title: Evaluation of a framework for case development and simulated patient training for complex procedures.
abstract: BACKGROUND
  Simulation for training and assessing clinicians is increasing but often overlooks the patient's perspective. In this paper, actors are trained to portray patients undergoing operations under local anesthetic within a high-fidelity simulated operating theater (SOT). There are few published accounts of approaches to case development and simulated patient (SP) training. We assess the feasibility of SPs playing complex surgical roles and evaluate a three-phased framework for case development and SP training.
  
  
  METHODS
  We developed two patient roles for carotid endarterectomy (CEA) under local anesthesia. In all cases, the conscious patient interacted with the surgical team throughout the procedure. SPs were trained to simulate routine and crisis situations, using our framework. After consulting with each SP, surgeons "performed" a CEA upon a model attached to the SP. Evaluation of the framework used interviews, observations, and written evaluations with SPs, surgeons, and the project team. Descriptive statistics summarize surgeons' ratings of realism and qualitative data are analyzed thematically.
  
  
  RESULTS
  In all, 46 simulations were conducted with 23 surgeons and three SPs. Real patient interview transcripts provided SPs with authentic information. The SP framework was easy to use, SP training was successful and surgeons' rated SP realism very highly. SPs valued guidance from the SOT control room using an audiolink.
  
  
  CONCLUSIONS
  Actors can be trained to portray patients undergoing complex procedures. Our framework for case development and SP training was effective in creating realistic roles. Future studies could evaluate this framework for additional procedures.
authors.affiliation: Regional Vascular Unit, St. Mary's Hospital, London, United Kingdom.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Black
authors.forename: Debra F
authors.initials: DF
authors.lastname: Nestel
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Horrocks
authors.forename: Rachael H
authors.initials: RH
authors.lastname: Harrison
authors.forename: Norma
authors.initials: N
authors.lastname: Jones
authors.forename: Cordula M
authors.initials: CM
authors.lastname: Wetzel
authors.forename: John H N
authors.initials: JH
authors.lastname: Wolfe
authors.forename: Roger L
authors.initials: RL
authors.lastname: Kneebone
authors.forename: Ara W
authors.initials: AW
authors.lastname: Darzi
mesh_terms: D016022:Case-Control Studies; D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods*; D003198:Computer Simulation; D016894:Endarterectomy, Carotid / Q000379:methods*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D009873:Operating Rooms / Q000458:organization & administration; D016544:Patient Simulation