A Handbook for Teaching and Learning in Higher Education Enhancing academic and Practice

436 ❘
Teaching in the disciplines
Stage 4
The learner now carries out the skill under close supervision, describing each step before
it is taken (adapted from Peyton, 1998: 174–177).
This model may be expanded or reduced depending on the background skills of the
learner. Digital/video recording may be used in stages 1 and 2. As in all teaching, the
learner should be given constructive feedback and allowed time for self-appraisal,
reflection and practice of the skills. Within the medical clinical skills centre, particularly
in SDL, we have found the use of itemised checklists useful adjuncts to learning,
particularly for the novice.
Simulation
Role play is an extremely useful teaching and learning tool. Students are able to investigate,
practise and explore all sides of a clinical interaction through their adopted roles;
these advantages may need to be pointed out to the student. Criticisms of this technique
are usually a product of poorly prepared sessions. Clear roles, with demonstration by
teachers, or using preprepared videos/DVDs, are useful ways of directing student
learning. Providing a supportive but quite formal environment during the sessions also
encourages students to maintain their role. Prewarned, with adequate debriefing and
reflection, the students usually find this a useful technique.
Simulated patients (SPs) were first used in the 1960s; their use in dental and medical
undergraduate and postgraduate education has expanded rapidly since the 1980s
(Barrows, 1993). They may be used instead of real patients in difficult clinical scenarios
(e.g. breaking bad news and in the reproduction of acute problems that would not be
assessable in traditional clinical examinations). In North America, and more recently in
the UK, trained real patients (patient as educator programmes) are increasingly used (e.g.
in the UK at the Sheffield University and King’s College London – see references),
including in training and assessing intimate clinical procedures such as vaginal speculum
or breast examination. In dentistry, SPs are principally used for communication skills
training and in assessment (Davenport et al., 1998).
Simulation of clinical scenarios has become increasingly sophisticated. Within the
safety of this setting, students can express themselves more freely while investigating
the patient perspective through the eyes of the actors. The teacher must provide a clear
brief for both actor and student, including detailed background scripts for the actors (see
Case study 2 in Chapter 2). It is important that students feel reasonably comfortable in
their given role and that the scenario is within their expected capabilities. Clear student
learning objectives/outcomes are required at all stages, but excessive demands and
expectations are often counterproductive. The simulation of clinical procedures and
communications skills at the same time, in settings as near to the real as possible, is of
increasing interest; this type of simulation also adds to realism/complexity in assessment