Simulating the longitudinal doctor-patient relationship: experiences of simulated patients in successive consultations.

CONTEXT: The use of simulated patients (SPs) in teaching communication and practical skills at medical schools is mostly limited to single-case use: a student has 1 consultation with an SP and receives feedback afterwards. Very little literature is available that describes consecutive consultations between the same student and SP. In this study, we explored the experiences of SPs in a new, longitudinal SP programme in which SPs met the same Year 3 students ('GP') in 4 consecutive consultations during the year. The SPs suffered from a chronic disease in their patient roles.

METHODS: Four focus group discussions were conducted with 23 SPs (8 men, 15 women; average age 60.9 years) who had performed in the new programme. Discussions were semi-structured and followed a pre-established interview guide. Data were categorised by 3 independent raters.

RESULTS: The SPs described the development of a more familiar relationship with students under the new programme, compared with single-case consultations. They developed specific expectations of students' performances. The SPs enjoyed participating in the programme and felt it was more realistic than single-case consultations. Feedback changed and became more detailed as SPs were able to compare consultations; students' response to feedback could be experienced during the next consultation.

DISCUSSION: Practising the development of a realistic, longitudinal doctor-patient relationship may help prepare students for real practice. Longitudinal feedback is now possible; it may be of higher quality and of benefit to SPs as well. These findings suggest new possibilities for SP-based education and research. Future studies should focus on quantitative analysis and students' perspectives.