Practical Skills Lay Actors (PSLAs)
This pack aims to clarify how we can work with real patients, service users and carers and lay actors using their own and others medical histories, signs and symptoms or experiences of health in simulation activities in the teaching and assessing of practical skills in the school of HSC
Equipment, simulation manikins, or human models
The use of simulation to teach practical skills is constantly developing. When making choices about which method or simulation activity you wish to use you need to consider the costs and benefits of different simulation opportunities.
1 Simulation equipment, e.g. METI, Laerdal
Working with simulation equipment, such as arms for taking blood pressure, is a good option for teaching skills which may need to be repeated by inexperienced students with tutors being able to adjust signs and symptoms to test if the student is developing the correct skill set.
2 Manikins
The use of manikins provides more complex simulation activities for teaching and assessment, the use of manikins can test a range of skills that it would not be possible / appropriate to practice with human models. Also manikins offer complete standardisation controlled by the assessor ensuring equity of learning and examination experience.
3 Virtual simulation
This offers excellent opportunities for simulation with standardisation much easier to achieve.
Simulation activities 1-3 may be enhanced by developing scenarios with users and carers which may be used by tutors in simulated activities. There may be checklists developed with users and carers to help students develop an awareness of their perspective. This is a cost effective way of ensuring user and carer involvement.
The use of simulation equipment is discussed in depth in the linked document (place web link here).
Human Models
When you have considered that using human models will offer the best learning or assessment opportunity for students you need to decide if this will be students as human models, members of the teaching team acting as models or if you would wish to work with members of the public.
There are disadvantages to using Practical Skills Lay Actors (PSLA). These are the resources needed to manage a group of users, carers or actors including recruitment, training, support, payment and administration costs. However the advantages are that a range of skills can be taught and assessed including the additional skills of listening, communication and empathy which are more difficult to assess when working with equipment only. PSLAs can respond to the student in the learning situation and provide feedback on performance. Real patients signs and symptoms may be less predictable or controlled by medication and will be less available. PSLAs can give consistency of learning experiences which can be adjusted to meet the needs of the student and stage of training. PSLAs may initially need more resources for training and support but as they gain experience they can contribute more and be an asset to a skills team.
There are many ways to work with PSLAs to help students learn skills. Examples are simple scenarios written in collaboration but used by academics in classrooms; co-developing web materials or study packs; developing complex scenarios where PSLAs act roles to promote learning; formulating standardised assessments (OSCEs) where a group of PSLAs work with clinicians and educators to develop scenarios and then carefully standardise the simulation experience to ensure each student has a comparable experience of assessment.
This section of the Human Model Pack looks at how we can maximise these learning and assessment opportunities with some practical steps to ensure an accomplished presentation in the skills labs.
Defining simulated and standardised PSLAs
v Simulated PSLAs are people who have trained to act an agreed set of signs and symptoms or responses, they may have a specific disability or illness being acted or they may not. Simulated PSLAs participate in developing and acting scenarios to help students learn skills and to give students constructive feedback. They may be involved in providing opportunities for students to reflect on their learning and perfect aspects of their skills. The need for training is high as simulated patients have to fully understand the signs and symptoms or the responses they will act and may be acting a range of scenarios. Also their interaction with students has to be carefully outlined to ensure effective skills teaching and constructive, appropriate feedback.
v Standardised PSLAs are used in skills assessment.
o Real patients have been used in medical education during OSCEs eg students have to detect abnormal heart sounds in a real person, this requires limited training of the patient however full consent must be obtained and information of the processes must be given to the patient.
o Standardised PSLAs are trained to act a user or carer consistently and within agreed criteria. There are often a small team of people who train together to standardise their presentation of the user or carer and ensure students being assessed have an equitable experience: for more detail read Collins and Harden (1999) or Wallace (2007). Where standardised patients are not real patients this requires more preparation including a rehearsal.
Role of coach in developing individuals for simulation activities
v A coach will work with individuals to develop their acting skills. They may work with the skills tutor and clinicians to ensure the PSLAs have the skills and knowledge to contribute effectively to students learning and assessment. Coaches can offer advice on costing and training programmes for PSLAs. A coach may be involved in recruitment and induction of PSLAs
Role of tutor and clinician in developing simulation activities
v Tutors agree the requirement of PSLAs in the teaching or assessment of skills. They agree the most effective method of involvement, costs of involvement and funding agreement. They may take on the role of coach or work with someone who has experience of coaching PSLAs. The tutor liaises as appropriate with clinicians and PSLAs to develop the teaching or learning activity as detailed later in the pack. The tutor also should evaluate the use of human models identifying strengths and weaknesses in the method used.
Staff training
v Team work is central to effective use of PSLAs in skills teaching, having a more experienced staff member in a team offers opportunities for ‘on the job’ learning
v The clinical skills team should have opportunities for their own learning to ensure effective PSLA involvement
v Worked examples of simulation scenarios with PSLAs are being developed for the user and carer website
v Worked examples of assessment activities with PSLAs are being developed for the user and carer website
Recruitment of people and choosing the best person for the simulation
v Agree if real patients, service user, carer or actor is needed
v Selection group agreed
v Interview people on database or agree recruitment strategy
v Select sufficient PSLAs to run the session/s
v Complete paperwork
o Letter of agreement (contract including consent)
o Agreement for recording simulation activities and releasing record including images for purpose of students learning and assessment
v Agree payment
v Complete induction
Cost and logistics of teaching and assessing skills with PSLAs
v Simulated and standardised clinical assessments with PSLAs incur additional costs and it is important to work out what these costs are likely to be and discuss this with the budget holder. Items to consider are
o Hourly rate for developing scenarios with PSLAs
o Hourly rate for the teaching or assessment activity
o How many PSLAs you will need and how many hours
o Travelling and other expenses to be offered
o Staff to ensure PSLAs are supported, debriefed and all paperwork is completed
o Cost of any equipment including digital recording of sessions if required
Developing scenarios for learning or assessment
v Agree the following, this may involve PSLAs with experience of the health issue being taught and/or clinicians
o Authors of scenario
o Learning objective / assessment criteria
o Symptoms and signs
o Diagnosis
o Possible other diagnosis
o Patients name in scenario
§ Age, sex, race, height, weight, disability,
o Patients profile
§ History, results of tests, signs, symptoms, medications taken
o Materials and equipment needed
§ Examinations needed
§ Do you need to develop ‘results’ for student to use
o Training materials for PSLA
§ Skills being taught / examined
§ Symptoms etc
§ Checklist for feedback
o Instructions to student
Training and mentorship for PSLAs
v Following induction PSLAs need training for their role. The content and level of training needs to reflect their individual involvement. Below is a list of things to consider
o What are learning objectives
o Working as team member to develop scenarios
o Developing acting skills
o Working one-to-one and / or working in groups
o Using your own experience to support learning, maintaining focus on learning objectives / assessment criteria
o Giving constructive feedback
o Specific knowledge and skills as identified in training sheet for PSLA
o Maintaining standardisation in OSCEs
o Reviewing learning and assessment activities
Debriefing of staff and PSLAs following simulation activities
v This is an important aspect of working with PSLAs and time must be built into costing and staff time to provide team debriefing
This pack has been developed from:-
Collins, J. Harden, R. (1999) The use of real patients, simulated patients and simulators in clinical examination Dundee: Association for Medical Education
Wallace, P. (2007) Coaching Standardised Patients for use in the assessments of clinical competence New York: Springer Publishing
kl-scarborough Page 5 25/06/2012