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Standardized Patients in Clinical Psychology and Psychotherapy: a Scoping Review of Barriers and Facilitators for Implementation

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Abstract

Objectives

The use of simulated and standardized patients (SP) is widely accepted in the medical field and, from there, is beginning to disseminate into clinical psychology and psychotherapy. The purpose of this study was therefore to systematically review barriers and facilitators that should be considered in the implementation of SP interventions specific to clinical psychology and psychotherapy.

Methods

Following current guidelines, a scoping review was conducted. The literature search focused on the MEDLINE, PsycINFO and Web of Science databases, including Dissertation Abstracts International. After screening for titles and abstracts, full texts were screened independently and in duplicate according to our inclusion criteria. For data extraction, a pre-defined form was piloted and used. Units of meaning with respect to barriers and facilitators were extracted and categorized inductively using content-analysis techniques. From the results, a matrix of interconnections and a network graph were compiled.

Results

The 41 included publications were mainly in the fields of psychiatry and mental health nursing, as well as in training and education. The detailed category system contrasts four supercategories, i.e., which organizational and economic aspects to consider, which persons to include as eligible SPs, how to develop adequate scenarios, and how to authentically and consistently portray mental health patients.

Conclusions

Publications focused especially on the interrelation between authenticity and consistency of portrayals, on how to evoke empathy in learners, and on economic and training aspects. A variety of recommendations for implementing SP programs, from planning to training, monitoring, and debriefing, is provided, for example, ethical screening of and ongoing support for SPs.

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References

  1. Eagles JM, Calder SA, Wilson S, Murdoch JM, Sclare PD. Simulated patients in undergraduate education in psychiatry. Psychiatr Bull. 2007;31(5):187–90. https://doi.org/10.1192/pb.bp.106.010793.

    Article  Google Scholar 

  2. Hodges BD, Hollenberg E, McNaughton N, Hanson MD, Regehr G. The psychiatry OSCE: a 20-year retrospective. Acad Psychiatry. 2014;38(1):26–34. https://doi.org/10.1007/s40596-013-0012-8.

    Article  PubMed  Google Scholar 

  3. Adamo G. Simulated and standardized patients in OSCEs: achievements and challenges 1992-2003. Medical Teacher. 2003;25(3):262–70. https://doi.org/10.1080/0142159031000100300.

    Article  PubMed  Google Scholar 

  4. Pheister M, Stagno S, Cotes R, Prabhakar D, Mahr F, Crowell A, et al. Simulated patients and scenarios to assess and teach psychiatry residents. Acad Psychiatry. 2017;41(1):114–7. https://doi.org/10.1007/s40596-015-0477-8.

    Article  PubMed  Google Scholar 

  5. Barrows HS. An overview of the uses of standardized patients for teaching and evaluating clinical skills. AAMC. Acad Med. 1993;68(6):443–51. https://doi.org/10.1097/00001888-199306000-00002.

    Article  CAS  PubMed  Google Scholar 

  6. Weaver M, Erby L. Standardized patients: a promising tool for health education and health promotion. Health Promot Pract. 2012;13(2):169–74. https://doi.org/10.1177/1524839911432006.

    Article  PubMed  Google Scholar 

  7. Miller GE. The assessment of clinical skills/competence/performance. Acad Med. 1990;65(9):S63–7. https://doi.org/10.1097/00001888-199009000-00045.

    Article  CAS  PubMed  Google Scholar 

  8. Muse K, McManus F. A systematic review of methods for assessing competence in cognitive–behavioural therapy. Clin Psychol Rev. 2013;33(3):484–99. https://doi.org/10.1016/j.cpr.2013.01.010.

    Article  PubMed  Google Scholar 

  9. Sholomskas DE, Carroll KM. One small step for manuals: computer-assisted training in twelve-step facilitation. J Stud Alcohol. 2006;67(6):939–45. https://doi.org/10.15288/jsa.2006.67.939.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Dimeff LA, Koerner K, Woodcock EA, Beadnell B, Brown MZ, Skutch JM, et al. Which training method works best? A randomized controlled trial comparing three methods of training clinicians in dialectical behavior therapy skills. Behav Res Ther. 2009;47(11):921–30. https://doi.org/10.1016/j.brat.2009.07.011.

    Article  PubMed  Google Scholar 

  11. Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5(1):69. https://doi.org/10.1186/1748-5908-5-69.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Colquhoun HL, Levac D, O’Brien KK, Straus S, Tricco AC, Perrier L, et al. Scoping reviews: time for clarity in definition, methods, and reporting. J Clin Epidemiol. 2014;67(12):1291–4. https://doi.org/10.1016/j.jclinepi.2014.03.013.

