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Table 3 Data Extraction Table

From: A systematic review: Children & Adolescents as simulated patients in health professional education

Reference Study location Sample Study Purpose Study design SP Population SP preparation Outcome Measures Learner Outcomes SP Outcomes SP related Considerations
Austin et al. [17] USA Nursing students
N = 263
Identify the Impact on health professionals & children following their involvement in disaster preparedness simulation Qualitative evaluation 16 children 6–15 years Multiple sessions targeting different areas of preparation & role practice Parental interview to gain understanding of child & parent experiences;
Written evaluations from nursing students about nursing process, confidence & knowledge gain
Identified 3 main nursing roles during mass casualty; assessment, triage & interventions; work in multi-professional team to improve rapid assessment & decision making skills; improved confidence (52 % reported some confidence, 21 % very confident & 19 % slightly more confident); 42 % gained awareness of hectic nature of mass casualty Parents reported children had an increased awareness of disaster-readiness;
Children loved the experience;
Parents felt education & preparation was excellent; Would allow child to participate again
Parental consent & presence;
School support;
Nurse dedicated to 1:1 support during Sim;
Avoidance of critical events;
‘Opt out’ option
Blake et al. [22] Canada Final year medical students N = 57 intervention group
N = 35 in control group
To determine if feedback from adolescent and mother leads to improvements in 4th year medical students’ psychosocial interviewing
To evaluate whether this skill persists in the long term (2–12 months post intervention, average 6.6 months)
Prospective randomized double blind study with 3 arms;
Intervention group received feedback from adolescent SP & SP mother after 2 interviews, 4 weeks apart. 2nd intervention group received feedback once after 2nd interview only.
3rd group did not participate in interview
9 SPs as mothers
10 female adolescent SPs
Standardized feedback training
Adolescents guided by SP mothers to give feedback
Adolescent focus group
Pre-test review by psychologist using modified Calgary-Cambridge guide of interview with adolescent and mother SP
Post-test review of second interview 4 weeks after pre-test
Evaluation of knowledge & psychosocial interviewing scores on 2 OSCE stations
Group who received feedback after 1st interview scored better on post-test;
Both intervention groups had higher scores in psychosocial inquiry station in OSCE but not in knowledge;
Adolescent interviewing
skills can be taught & retained up to a year.
  Time spent recruiting
& training is important.
Blake et al. [23] Canada N = 54 final year medical students To identify any adverse effects on adolescents who regularly undertake risk-taking roles; to capture the viewpoint of adolescents over time; to describe the training and monitoring process for adolescents as risk-taking SPs Prospective study involving control groups n = 11 female adolescents aged 13–15 Y
Control n = 6
SPs of same age & grades completed
Information session SP:Pre & post Interviews using Achenbach’s youth self-report & Piers Harris Children’s self-concept scale;
Focus groups;
Parental interview & questionnaire
  PRE: SCS &YSR not in clinical range of concern for study or control groups; Focus groups:
Develop attachment to SP mother; Wish to come out of character to give feedback;
Benefitted from experience but SP work did lose glamour and become a job
Parent interview: Saw as opportunity for adolescent empowerment & to better understand how difficult it is for doctors, no increased interest in risk-taking behaviours
Recruitment & screening important;
Exit strategy;
Bokken et al. [29] Netherlands 2nd year medical students over 5 years Evaluate the views of teachers, students & adolescent SPs regarding the SP program; Evaluate the extent to which all 3 felt the program had changed over 5 years; Evaluate the lessons learner 5 year experience of the SP program Pre/post tst n = 16 adolescent girls 13-19y
n = 2 males
Introduction session & feedback training Students rated quality of SP role performance & feedback using Maastricht assessment of simulated patients (MaSP); Adolescent SP questionnaire about their experience; Faculty completed questionnaire about SP consultation, quality of feedback & role play & students reactions Authenticity of encounter 7.5-8/10, adolescent SP fits role & stays in it; general performance of adolescent SP decreased over 5 years; Faculty saw encounter as authentic, able to address specific aspects of communication not able to be assessed in other ways, SPs able to give natural & spontaneous feedback No personal disadvantage; Some difficulty with feedback; 8 role plays per day ideal; No differences in evaluation across 5 years Parents advised by adolescent;
Individualized role
Bokken et al. [30] Netherlands Medical students N = 341 Evaluation of effects on adolescent SP of performing a role, the quality of their role playing and feedback Descriptive
Adolescents aged 16–18
N = 12
Role developed with adolescents based on their own experience.
