Title: Online Simulated Patient Interaction and Assessment (OSPIA) platform
Introduction
Medical students need to develop communication skills for working with patients. Whilst real patients in hospitals present opportunities for developing these skills there are also some obvious problems when students are just starting out. Students are nervous and unfamiliar with the environment and have rudimentary skills; patients are ill, staff are busy and hospitals provide unpredictable learning opportunities.
To meet those challenges, a Simulated Patient Program (SPP) delivered on campus was introduced into the Medicine program in 2015. Community volunteers come to campus to play a patient role and students get reliable, scheduled opportunities to work one-on-one with a patient and receive feedback from the patient, peers and tutors. Assessments can be completed and enter the student portfolio, along with reflective tasks such that students consider how to continue to develop their skills in future patient interactions.
Whilst the campus-based SPP is very valuable, the opportunity to work with willing volunteers can obviously be extended to the online environment, especially when considering skills, like communication, that can be learned and assessed effectively in that environment. Furthermore, online scheduling means both student and Simulated Patient (SP) can participate when it suits them, with no need for travel to a particular location. On this basis, in 2016, the OSPIA platform was launched. Landing pages provide tabs covering training and FAQs, plus an online calendar that allows SPs to enter their availability and for students to select their appointment, which is confirmed by SMS/email, with no administrative input. At the appointment time, both participants enter the platform and start a video-telephony interaction, with students having completed a pre-task self-assessment of their skills. The interview takes place, during which SPs can provide both written and emoji style feedback (directly related to the assessment criteria) which is timestamped to the video (not seen in real time). After the interaction, participants complete post-activity tasks: students self-assess using the same assessment form being completed by the SP and elect if the interaction is for practice or to enter their formal portfolio record; SPs assess the students and this is then automatically shared with the student whom is now prompted to complete their reflective task.
In March 2020, with the onset of COVID lockdowns and all relevant constraints and restrictions, both hospital placements and the SPP were suddenly not available. OSPIA became the only venue in which junior medical students could continue their clinical training. Furthermore, with lockdown many people who previously volunteered in face-to-face activities, were forced inside – including our own campus volunteers. Consequently, with some gentle nudging our online volunteers force grew threefold and we were well placed to substantially increase the number of opportunities for students to develop their communication skills. Even after lockdown (and with ongoing lockdowns and restrictions persisting in Victoria and Melbourne especially) our SPs remained ever more engaged in our program.
Theoretical Background
OSPIA was based on the underlying technology named EQClinic. We have previously shown the educational benefit when students interact with all aspects of the OSPIA platform:
Liu C, Lim RL, Taylor S, Calvo RA, 2019. Students' behavioural engagement in reviewing their tele-consultation feedback within an online clinical communication skills platform. Computers in Human Behavior. https://doi.org/10.1016/j.chb.2019.01.002
Liu C; Lim RL; McCabe KL; Taylor S; Calvo RA, 2016. A web-based telehealth training platform incorporating automated nonverbal behavior feedback for teaching communication skills to medical students: A randomized crossover study. Journal of Medical Internet Research, vol. 18, http://dx.doi.org/10.2196/jmir.6299, ROS ID: 850134
Liu C, Scott, KM, Lim RL, Taylor S, Calvo RA, 2016. EQClinic: a platform for learning communication skills in clinical consultations. Med Educ Online. 21: doi: 10.3402/meo.v21.31801
Liu, C., Calvo, R. A., Lim, R., & Taylor, S. (2016). EQClinic: A Platform for Improving Medical Students’ Clinical Communication Skills. In X. Yin, J. Geller, Y. Li, R. Zhou, H. Wang, & Y. Zhang (Eds.), Health Information Science (pp. 73–84). Springer International Publishing.
Aims
The aim of our rapid pivot to a dramatically scaled up offering of OSPIA was very simple: to continue, in the only form possible under COVID lockdown and subsequent restrictions, the clinical training of junior medical students involving direct interactions with simulated patients, in order to develop their communication skills.
A further aim was to continue our journey in community engagement and increased participation by finding opportunities in online volunteerism that were more available and appealing under COVID restrictions, thus providing a productive and beneficial volunteering activity for our volunteers, whilst also increasing the availability of authentic and educationally effective ‘patient’ interactions for our students.
Progress / Outcomes / Next steps
In this COVID affected year when educators lost opportunities to interact with their students and medical students worldwide were unable to attend clinical placements and interact with patients, OSPIA was an invaluable part of our teaching that showed its utility, flexibility and scalability at a crucial time. We delivered in excess of 1500 authentic online appointments (a fivefold increase on 2019), for a student group numbering approximately 600, with each interaction lasting about 30 minutes and producing meaningful, actionable feedback, assessments which seamlessly enter the student record and reflective tasks to help students develop these critical skills. Due to the online nature of the platform and the sustainable way in which it was built this was achieved with minimal administrative oversight.
As a result of our ability to continue clinical training thanks to OSPIA, we will conduct the summative assessment of communication skills (in a somewhat modified format) in our end of year clinical examinations. In turn, this means that the doctor training pipeline can continue despite the constraints and restrictions COVID has imposed on our teaching elsewhere.
During this year, we have also built a relationship with Changineers, a social enterprise model IT organisation, that is commercialising a new underlying platform VETME, which will provide us with an updated version of OSPIA, as well as another version which will address training needs in Year 3 and 4 of the Medicine program. We anticipate that authentic, online clinical training will continue to be an important and effective part of UNSW Medicine program for years to come – come pandemic or no.