    Article  PubMed  Google Scholar 

  13. Armstrong R, Hall BJ, Doyle J, Waters E. Scoping the scope’of a cochrane review. J Public Health. 2011;33(1):147–50. https://doi.org/10.1093/pubmed/fdr015.

    Article  Google Scholar 

  14. Kühne F, Maas J, Wiesenthal S, Weck F. Supervision in der Verhaltenstherapie. Ein Scoping Review zur Identifikation von Forschungszielen. Z Klin Psychol Psychother. 2017;46(2):73–82. https://doi.org/10.1026/1616-3443/a000414.

    Article  Google Scholar 

  15. Moher D, Liberati A, Tetzlaff J, Altman DG, The PG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Dogherty EJ, Estabrooks CA. Why do barriers and facilitators matter? In: Richards DA, Hallberg IR, editors. Complex interventions in health: an overview of research methods. London, UK: Routledge; 2015. p. 273–81.

    Google Scholar 

  17. Higgins JPT & Green S (Eds.). Cochrane handbook for systematic reviews of interventions. Version 5.1.0 [updated March 2011]: The Cochrane Collaboration, 2011. Available from: www.handbook.cochrane.org.

  18. Mayring P. Qualitative inhaltsanalyse. Grundlagen und Techniken, 12., Neuausgabe, 12., vollständig überarbeitete und aktualisierte Aufl. Beltz Pädagogik. 2015.

  19. Lang CS, Hahn JA. BLAST model: an innovative approach to prepare second-degree accelerated BSN students for inpatient psychiatric clinical experiences. J Psychosoc Nurs Ment Health Serv. 2013;51(3):38–45. https://doi.org/10.3928/02793695-20130130-01.

    Article  PubMed  Google Scholar 

  20. Masters KS, Beacham AO, Clement LR. Use of a standardized patient protocol to assess clinical competency: the University of Colorado Denver Comprehensive Clinical Competency Examination. Train Educ Prof Psychol. 2015;9(2):170–4. https://doi.org/10.1037/tep0000079.

    Article  Google Scholar 

  21. Krahn LE, Sutor B, Bostwick JM. Conveying emotional realism: a challenge to using standardized patients. Acad Med. 2001;76(3):216–7. https://doi.org/10.1097/00001888-200103000-00003.

    Article  CAS  PubMed  Google Scholar 

  22. Abramowitz MZ, Rollhaus ED. The case against standardized patients' simulating psychotic disorders. Acad Psychiatry. 2013;37(6):444. https://doi.org/10.1007/BF03340093.

    Article  PubMed  Google Scholar 

  23. Milbourne GB. A psychological consultation model for Ukraine: integrating mental health into primary care through standardized patient training. US: ProQuest Information & Learning; 2006.

    Google Scholar 

  24. Edwards KS, Parish SJ, Rosen RC, Garvert DW, Spangler SL, Ruzek JI. A standardized patient methodology to assess cognitive–behavioral therapy (CBT) skills performance: development and testing in a randomized controlled trial of web-based training. Train Educ Prof Psychol. 2016;10(3):149–56. https://doi.org/10.1037/tep0000119.

    Article  Google Scholar 

  25. Glenton C, Colvin CJ, Carlsen B, Swartz A, Lewin S, Noyes J, et al. Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: qualitative evidence synthesis. Cochrane Database Syst Rev. 2013;10(10).

  26. Brenner AM. Uses and limitations of simulated patients in psychiatric education. Acad Psychiatry. 2009;33(2):112–9. https://doi.org/10.1176/appi.ap.33.2.112.

    Article  PubMed  Google Scholar 

  27. Ellis DM, Brou R, King R, Tusa P. Psychiatric simulation on a budget. Clin Simul Nurs. 2015;11(11):469–71. https://doi.org/10.1016/j.ecns.2015.09.002.

    Article  Google Scholar 

  28. Rockenbauch K, Fabry G, Petersen C, Daig I, Philipp S. Der einsatz von schauspielpatienten in der medizinischen psychologie—Allgemeiner überblick und konkrete umsetzungsbeispiele. Simulated patients in medical education programs: review and examples of implementation. Z Med Psychol. 2008;17(4):185–92.

    Google Scholar 

  29. Jarosinski JM, Webster DA. Acting with a purpose: the lived experience of actors in the role of standardized patients portraying mental illness. Clin Simul Nurs. 2016;12(12):539–45. https://doi.org/10.1016/j.ecns.2016.08.005.

