Martin Andrés, Weller Indigo, Amsalem Doron, Adigun Ayodola, Jaarsma Debbie, Duvivier Robbert, de Carvalho-Filho Marco Antonio
Child Study Center, Yale School of Medicine, New Haven, CT, United States.
Standardized Patient Program, Teaching and Learning Center, Yale School of Medicine, New Haven, CT, United States.
Front Psychiatry. 2021 Jan 8;11:616239. doi: 10.3389/fpsyt.2020.616239. eCollection 2020.
Co-constructive patient simulation (CCPS) is a novel medical education approach that provides a participatory and emotionally supportive alternative to traditional supervision and training. CCPS can adapt iteratively and in real time to emergent vicissitudes and challenges faced by clinicians. We describe the first implementation of CCPS in psychiatry. We co-developed clinical scripts together with child and adolescent psychiatry senior fellows and professional actors with experience performing as simulated patients (SPs). We conducted the simulation sessions with interviewers blind to the content of case scenarios enacted by the SPs. Each hour-long simulation was followed by an hour-long debriefing session with all participants. We recorded and transcribed case preparation, simulation interactions, and debriefing sessions, and analyzed anonymized transcripts through qualitative analysis within a constructivist framework, aided by NVivo software. Each of six CCPS sessions was attended by a median of 13 participants (range, 11-14). The first three sessions were conducted in person; the last three, which took place during the COVID-19 pandemic, via synchronized videoconferencing. Each of the sessions centered on clinically challenging and affectively charged situations informed by trainees' prior experiences. Through iterative thematic analysis we derived an alliterating "9R" model centered on three types of Reflection: (a) action/"while doing" (Regulate, Relate, and Reason); (b) action/"having done" (Realities, Restraints, and Relationships); and (c) action/"will be doing" (with opportunities for Repair and Reaffirmation). CCPS is an experiential approach that fosters autonomous, meaningful, and individually tailored learning opportunities. CCPS and the 9R model for reflective practice can be effectively applied to psychiatry and have the potential to contribute uniquely to the educational needs of its trainees and practitioners.
共同建构式患者模拟（CCPS）是一种新颖的医学教育方法，它为传统的监督和培训提供了一种参与性且情感上支持性的替代方式。CCPS可以实时迭代地适应临床医生面临的突发变化和挑战。我们描述了CCPS在精神病学中的首次应用。我们与儿童和青少年精神病学高级研究员以及有扮演模拟患者（SP）经验的专业演员共同开发临床脚本。我们在面试官对SP所演绎的病例场景内容不知情的情况下进行模拟 sessions。每次长达一小时的模拟之后，都会与所有参与者进行长达一小时的汇报总结环节。我们记录并转录了病例准备、模拟互动和汇报总结环节，并在NVivo软件的辅助下，通过建构主义框架内的定性分析对匿名转录本进行了分析。六个CCPS sessions的每次 session 平均有13名参与者（范围为11 - 14名）。前三场session是面对面进行的；最后三场在新冠疫情期间通过同步视频会议进行。每个session都围绕着由学员先前经验所引发的具有临床挑战性和情感冲击力的情况展开。通过迭代主题分析，我们得出了一个以三种反思类型为中心的押韵“9R”模型：（a）行动/“在做的过程中”（调节、关联和推理）；（b）行动/“做完之后”（现实、限制和关系）；以及（c）行动/“将要做”（有修复和重申的机会）。CCPS是一种体验式方法，可促进自主、有意义且个性化定制的学习机会。CCPS以及反思性实践的9R模型可以有效地应用于精神病学，并有可能为其学员和从业者的教育需求做出独特贡献。