Role related & feedback training
Students rated quality of SP role performance & feedback using MaSP; Adolescent questionnaire about effects of SP role; Faculty evaluation of, quality of feedback & role play Learners indicated satisfaction with quality of role play & feedback; Student doctor & observer rated SP performance differently; Teachers noted a positive & authentic experience & acknowledged students may feel attracted to SP Positive experience; Easier playing a role close to own experience; Need more feedback training Given letter for parents but not mandatory to give it to them;
Paid for their time
Brown et al. [18] USA Medical students & Residents Description of a pilot program to aid in training residents & medical students in complex interviewing skills addressing adolescent mental health issues Qualitative Children & adolescents aged 9–19 years 2 training sessions
Not involved in case preparation
Resident & medical student questionnaire about the program & achievement of learning outcomes,
Focus groups with child–parent SP dyads focused on preparation for roles, reactions to participation, ability to give feedback, reactions to roleplaying with biological/SP mother
Learning outcomes achieved & mostly positive program feedback – 2 learners preferred SP approach whilst 3 preferred lecture format Child: Fun; empowering; contribute to learning for doctors; financial benefit
SP & SP parent: Training was good preparation; Mixed reaction to providing feedback – some would prefer to give to faculty instead of directly to learner ; Varied opinion about biological/SP mother
No psychological follow up
Children made links with personal experiences
Don’t need own parent present
‘Opt out’ clause
Feddock et al. [19] USA Medical students N = 95 intervention
N = 91 control group
Determine effect of adolescent medicine workshop on knowledge & clinical skills Randomised controlled trial Intervention:
Medical students participating in adolescent medical workshop
Control: Medical students in alternative workshop
   End of year clerkship exam with adolescent SP encounters; 3rd year clinical exam; written exercise & questions specific to adolescent medicine on clerkship written exam Performance of intervention group higher on clinical skills & written exam   
Hanson et al. [24] Canada 2nd year medical students Evaluation of adolescent selection methods & simulation effects for low & high stress roles in a psychiatry OSCE Randomised controlled trial
SP assigned to low stress/high stress role or control group
Secondary school age adolescents Information & training session
Employment & psychological screening
Simulation impact questionnaire; Interview; Focus group; Adolescent self-perception profile; Achenbach behaviour questionnaires;
Parental version of simulation impact questionnaire;
3 months after participation – interview; project role questionnaire to identify comfort enacting various roles
  Identify good/bad doctors; Importance of training for SP work; Some adverse effects on relationships with peers, parents & school performance; No pre/post change in self-perception or Achenbach questionnaire; Discomfort with sexually explicit questions
Parents reported no adverse effects, small increase in self-confidence, job skills & sense of responsibility
Adolescent & parent consent
Hanson et al. [25] Canada   Evaluating safety of suicidality sim Pre-post N = 24
14–17 years
Information session
Group training
Suicidal ideation questionnaire; Reynolds adolescent depression scale; behavioural measures   No deterioration in mental health status; Suicidality role showed negative reaction with; 2 reports of brief depression Consent
Ethics approval
MH specialist
Stress relief methods
Hanson et al. [26] Canada N = 34 paediatric residents Determine association between simulation discomfort & mental illness stigma Randomised controlled trial N = 24
14–17 years
Randomised to suicide/depression or cough scenario
4 hours training & rehearsal Project role questionnaire   Discomfort with sex questions due to lack of knowledge; Adolescents experienced in mental illness roles anticipated greater comfort portraying subsequent stigma associated roles Consent
Ethics approval
Lindsey-Lane et al. [20] USA Paediatric medical residents
N = 56
Obtain qualitative data about the appropriateness, feasibility & responses of child SPs in CSA Observational n = 11 aged 7–16
n = 9 adults paired with children
Training sessions until consistency gained between history, PE & professional skills Adult SP: Patient encounter checklists; Child SP gave overall patient satisfaction rating on checklist; SP focus groups with child/adolescents or SP and real parents; Residents completed questionnaires related to realism & challenge Residents ratings low for fairness (2.9/5), but higher for enjoyment (3.1), realism (3.9) & challenge (4.1) Child & adult SP satisfaction ratings concordant; Parent Focus Groups gave positive feedback about learning, working hard at a real job; SP parents noted child SP had negative reactions if ignored or talked down to
Children found experience at times exciting, nerve wracking & boring, tiring by the end of 6 hours, but good to earn money
Careful selection, in-depth training and debriefing by individuals experienced in communication with children
Pullon et al. [27] NZ N = 69 medical students Assess consultation skills teaching & risk of harm to involved adolescent SPs Retrospective evaluation Adolescent girls (14–18) n = 4
n = 3 adult SPs
Discussion about suitability of case
Student self-evaluation, video tape review of consultations by tutor; Interviews with adolescent SPs; Retrospective student evaluation via focus group Increased confidence in consultation skills, however no clear effect on clinical performance Adolescents positive about role, no negative effects but able to identify possible harm if supports not put in place Parental & student consent
Clear criteria of concern
Rowe et al. [28] Africa 5 rural community & one city health service To evaluate health care worker performance during consultations Evaluation survey 6 children aged 6 m-59 m
5 SP mothers
SP mothers: 3 training days 3 months prior and a 2 day refresher just prior to study.
No child SP preparation identified
Survey result analysis – client survey & conspicuous observation   No serious problems for SPs Ethics approval obtained
Tsai [12] Taiwan 19 studies – English, searched via Medline Review use of child SPs & difficulties in using children in assessment of competence Systematic review Children as SPs in clinical assessments     Children from infancy to adolescence can participate as SPs in clinical assessments; Children should have a substitute; Can provide feedback; More negative impacts for younger children; Use of children should be avoided for ethical reasons Only work with children for assessments that cannot be measured by other methods
Woodward, & Gliva-McConvey, [21] USA   Identifying the effects of simulation on children Qualitative
N = 7 Children 6-18 Random selection from existing pool of child SPs Focus group   Important skills & information gained; Positive & negative outcomes for younger children; fun can disassociate from role; Mainly positive for older children; Help adults learn; Identify good & bad doctors Mothers included if children <13
Role close to the child’s personality & developmental age. Greater risk in younger children. Methods to monitor effects on children