    Article  Google Scholar 

  30. O’Connor FW, Albert ML, Thomas MD. Incorporating standardized patients into a psychosocial nurse practitioner program. Arch Psychiatr Nurs. 1999;13(5):240–7. https://doi.org/10.1016/S0883-9417(99)80034-X.

    Article  PubMed  Google Scholar 

  31. Schäfer M, Georg W, Mühlinghaus I, Fröhmel A, Rolle D, Pruskil S, et al. Neue Lehr-und Prüfungsformen im Fach Psychiatrie. Nervenarzt. 2007;78(3):283–93. https://doi.org/10.1007/s00115-005-2048-9.

    Article  PubMed  Google Scholar 

  32. Philipp S, Merten K. Erfahrungen mit Standardisierten Patienten im neuen Lehrkonzept zur Vermittlung kommunikativer Kompetenzen im Fach Medizinische Psychologie—das Jenaer Modell. Experiences with the Jena concept, with standardized patients and whose evaluation. Z Med Psychol. 2006;15(1):11–9.

    Google Scholar 

  33. Festa LM, Baliko B, Mangiafico T, Jarosinski J. Maximizing learning outcomes by videotaping nursing students’ interactions with a standardized patient. J Psychosoc Nurs Ment Health Serv. 2000;38(5):37–44.

    CAS  PubMed  Google Scholar 

  34. Alexander L, Dearsley A. Using standardized patients in an undergraduate mental health simulation: a pilot study. Int J Ment Health. 2013;42(2–3):149–64. https://doi.org/10.2753/IMH0020-7411420209.

    Article  Google Scholar 

  35. Choi YJ. Exploring experiences of psychiatric nursing simulations using standardized patients for undergraduate students. Asian Nurs Res. 2012;6(3):91–5. https://doi.org/10.1016/j.anr.2012.07.001.

    Article  Google Scholar 

  36. Melluish S, Crossley J, Tweed A. An evaluation of the use of simulated patient role-plays in the teaching and assessment of clinical consultation skills in clinical psychologists' training. Psychol Learn Teach. 2007;6(2):104–13. https://doi.org/10.2304/plat.2007.6.2.104.

    Article  Google Scholar 

  37. Davis S, Josephsen J, Macy R. Implementation of mental health simulations: challenges and lessons learned. Clin Simul Nurs. 2013;9(5):E157–E62. https://doi.org/10.1016/j.ecns.2011.11.011.

    Article  Google Scholar 

  38. Hodges B, Regehr G, Hanson M, McNaughton N. An objective structured clinical examination for evaluating psychiatric clinical clerks. Acad Med. 1997;72(8):715–21. https://doi.org/10.1097/00001888-199708000-00019.

    Article  CAS  PubMed  Google Scholar 

  39. Abdool PS, Nirula L, Bonato S, Rajji TK, Silver IL. Simulation in undergraduate psychiatry: exploring the depth of learner engagement. Acad Psychiatry. 2017;41(2):251–61. https://doi.org/10.1007/s40596-016-0633-9.

    Article  PubMed  Google Scholar 

  40. Lane C, Rollnick S. The use of simulated patients and role-play in communication skills training: a review of the literature to august 2005. Patient Educ Couns. 2007;67(1–2):13–20. https://doi.org/10.1016/j.pec.2007.02.011.

    Article  PubMed  Google Scholar 

  41. Alfes CM. Nursing alumni as standardized patients: an untapped resource. Clin Simul Nurs. 2013;9(12):E593–E7. https://doi.org/10.1016/j.ecns.2013.05.001.

    Article  Google Scholar 

  42. Bögels SM. A structured-training approach to teaching diagnostic interviewing. Teach Psychol. 1994;21(3):144–50. https://doi.org/10.1207/s15328023top2103_3.

    Article  Google Scholar 

  43. Standardized Patients CYJ. For Korean psychiatric nursing student simulations. Clin Simul Nurs. 2013;9(9):E385–E92.

    Article  Google Scholar 

  44. Doering S, Schneider G, Burgmer M, Sensmeier J, Schrewe FB, Friederichs H, et al. Evaluation of the clinical course “psychosomatics and psychotherapy” employing standardized patients. Z Psychosom Med Psychother. 2010;56(4):385–98. https://doi.org/10.13109/zptm.2010.56.4.385.

    Article  PubMed  Google Scholar 

  45. Eckel J, Merod R, Vogel H, Neuderth S. Einsatz von Schauspielpatienten in den psych-'Fächern des medizinstudiums—Verwendungsmöglicheiten in der Psychotherapieausbildung? use of standardized patients in the psycho-social subjects of medical studies—applicability of standardized patients in postgraduate psychotherapy training curricula? PPmP: Psychotherapie Psychosomatik Medizinische Psychologie. 2014;64(1):5–11.

