First-ever interactive simulation workshops prove popular

The Academy’s first-ever clinical simulation workshops were a sell-out success in New York. Three hands-on sessions provided one-on-one simulation and feedback in “Medication Management,” “Breaking Bad News,” and “The Difficult Patient.”

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A physician (right) practices talking to a patient/actor during the “Breaking Bad News” workshop.

“This was an expansion of the existing AAD simulation program focusing on hands-on skills practice using synthetic skin and cadavers,” said program director Kanade Shinkai, MD, PhD, associate professor of dermatology at the University of California, San Francisco. “Simulation is very robust in undergraduate medical education and we are already seeing it used very successfully for graduate and continuing medical education. This was a pilot program — we only had space for 60 attendees, and tickets sold out almost immediately.”

The simulation program was facilitated by Eastern Virginia Medical School, which has a large and active medical simulation program. Dr. Shinkai and AAD education experts, including Jennifer Thompson and Tracy Farhan, worked with the simulation program to create three realistic cases and train the actors.

Each participant had an individual clinical encounter with as many as three simulated patients. The trained medical actors worked from very detailed scripts. Each encounter was about 20 minutes, Dr. Shinkai said, with about 10 additional minutes for oral feedback. The actors also provided written feedback for each participant.

“Medication Management” featured a young woman who was just starting to use isotretinoin. Like many real patients, she had gathered a significant amount of information and misinformation from friends, family, and the Internet. Some of her questions were a genuine search for information and some were a statement of opinion.

“There are many controversies surrounding isotretinoin, some of them better founded than others,” Dr. Shinkai said. “It is a potent teratogen, and much of the counseling clinicians provide focuses on pregnancy prevention and medically necessary lab monitoring. But the science when it comes to side effects, such as mood/psychiatric disorders and inflammatory bowel disease, is complex. Patients often come armed with strong beliefs or misconceptions about the medication. Our goal was to give participants the opportunity to rise up and serve the patient well by answering her questions with accurate information, with empathy, and with the appropriate bedside manner, and to get feedback on how they counseled her.”

“Breaking Bad News” gave participants an opportunity to practice their skills in giving a patient a new diagnosis of melanoma following a skin biopsy. Delivering this kind of bad news is a standard part of dermatologic practice, Dr. Shinkai said, but the real world rarely provides feedback or suggestions on ways to improve a clinician’s communication skills, especially with such a high-stakes discussion.

“We trained the actor to ask the questions every dermatologist hears, ‘Am I going to die?’ ‘Do I need chemo?’ ‘Does this mean medical visits forever?’ and “What is melanoma?’” she said. “A lot of our participants are board-certified with years of experience. Though clinicians are familiar with the science of melanoma, it is a different skill to discuss this science — including what is, and what is not, known — with a patient. For some, this was probably the first time they were able to counsel a patient and get honest feedback on their medical knowledge, their communication skills, and their empathy.”

“The Difficult Patient” workshop featured a business executive who waited three months for a standard 10-minute appointment. The patient was very determined to have several skin complaints addressed now, today, before going back to work. The problem was that this patient was complaining of hair loss, toenail fungus, and whole body itch without rash, needed a full body mole check, and wanted botulinum toxin maintenance.

“We designed this case so there are no red flags,” Dr. Shinkai said. “It’s a familiar scenario that can be very flustering to physicians and leads to a lot of misunderstandings with our patients. Agenda-setting with patients is a critical skill for dermatologists so you don’t miss anything medically important and also don’t burn out from bending over backwards to accommodate those demanding patients.”

The program for Summer Academy 2016 has not yet been confirmed, so it is too early to know if the simulation program will be expanded. But dermatologists can expect to see simulation in other settings.

“Simulation has become an important aspect of undergraduate, graduate, and postgraduate medical education,” she said. “It behooves us to use this highly effective tool to hone our communication skills to best serve our patients, as well as in the upcoming days of reimbursement based on patient experience and satisfaction.”

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