Report of SPOTS 10TH CONFERENCE, Friday, 25 March 2011, Manchester

There were 18 members present. Steve Attmore (Cambridge) introduced the event, and the first presenter was Byron McGuinness of the Manchester School of Medicine. (Byron is part-time simulated patient coordinator.) After a brief overview of the undergraduate curriculum, describing the emphasis on roleplay, feedback, self assessment and peer observation, Byron conducted a communication skills workshop with participants as if we were 1st Yr undergraduates. This included: open/closed Qs, verbal & non-verbal reinforcement; back to back: face to face & ‘chair to floor’ interviews plus reflection, as well as other interviewing styles.

The next item was a discussion on 'Sharing Experiences of the GP Recruitment Process – training and other issues' - introduced by Karen Roberts and Helen Timmins from Birmingham Medical School. There was a general belief that this year’s scenarios worked better, with an easier flow. There was discussion of the training given to SPs for this work: duration, methods, peer-review, etc. [For a video clip from this session, please go to www.simpaticoagency.com website and click on 'Videos'.]

However, concern was expressed over the lack of opportunity for SPs to give feedback. Although some research has indicated that SP assessment can be dispensed with, there was general dismay that SP’s expertise was being overlooked. SPs participating in the event felt that their views recorded on the feedback form were redundant, and there was a fear that the trend in GP selection was towards a defensive, formulaic selection process which lacked integrity.

Carrie Hamilton (Southampton) recounted that she had provided SPs for the recruitment rounds hitherto, but this year the Deanery contacted acting agencies direct to recruit and train – without any competitive tendering process or other rationale [known to Carrie at that time]. Members commented on the criteria and training for roleplayer selection; it was felt standards were threatened by the random recruitment of roleplayers/actors [however good these be: point noted, Pene].

Not all SP organisers had submitted a report on the selection process to their Deaneries. It was suggested that a unified voice of SPs needed to be heard, especially with regard to training and standards. [Roger Price at NRO to be contacted by SA on behalf of SPOTs.]
Simulating Rare & Serious Diseases using Scenarios, Acting & Make up. Prof Jim Parle (Birmingham) introduced a session showing how students could be trained to gain practical experience of diagnoses especially regarding infrequently-seen or serious cases. The two conditions selected were pancreatitis and meningococcal meningitis. These were resource-light, requiring one roleplayer per condition, a bit of make up, a couch and minimal training. The rationale for this was that students need to appreciate the signs and symptoms of serious conditions which in practice they could never get to handle.

Again, using participants as an undergraduate group on a mini-ward round, we got to question, examine, prod & poke the SPs, with Jim guiding, directing and challenging the group along the way. Members felt this was a valuable technique which could be developed beneficially in clinical training. Needless to say, bruising, moaning & writhing were fully up to standard: well done Helen, Karen & Ali!

After lunch, Michelle Gutteridge and Jag Sihota, of Warwick Medical School, led a discussion of work in progress on training SPs in their professional development. In particular, the question of whether SPs feedback in or out of role was explored; Warwick has developed a policy directing that feedback should be given out of role, as this proved less emotionally challenging for students (? evidence).

Nearly all SPOTS members commented that they ask SPs to feedback in role predominantly. There followed a discussion on the subject, showing a good deal of thought and expertise. Generally psychiatric and high-emotion roles were felt to need out-of-role feedback, and there were other subtle variations on the theme (including half in/half out, and the observation that ‘educator analysis’ came into out-of-role feedback). There was also followed a lively discussion on debriefing methods, styles of, and need for or not, etc.
Byron reported that his SPs have a systematic process for feedback and training, including peer review; a new roleplayers’ proforma to record issues, and regular feedback on roleplayers from facilitators, details of which he offered to share with SPOTS members.
Michelle requested ideas for preparation and training of SPs with psychiatric roles.
Likewise, Alison Whitfield from Nottingham would like to receive strategies for debriefing at the end of a session.

Pene Hermann-Smith (Glasgow) rounded off the activities of the day with a discussion of methods, pros & cons, etc. of training SP volunteers for medical exams. She explained that Glasgow has introduced volunteers into 1st Yr exams, as ‘expert patients’. This was being developed by training to make these volunteers into SPs. These were mainly retired people, working unpaid but receiving expenses. Participants were concerned at the introduction of well-motivated but non-professional simulators, and questioned the style, quantity etc. of training needed. While it was believed by many that the motivation of the volunteer was bona fide, it was feared that it might prove difficult to bring them all up to acceptable standards for a range of roles. Volunteers need to have clear ideas about standards and expectations, and to be responsive for and to feedback.

Most members felt that this was an issue of concern for quality control, and asked what SPOTS role in this might be. It was felt (qv Southampton above) that the untrained few might damage the professional standing of SPs & agencies.

Finally Steve Attmore described possible activities and opportunities for SPOTS in the year. The next ASPiH Conference will be in Cardiff in November. Warwick weas mentioned as possible hosts for next SPOTS Conference (30 March 2012). There was a suggestion that SPOTS might become a Special Interest Subgroup of the UK Council on Medical Education.
Frank Coffey (Nottingham) encouraged members to put in abstracts for this year’s ASPiH Conference, and Steve will put a link for this on SPOTS’ website. It was felt that the last ASPiH conference (Newcastle, Nov ’10) showed an encouraging level of interest in SPs and the human dimensions of training.

Everyone felt the day had been enjoyable and rewarding, and thanked contributors and Steve for their efforts in building a very successful event.

[Libby Dicken, roleplaynorth, Newcastle March 2011]