Some neurological impairments such as spasticity or ataxia cannot be simulated. To properly learn how to be and act as a physiotherapist with people with neurological impairments, lecturers from Haute Ecole de Santé Vaud (HESAV) opted for a new pedagogical framework: to resort to real patient to take on the role of patients instructor (PI), sometimes called real simulated patients (Bokken et al., 2010; Cleland et al., 2009). In this situation, real patients put their experiential knowledge at the service of the learner (Pageau et al., 2021). PI should be recruited among expert patients. They have a good knowledge of their disease and an excellent perception of the quality of the physical examination and the physiotherapeutic treatment (Demaurex & Vu, 2013). The objective of the inclusion of PI was to create a pedagogical framework that promotes learning while guaranteeing an authenticity valued by the students (Bokken et al., 2010). The participation of real patients is known to improve their sense of responsibility, professional identity and empathy (Bokken et al., 2010). To overcome some limitations known in teaching with real patient (Bokken et al., 2010), the purpose of the framework chosen at HESAV was to strengthen the PI’s knowledge and to train them to give constructive feedbacks.
The recruiting of expert patients in neurology was made amongst the lecturers’ patient networks. After a presentation of the program and obtaining a minimum score of 27 on the Mini Mental State Evaluation, the patients confirmed their participation. The simulation specialist finished the process in carrying out a last interview to identify the expectations, motivations, and limits of the patients in order to guarantee their physical and psychological safety.
The training of the PI was then carried out over four half-days to transmit the essential elements of evaluation and treatment in neurology and to develop their capacity to deliver constructive feedbacks. Finally, they have been four sessions of teaching with the students. The entire program was then evaluated and the students’ perception are presented here.
53 students who participated in the PI program were questioned. An online questionnaire containing 18 questions was administered to them.
47 complete answers (89%) were analyzed. Students’ adherence to the training program with PI was high and the evaluation highlighted the importance given to the different pedagogical methods used in this device. 80% of the students thought they had enough tools and knowledge to take full advantage of the meetings. The encounter with the patient was the most important dimension in student learning. Although this was a formative situation, it seemed realistic to the students. It allowed them to keep their place as learners while exercising their professional role. Despite the perception of a caring environment, students reported feeling stressed when they had to practice in front of their peers. This was due to their uncertainty in their ability to adapt to the different clinical presentation of the patients, particularly to their physical and cognitive skills.
Teaching with PI seems to be coherently integrated into the device of training skills in neurological physiotherapy. The added value is to allow students to practice the assessments of impairments, difficult or even impossible to simulate, learned in a non-played situation. The authenticity was valued by students, increasing their involvement. The meetings with the PI are also an opportunity to realize the importance of adapting the tests and the treatment to the patients’ capacities, a complex skill, developed normally only in internship.
In addition, it is possible to recruit and train neurologically affected “real patients” to become patient instructors through a procedure based on specific criteria. PI should have the ability to increase their expertise about their illness, about physiotherapy assessments and treatments, and in providing constructive feedback to students.
Bokken, L., Rethans, J.-J., Jöbsis, Q., Duvivier, R., Scherpbier, A., & van der Vleuten, C. (2010). Instructiveness of real patients and simulated patients in undergraduate medical education : A randomized experiment. Academic Medicine: Journal of the Association of American Medical Colleges, 85(1), 148‑154.
Cleland, J. A., Abe, K., & Rethans, J.-J. (2009). The use of simulated patients in medical education : AMEE Guide No 42. Medical Teacher, 31(6), 477‑486.
Demaurex, F., & Vu, N. (2013). Patients simulés/standardisés. In S. Boet, G. Savoldelli, & J.-C. Granry (Éds.), La simulation en santé De la théorie à la pratique (p. 51‑62). Springer.
Pageau, S., Burnier, I., & Fotsing, S. (2021). Stratégies de recrutement et de formation des patients en éducation : Une synthèse de la littérature. Pédagogie Médicale, 22(2), 91‑100.