Managing Difficult Patient Encounters: Simulation Design, Findings, and Call to Action
Objective. To implement and evaluate a difficult patient encounter skills laboratory simulation emphasizing students’ self-assessed communication abilities and affective skills. Methods. Twelve simulation scenarios represented difficult patient encounters in a variety of practice settings. All students completed a self-assessment of their ability to communicate during difficult patient encounters before and after the simulations and wrote a guided reflection afterward. The impact of the simulation was evaluated through quantitative and qualitative methodology. Three student cohorts were analyzed for significance of change in self-perceived communication abilities. Thematic analysis of the qualitative reflection responses was performed. Results. Over three years, three independent student cohorts of third-year professional students participated in the simulations (n = 236). Variability between cohorts was not statistically significant. Students self-rated their ability to communicate on a 0-100 scale. Mean self-rating of ability prior to the simulation was 57.7 and after was 79.2 (SD 15.9, 15.2). This mean difference of 21.5 shows an approximate 20% increase in self-rated ability. Qualitative analysis revealed that students found the simulation revealed areas needing further development, promoting self-awareness. Students discussed that a safe, formative environment contributed to their growth and was relevant to their future professional practice. Conclusion. This simulation fills a gap in skills-based education, addresses the affective domain of ACPE Standards, transfers easily to schools and colleges of pharmacy, and demonstrates significant quantitative and qualitative findings. This supports a call to action for pharmacy educators to provide purposeful opportunities for students to practice communicating with patients during difficult encounters.