This talk was recorded live on the second day at DFTB17 in Brisbane. If you missed out in 2017 then why not check out our YouTube channel.
For our inaugural conference we were very privileged to have a world expert on communicating with children. In his 6 year career Callum has gone from novice to wunderkind, able to speak to children in terms that they understand. In this talk, he is ably abetted by his father, Ian Summers. Ian is a leading medical educator who is passionate about using simulation to make us better clinicians. Together they explore the role that could be played by paediatric simulated patients. They are also joined by a very special guest.
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On reading this brain fart , or even worse brian fart as it is written, is probably not the right term as this was more a mental freeze moment: with apologies to Debra (yes its IS Debra) Nestel who was kind enough to give me some background info for preparation of this talk. The “Jesse” I confirm with at the time, is Jesse Spurr who is sitting in the audience as my “go to” person to give me an encouraging nod. Secrets of speakers- always know where your go to people are sitting! The other part of speaking is of course feedback and thanks to Andy, Ross Fisher and Jesse all there, and Ben Symon and Vic Brazil for reviewing the video and giving me their insights.
Thank you Camilla for your kind thoughts and for adding great depth to the dicussion.
It’s fascinating to think that adults taking paediatric roles can be trained to provide useful SP input and your initial concerns about this would have been shared by me…so thanks for passing it on.
I am partly biased by the three children I know best (now aged 14,12 and 7) to think that they could all work roles where they could receive bad news or a scary diagnosis with the right level of explanation and pre-brief/debrief and role construction combined with support. I look also at the enormous numbers of children working in film and theatre and the demanding roles and scenes that they are exposed to . Granted, child actors and stars might not have the best record for mental health/sobriety as adults (!) but we require much lower levels of intensity, immersion and duration of exposure than, say Jodie Foster in Taxi Driver who must have to spend weeks on set in character. Are we underestimating the capacity of children to push themsleves and to take on and enjoy roles, or alternatively could we underestimate the level of support they need (Lyndsey Lohan, Drew Barrymore etc etc)
Part of my intent on taking Callum on stage at the age of 6 and to get him to adopt his SP role was to show that if it could be done live on stage in front of 200 people to a strict 20 minute timescale then it could be possible to do much more in a small room with limited participants and the ability to stop and pause and derole as necessary to ensure safety. Part of the intent was also a bit meta, both to talk about and to demonstrate the construction of his role and the support around it.
There is a hidden aspect to this talk too. I had another 4 (or so) talks prepared for all the eventualities of unusual stuff that might happen with variations of how Callum might respond on stage, or miss his cues and lines. It is quite funny to watch myself work and talk (and at one stage have a ” brian fart” moment as I forgot a name) under the cognitive load of it all. There was a background support crew for Callum with everyone from the delightfully silly Andy Tagg and Casey Parker and to people backstage waiting to show him back to the toliet, his Mum in the audience, and of course me who could have just stopped, given him a hug and continued on with my pre-planned talk as to why you shouldn’y try and use your son as a model SP in front of an audience!
Finally, the talk intentionally contains many more questions than it does answers which reflects both my lack of expertise in paediatric SP’s and the provison of feeback by children to their adult carers and the field in general compared to higher frequency simulation like high tech adult mannequins and simulation debriefing. I am delighted to have real experts join the discussion and hope more will.
There will also be a community that develops this from a paediatric social work, nursing or paramedic side and I would love to hear from you too.
Thanks to Camilla and others.
Thank you so much Ian for this wonderful talk about an important subject!
As you mention in your talk, there is very limited research about children (and adolescents) used as SPs. One of the best overviews we have right now is the fantastic review by Gamble et al, as they mention not many studies have been conducted (full text reference in your previous comment). This mirrors my experiences in Denmark quite well, where we (to my knowledge) do not use children as SP, neither in communication courses during med school nor during your pediatric specialization. And what a shame!
A newly published report from the Danish National Council for Children describes that every fifth child admitted to the hospital during the past year felt they had been forced to do something against their will – 38 % if we look at the chronically ill children. The children were asked what could have prevented this and their answers included inclusion, time to prepare and additional information. In the same study, 47% of pediatric patients reported they were not involved in decisions as much as they wanted to be during their time in the hospital ((1), unfortunately reference only in danish).
Surprising as Denmark is a country where we are quite aware about children having the right to have their opinions taken into account.
Also in Denmark, we see that students, especially those with limited personal experience with children, can find communication and interaction with children and adolescents very difficult in a clinical setting. In spite of this, we do not have any communication courses with this patient group during med school. So even though this lack of experience is an obvious threat to patient safety, we let young doctors practice these skills on real patients in the clinic without any guidance or feedback.
Two years ago I decided to design a voluntary 2-day course for medical students, where they are introduced to communication with different types of pediatric patients: whole family of acutely unwell or chronically sick/injured child, including parents and any affected siblings; adolescents with a psychiatric diagnose; and young patients with chronic diseases (with focus on the HEADSS assessment tool (2). During the course we have 4 simulations, where the participants get a chance to practice their communication skills in a “patient-safe” environment. For this part we have thought a lot about using children as SP’s and will be introducing this in our September course. But so far we have been trying out another solution with actor trained med students “acting” as children/adolescents. I had a lot of concerns about this – especially concerns about learner engagement and immersion when you are using an actor to portray a completely other age group. But to my big surprise this has not been a problem in the last 3 courses!!! Maybe because our adult “SPs” have been properly trained by an actor with huge insight in the pediatric patient, maybe because our course participants are still novices and struggling with the communication itself and therefore not in need of completely realistic situations? I actually don’t know. But what I do know is, that I believe it would be more relevant to use a child as a SP, which could maybe enhance the feeling of immersion and maybe (just maybe) enhance transfer. Why we have been a little careful about this is of course the feasibility and especially ethical concerns. Using a child SP for a “standard” communication scenario is one thing, using a child in a communication scenario regarding a cancer diagnosis and a sibling soon to die is a completely other thing! What we will be doing next time is using a child SP for the 3-way communication scenario about an injured leg, a young actor for the difficult conversation/relative/grief scenario and a chronically ill adolescent as a SP for our HEADSS scenario. We will be using direct feedback from the SPs and of course feedback from faculty.
Furthermore, I’m looking a bit into the possibility for use of virtual/augmented/mixed reality in communication scenarios. Maybe this can help us create standardized patients in a new way?
Please add comments or let us know about your work with children as SP or in giving feedback to health practitioners regarding communication. What works? What doesn’t?
Any feedback to me on the talk would be great. Did it work for you?
There are people out there doing much more paediatric SP work then I do. Please write.
Some links mentioned in this presentation of good background reading:
A systematic review Children and Adolescents as simulated patients in health professional education. Full text article:
Standardised patient educators standards of best practice Free text available here: