation to support learning, assessment, changing attitudes about psychiatry, decreasing stigma, and building empathy among medical students. Of the 352 articles generated, 85 dealt specifically with the use of simulation in undergraduate medical education and spanned a period from 1977 to 2013. Seventy-three percent of the papers looked at the use of standardized patients and 19% utilized an online or web based simulation intervention. Five papers looked at virtual patients in enhancing education. The vast majority of the papers reviewed used simulation in teaching or skill building while seventeen percent discussed its value in assessment or Objective Structured Clinical Examination. Two papers discussed the value of simulation in building cultural competency among medical students.4-5 Conclusion Despite the varied uses of simulation across many health disciplines, little has changed in undergraduate psychiatric education since the 2008 review.3 Some papers focused on skills such as communication skills, empathy and decreasing stigma in psychiatry.6-10 Expanding on these is essential since they are relevant to all facets of the practice of medicine. While a small percentage of papers used simulation-based e-learning models or virtual patients, given the significant resource required for SPs and the challenges in accommodating such learning experiences within an already dense curriculum, these modalities show promise.11 Virtual patients, are reflective of the emergence of the field of telepsychiatry and enable more opportunities for simulation-based learning across a diverse set of contexts.2 Future directions include evaluating the efficacy of these interventions using models of learning to inform future curriculum development in undergraduate psychiatry.12 References 1. Humphrey HJ. Marcangelo M. Rodriguez ER. Spitz D. Assessing competencies during education in psychiatry. International Review of Psychiatry. 25(3):291–300, 2013 Jun. 2. Srinivasan M, Hwang JC, West D, Yellowlees PM. Assessment of clinical skills using simulator technologies. Acad Psychiatry. 2006;30:505–515 3. McNaughton N, Ravitz P, Waddell A, et al: Psychiatric education and simulation: a review of the literature. Can J Psychiatry 2008; 55:3–11 4. Smith BD, Silk K. Cultural competence clinic: an online, interactive, simulation for working effectively with Arab American Muslim patients. Acad Psychiatry, 2011; 35:312–6. 5. Ekblad S, Manicavasagar V, Silove D, Baarnhielm S, Reczycki M, Mollica R, et al. The use of international videoconferencing as a strategy for teaching medical students about transcultural psychiatry. Transcultural Psychiatry 2004; 41, 120–129. 6. Cohen DS, Colliver JA, Marcy MS, Fried ED, Swartz MH. Psychometric properties of a standardized-patient checklist and rating-scale form used to assess interpersonal and communication skills. Acad Med. 1996 Jan;71(1 Suppl):S87–9. 7. Sack S. Drabant B. Perrin E. Communicating about sexuality: an initiative across the core clerkships. Academic Medicine 2002 Nov; 77(11):1159–60, 8. Krahn LE, Bostwick JM, Sutor B, et al: The challenge of empathy: a pilot study of the use of standardized patients to teach introductory psychopathology to medical students. Acad Psychiatry 2002; 26:26–30 9. Bunn W, Terpstra J. Cultivating empathy for the mentally ill using simulated auditory hallucinations. Acad Psychiatry. 2009;33:457–460 10. Galletly C, Burton C. Improving medical student attitudes towards people with schizophrenia. Aust N Z J Psychiatry. 2011 Jun;45(6):473–6. 11. Hasle JL1, Anderson DS, Szerlip HM. Analysis of the costs and benefits of using standardized patients to help teach physical diagnosis. Acad Med. 1994 Jul;69(7):567-70. 12. Kolb D: Kolb D Experiential Learning: Experiences as the Source of Learning and Development. 1984 Englewood Cliff, NJ Prentice-Hall. Disclosures None

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