Learning patient-centredness with simulated/standardized patients: A realist review: BEME Guide No. 68

Given the positive outcomes of patient-centred care on health outcomes, future doctors should learn how to deliver patient-centred care. The literature describes a wide variety of educational interventions with standardized patients (SPs) that focus on learning patient-centredness. However, it is unclear which mechanisms are responsible for learning patient-centredness when applying educational interventions with SPs. This study aims to clarify how healthcare learners and professionals learn patient-centredness through interventions involving SPs in different healthcare educational contexts. A realist approach was used to focus on what works, for whom, in what circumstances, in what respect and why. Databases were searched through 2019. Nineteen papers were included for analysis. Through inductive and deductive coding, CIC’MO configurations were identified to build partial program theories. These CIC’MOs describe how Interventions with SPs change the Context (C→C’) such that Mechanisms (M) are triggered that are expected to foster patient-centredness as Outcome. Interventions with SPs create three contexts which are ‘a safe learning environment,’ ‘reflective practice,’ and ‘enabling people to learn together.’ These contexts trigger the following seven mechanisms: feeling confident, feeling a sense of comfort, feeling safe, self-reflection, awareness, comparing & contrasting perspectives, combining and broadening perspectives. A tentative final program theory with mechanisms belonging to three main learning components (cognitive, regulative metacognitive and affective) is proposed: Interventions with SPs create a safe learning environment (C’) in which learners gain feelings of confidence, comfort and safety (affective M). This safe learning environment enables two other mutual related contexts in which learners learn together (C’), through comparing & contrasting, combining and broadening their perspectives (cognitive M) and in which reflective practice (C’) facilitates self-reflection and awareness (metacognitive M) in order to learn patient-centeredness. These insights offer educators ways to deliberately use interventions with SPs that trigger the described mechanisms for learning patient-centredness.

鉴于以患者为中心的护理对健康结果产生的积极影响，未来的医生应当掌握提供以患者为中心的护理的技能。文献中描述了多种涉及标准化患者（SPs）的教育干预措施，这些措施旨在培养患者的中心意识。然而，当采用标准化患者进行的教育干预时，哪些机制负责培养患者的中心意识尚不明确。本研究旨在阐明医疗学习者和专业人士如何通过涉及标准化患者在不同医疗教育情境下的干预措施来学习患者的中心意识。本研究采用现实主义方法，聚焦于哪些因素、针对哪些人群、在何种情境下、在何种程度上以及为何能够发挥作用。数据库检索截止至2019年。共纳入19篇论文进行分析。通过归纳和演绎编码，识别出CIC’MO配置以构建部分程序理论。这些CIC’MOs描述了标准化患者干预措施如何改变情境（C→C’），从而触发机制（M），这些机制预计将促进以患者为中心的结果。标准化患者干预措施创造了三个情境，即‘一个安全的学习环境’、‘反思性实践’以及‘促进人们共同学习’。这些情境引发了以下七个机制：自信感、舒适感、安全感、自我反思、意识、比较与对比观点、结合与拓展观点。提出了一种假设性的最终程序理论，其中包含属于三个主要学习成分（认知、调节性元认知和情感）的机制：标准化患者干预措施创建了一个安全的学习环境（C’），其中学习者获得自信、舒适和安全感（情感M）。这个安全的学习环境使学习者能够在两个相互关联的情境中共同学习（C’），通过比较与对比、结合与拓展他们的观点（认知M），并在反思性实践中（C’）促进自我反思和意识（元认知M），以学习以患者为中心的护理。这些洞见为教育者提供了利用标准化患者干预措施来有意触发描述的机制，以促进学习患者的中心意识的方法。