Quality assurance of role portrayal of simulated patients - The current status of a multicenter qualitative-exploratory study

Peters, Tim; Bauer, Daniel; Brem, Beate; Eberz, Peter; Goerges, Ulf; Schwarz, Laura; Weckmann, Gesine; Thrien, Christian (31 August 2022). Quality assurance of role portrayal of simulated patients - The current status of a multicenter qualitative-exploratory study. In: 7th Swiss Conference on Standardized Patients and Simulation in Healthcare (SPSIM). Lausanne: HESAV

Background
Working with simulated patients (SPs) is an established and indispensable method in medical education (Cleland et al. 2009, Lewis et al. 2017, Nestel 2015). In this context, adequate role portrayal and its quality assurance are of great importance both in teaching and, in particular, in standardized, summative assessments. Tensions may occur between role specifications and local contextual conditions on the one hand and a credible and authentic role portrayal on the other. With the Fair-OSCE (Brem et al. 2015), the Maastricht assessment of Simulated Patients (Wind et al. 2004) and the Nijmegen Evaluation of the Simulated Patient (Bouter et al. 2013), tools exist that focus partly on the role portrayal of SPs in medical education, but a broad, scientific evaluation of the importance of good role portrayal and relevant aspects of quality assurance is lacking so far in the international literature.

Methods
To address this research gap, a working group was formed within the German Society for Medical Education’s standing committee on simulated persons and the following research questions were formulated: (1) What is the influence of the quality of simulated patients’ role portrayal for the achievement of learning objectives/examination goals in health professions education? (2) What is good role portrayal in the context of simulations in health professions education? Subsequently, a research concept was created to address these questions. Taking a qualitative-explorative approach, semi-structured interviews and focus groups will be conducted at institutions of medical and health professions education in the German-speaking countries Austria, Germany, and Switzerland. The audio data will be transcribed according to the GAT 2-scheme (Selting et al. 2009) and subsequently analyzed inductively according to qualitative content analysis (Mayring 2000) following concepts of grounded theory.

Results
In the course of the multicenter preparations, the four stakeholder groups, students, lecturers, SP-trainers, and simulated patients were identified. For each stakeholder group, relevant aspects of role portrayal and quality assurance were identified in several workshop rounds over a period of 2 years and interview guides for the stakeholder groups were developed and consented. To gather data from both individual statements and group-dynamic discussions, individual semi-structured interviews and focus group discussions are planned with each stakeholder group. IRB approval for this study is in progress and the study start is planned for the summer or early fall 2022; first results can be expected in spring 2023.

Discussion
Despite the high significance of employing SP methodology, the understanding of terms such as "quality" and "good acting" or "sufficient role portrayal" can vary greatly depending on the perspective. Research is needed to address this lack of standardization. Because of the high effort of the research needed to address this issue, it is of central importance for the group of authors to discuss the concept with experts in the international area before it goes into implementation.

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