‘Acting it out really makes it stick in your brain’: Educating students for patient portrayal during peer simulation

Introduction: Peer simulation is a method of simulation-based education (SBE) whereby students are educated to portray patient roles for peers. This potentially delivers accessible, high-impact, low-cost SBE that could be utilised in lower resourced settings. However, the most effective method of educating students to portray patient roles is currently not known. This study aimed to determine if the method of education for patient portrayal impacts portrayal accuracy, empathy development, and academic performance. Students’ perspectives of education approaches were explored. Methods: A semester-long mixed-methods study evaluated two education approaches for patient portrayal during peer simulation. The intervention approach was based on evidence for training simulated patients (SP) for patient portrayal. The control approach reflected unstructured preparation or ‘role-play.’ Patient portrayal accuracy, empathy, and academic grades were measured. Focus groups explored students’ perceptions of education approaches. Group differences were examined using one-way analysis of covariance, and linear regression models identified factors associated with academic grades. An interpretivist approach was adopted for focus group analysis. Results: Fifty-seven third-year, undergraduate physiotherapy students were randomised into two groups. Following education, there were no significant differences between groups on portrayal accuracy, empathy or grades. Blinded, observer-rated accuracy of patient portrayal was significantly associated with overall subject (β = 0.3; 95% CI: 0.1, 0.3) and practical skill (β = 0.4; 95% CI: 0.2, 0.7) grades. Qualitative findings suggested preparing for, and committing to, accurate patient portrayal was important for student learning. Scaffolded education including tutor guidance, feedback, and videos was considered important for learning patient roles. Discussion: Immersion in accurate patient portrayal is supported by multi-modal, scaffolded education. Whilst both education approaches had similar efficacy, delivery of structured, tutor-guided education for patient portrayal was valued by students. Similar to SP methodology, educators should provide videos, tutor-led group rehearsal, and feedback to guide performance, encourage patient portrayal accuracy, and promote role immersion.