Students take turns in the “deteriorating patient simulation” hot seat

Apr 12, 2018
Author: 
Erin Howe

MD Student Eliza Pope participates in a deteriorating patient simulationA patient drops by your clinic without an appointment. You know him to be a friendly, sociable person who has scizophrenia that he manages well. But today he doesn’t seem to be himself. You’re concerned for him, but your schedule is fully booked. What do you do?

This is the scenario second-year medical students explored during a recent workshop involving a “deteriorating patient simulation” (DPS) as part of in the Foundations curriculum.

In a DPS, a facilitator leads a group of about 20 students through a fictional medical scenario. In pairs, the students take turns making decisions on how to care for the patient as the situation unfolds. The experience gives learners an opportunity to make a series of patient care choices and see what impact those decisions have on the outcome.

The exercise also allows students to develop deeper clinical reasoning skills and familiarity with working in ambiguous and complex situations, says Sanjeev Sockalingam, an associate professor in the Department of Psychiatry.

Across Ontario, about 1.3 million people live with both physical and psychiatric illnesses. And according to Sockalingam, encounters like the one outlined in the workshop are becoming more common.

“We need to train our students to meet those needs in the future,” he says. “We know physical and mental health conditions often work against each other if they’re not well managed. And research shows each type of illness has worse outcomes if you don’t treat both more effectively.”

Dr. Alex Raben, a third-year psychiatry resident, sees real-life situations where people have both types of illness. He was a DPS workshop facilitator and helped lead students through the scenario. Raben says it’s good representation of what they will encounter as they embark upon clinical training.

“You’re often faced with decisions you have to make on the spot and you don’t necessarily have much time to deliberate,” he says. “While I was helping with this session, I was reminded of some of the high-pressure moments I’ve had working with patients.”

There’s a big different between this kind of teaching session and a lecture-based class. Raben says having students take turns in the hot seat to make decisions encouraged all of his group’s participants to contribute to the discussion.

2T0 student Eliza Pope says the chance to apply her knowledge in response to a developing case is exciting, noting the experience of better understanding how patients may present in different circumstances. She says this kind of simulation is especially helpful as she and her classmates approach clerkship, the clinical rotations that characterize the third and fourth year of medical school.

“We’re going to find ourselves in situations where we don’t necessarily know the ‘correct’ answer,” she says. “I enjoyed the debrief afterward to compare my decisions with the ones my classmates made. It was helpful to hear their perspectives about how best to help this ‘patient’ and to hear from our facilitator why some options do or don’t work in various contexts. It’s a great way to learn without worrying about how our decisions might affect a real person.”

DPS is also used to help train health professions students at other schools, but what sets this particular scenario apart is the inclusion of a mental health element, says Sockalingam, who is also Director of Curriculum Renewal for the Medical Psychiatry Alliance (MPA).

The first program of its kind in Canada, MPA isa partnership of the University of Toronto, CAMH, SickKids and Trillium Health Partners to transform health care delivery to people who have concurrent physical and psychiatric conditions.

“U of T is committed to addressing these issues, which reflect societal needs,” says Sockalingam. “MPA has been woven throughout the first two years of the Foundations curriculum, through some of the weekly case-studies, simulations and electives. We continue to innovate with the help of medical education researchers at the Wilson Centre.”

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