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PHD - Doctor of Philosophy




The purpose of this study was to explore the experiences of simulated patients (SPs) with the process of providing verbal feedback for first-year medical students and residents during formative simulation activities. Feedback to medical trainees provides a valuable learning context, effecting communication and interpersonal skills which impact healthcare outcomes and patient safety. This qualitative research study used a grounded theory approach based on data from semi-structured interviews with 17 SPs who were casual employees of a standardized patient program for a large academic medical center in the mid-Atlantic region of the USA. The study analyzed what participants said about their motivations for working as an SP; how they gained feedback skills; transitioning from the patient role to providing feedback; preparing and delivering feedback; and similarities and differences of providing feedback for first-year medical students and residents. The researcher constructed an interpretive substantive theory grounded in the data: Preparing and delivering verbal feedback for formative simulated patient medical education activities are complex processes: (a) in which the SPs take on the roles of patient, evaluator, and educator; (b) that are influenced by a dynamic interplay of the activity, the SP, and the trainee; (c) which require SPs to have a range of skills, learned informally via work and life experiences and/or formally via training; and (d) which SPs perform, contributing to medical education. Two theoretical models describing the feedback process are presented. One illustrates the influencing conditions, stages of SP feedback, organizational context, SP strategies for feedback, actions and interactions, and consequences of the process. The second model presents the stages of the feedback preparation and delivery process, the tasks the SPs are engaged in at each stage, and the conditional factors associated with the activities, SPs, and trainees. Recommendations for medical education SP activity design include: (a) integrating the clinical goals with the dynamic interactions of SPs and trainees; and (b) incorporating learner-centered feedback training modules for SPs.



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