Model patient: using actors to enhance patient communication skills

Optometrist, academic and AOP Councillor Rakhee Shah (pictured) has been investigating whether actors can be used to enhance the feedback that optometry students receive on their communication with patients. Her research received a silver award at City, University of London’s Health Has Got Talent event. She talks to OT about the aim of the project.

What did this research involve?

Two actors who had been intensively trained on all elements of an eye examination had their eyes examined by two students. The students had all consented to take part in the study. The actors presented for the eye examinations unannounced. Only the clinic receptionists and the clinic lead knew who the actors were. At the end of the eye examination, the actors completed a feedback form detailing all of the questions that were asked, all of the tests that had been performed and some provided some written feedback on the students’ communication. Within this section, the actors commented on whether their reason for the visit was addressed, whether the student introduced themselves as well as other areas of communication such as professionalism, rapport, language and body language.

Student communication is already observed and commented upon by visiting clinical tutors who supervise two students at any one time. We wanted to assess how the feedback provided by actors compared to that shared by visiting clinical tutors.

We found that while students felt they valued the feedback that is provided by the visiting clinical tutors on their clinical techniques and skills, the actors generally provided more detailed, subjective feedback around students’ communication.

How unique is this approach?

As far as I’m aware there is no other optometry school that has done anything similar to this in England. Most universities have people with different abnormal ocular conditions who sit as patients during various clinics. These patients are not actors or simulated patients; they are demonstration patients. There has been one other study published where actors were used in the US, but the students knew the actors were coming in and their encounters were being recorded. The students viewed the recordings at a later date and reflected back on their communication skills. I think this particular approach is quite new.

How could actors enhance the education of optometry students in the future?

I would like to use this approach on a larger scale and see what the impact of it is. If we look at how optometry has evolved up until now, it is becoming more and more crucial for optometrists to be able to relay information to their patients in an effective and empathetic manner. For this to happen seamlessly, good communication is key.

The good thing about using actors is that you can modify them to simulate a range of conditions. Optometry students have to see 18 patients while they are at university. They might not necessarily come across a patient who, for example, has recently experienced flashing lights. When they experience this in pre-reg year for the first time, there may be slight panic. Using actors as simulated or standardised patient might be a way to get around those scenarios that are difficult to teach and one might not experience on a regular basis.

I think there is definitely a place for using actors in education but the only snag is the cost. One way to get around this is to consider using students from other medical disciplines to sit as patients for optometry students and then the optometry students sitting as patients for them in return. This would encourage the students to build inter-disciplinary relationships. This could work as a simulated patient experience instead of having optometry students provide feedback on each other. This way the patient is unfamiliar with the language that optometrists use. This might be something to introduce very early on and then perhaps think about using actors in the second and third year of study.