I guess I have my mum to thank for my interest in the arts and health (thanks mum!) She’s had various health problems over the years, which has given me an insight into many things and a vested interest in the NHS. My mum also worked as a Simulated Patient (SP) with North West Spanner, an agit-prop theatre company who moved into medical education. She later went on to work at Hope Hospital in Manchester, and all over the country.
I watched my mum for many years. I first worked as an SP myself when I was just 16. Since then the world of simulation has changed a lot. Despite the changes, much of my work still draws on the basic principles I learnt back then. So here are some of my observations and reflections on simulation then and now…
What is a Simulated Patient (SP)?
SPs are essentially specialist role players. Traditionally SPs take on the role of a patient so that health professionals or students can practice their communication skills. The idea behind simulation is that it creates a safe spaces for practice, reflection, feedback, and assessment.
How is simulation different to role play?
I don’t think there is a definitive answer to this. However, in my opinion, there are a couple of key differences. During a simulation, at least one person is being themselves. For example, in a doctor / patient conversation, the SP is role playing but the doctor is doing what they would normally do in practice. The communication between the two people is real, therefore the SP can provide authentic feedback.
There are of course other techniques (for example Forum Theatre or role play) where people do pretend to be someone else. There are definitely benefits to stepping into someone else’s shoes, but the aim is slightly different.
How have things changed?
In the past, SPs were generally professional actors. Many actors still work as SPs now. However much work has been done to bring the voice of real patients and carers to the world of simulation. This has mirrored the growth of Patient and Public Involvement (PPI) more generally within health education and research. I guess this idea of ‘real’ patients vs actors is contentious, as we are all patients at some point in our lives. The key thing for me is that SPs are not characters created solely by health professionals. SPs are not sophisticated audio-visual aids. They are real people who can use their life experiences to inform both roles and feedback.
You now see people from non-acting backgrounds getting involved in a variety of ways. There are too many people doing good work in this area to mention them all here. If you’re interested in knowing more, then I would look up Penny Morris at the London Professional Support Unit or the Comm Skills team at the Leeds Institute of Medical Education.
I want to be clear that I’m not trying to put professional actors out of work here! There are many aspects of my actor training which have helped me to be an SP and to train others to do the same. However it’s a specific approach to acting where you draw on aspects of your own life to inform a role and where the learning of those around you is more important than the outward portrayal of a character.
The other change I’ve noticed is the increasing use of simulation outside of education. In my own work I’ve taken the basic SP method and adapted it for use in a variety of contexts. For example,
- Public dialogue events which bring together people to explore health issues from different perspectives (Thanks to Hament Patel from Organisation Change Practitioners for support with this work). For an example of this work see the Participation Compass website.
- Facilitating public involvement in the interpretation of research data.
- Exploring clinical trial design and recruitment.
Professor Roger Kneebone has also done some really innovative work in this area. For example, Hybrid Simulation (the combination of actors with inanimate models to create realistic clinical encounters) and the ‘The Time Travelling Operating Theatre’ project.
I’d love to know what else is happening out there in the world of simulation! Get in touch or leave a comment. This is my first proper post so I would value any feedback.