    Google Scholar 

  46. Jacobs AC, van Jaarsveldt DE. ‘The character rests heavily within me’: Drama students as standardized patients in mental health nursing education. J Psychiatr Ment Health Nurs. 2016;23(3–4):198–206. https://doi.org/10.1111/jpm.12302.

    Article  CAS  PubMed  Google Scholar 

  47. Krahn LE, Bostwick JM, Sutor B, Olsen MW. The challenge of empathy: a pilot study of the use of standardized patients to teach introductory psychopathology to medical students. Acad Psychiatry. 2002;26(1):26–30. https://doi.org/10.1176/appi.ap.26.1.26.

    Article  PubMed  Google Scholar 

  48. Lewis JM. On the use of standardized patients. Acad Psychiatry. 2002;26(3):193–6. https://doi.org/10.1176/appi.ap.26.3.193.

    Article  PubMed  Google Scholar 

  49. Maharajh HD, Baboolal NS. The use of standardized patients (SP) in assessing clinical performance in postgraduate psychiatry: a preliminary report from the university of the West Indies. Int J Ment Health. 2005;2(1):1–5.

    Google Scholar 

  50. Marwaha S. Objective structured clinical examinations (OSCEs), psychiatry and the clinical assessment of skills and competencies (CASC) same evidence, different judgement. BMC Psychiatry. 2011;11:6.

    Article  Google Scholar 

  51. McNaughton N, Ravitz P, Wadell A, Hodges BD. Psychiatric education and simulation: a review of the literature. Can J Psychiat-Rev Can Psychiat. 2008;53(2):85–93. https://doi.org/10.1177/070674370805300203.

    Article  Google Scholar 

  52. McNaughton N, Tiberius R, Hodges B. Effects of portraying psychologically and emotionally complex standardized patient roles. Teach Learn Med. 1999;11(3):135–41. https://doi.org/10.1207/S15328015TL110303.

    Article  Google Scholar 

  53. Partschefeld E, Strauß B, Geyer M, Philipp S. Simulationspatienten in der psychotherapieausbildung: evaluation eines lehrkonzepts zur entwicklung therapeutischer fertigkeiten. Simulated patients in psychotherapy training. Evaluation of a teaching concept for development of therapeutic skills. Psychotherapeut. 2013;58(5):438–45. https://doi.org/10.1007/s00278-013-1002-8.

    Article  Google Scholar 

  54. Piette A, Muchirahondo F, Mangezi W, Iversen A, Cowan F, Dube M, et al. Simulation-based learning in psychiatry for undergraduates at the University of Zimbabwe medical school. BMC Med Educ. 2015;15:8.

    Article  Google Scholar 

  55. Sadeghi M, Tagliva A, Mirsepassi G, Hassanzadeh M. How do examiners and examinees think about role-playing of standardized patients in an OSCE setting? Acad Psychiatry. 2007;31(5):358–62. https://doi.org/10.1176/appi.ap.31.5.358.

    Article  PubMed  Google Scholar 

  56. Seager P. Simulated patients. Psychiatr Bull. 2007;31(8):316. https://doi.org/10.1192/pb.31.8.316.

    Article  Google Scholar 

  57. Webster D, Seldomridge L, Rockelli L. Making it real: using standardized patients to bring case studies to life. J Psychosoc Nurs Ment Health Serv. 2012;50(5):36–41. https://doi.org/10.3928/02793695-20120410-06.

    Article  PubMed  Google Scholar 

  58. Wündrich MS, Nissen C, Feige B, Philipsen AS, Voderholzer U. Portrayal of psychiatric disorders: are simulated patients authentic? Acad Psychiatry. 2012;36(6):501–2. https://doi.org/10.1176/appi.ap.11090163.

    Article  Google Scholar 

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Acknowledgements

We would like to thank Marie-Luise Lux for initializing the network graph and Dr. Brian Bloch for his comprehensive editing of the English.

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  1. University of Potsdam, Potsdam, Germany

    Franziska Kühne, Destina Sevde Ay, Mara Jasmin Otterbeck & Florian Weck

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  1. Franziska Kühne
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Correspondence to Franziska Kühne.

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Kühne, F., Ay, D.S., Otterbeck, M.J. et al. Standardized Patients in Clinical Psychology and Psychotherapy: a Scoping Review of Barriers and Facilitators for Implementation. Acad Psychiatry 42, 773–781 (2018). https://doi.org/10.1007/s40596-018-0886-6

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