Introduction:

Simulation within physiotherapy education, is effective in developing many essential clinical and professional skills [1]. Standardised patients (SPs) help create high fidelity scenarios reflecting real-world environments, enabling students to practice person-centred care, communication skills and empathy, alongside hands-on clinical techniques [1]. The cost of hiring external actors, however, is one of the biggest barriers faced by Higher Education faculty staff [2]. While peer-peer simulation has been shown to be effective [1], our own experiences demonstrated a reluctance for many students to take on a performance role. Collaborative discussions with the university Acting programme highlighted several mutual benefits if the non-medically trained acting students were able to portray realistic patients and the physiotherapy students could ‘buy into’ character age differences. Maintaining psychological safety was also a priority.

This phenomenological study aimed to explore students’ perceptions of simulated learning, and the impact acting student SPs had on the learning experience. As qualitative methodologies are poorly represented in physiotherapy education simulation literature, a second aim was to add depth to our current knowledge.

Methods:

70 physiotherapy students undertook a day of simulated learning in the University simulation wards. In groups of 6, students either led or observed 2 scenarios. 4 SPs of varying ages and medical presentations were portrayed by student actors, none of whom had previously been involved in simulation. A short training seminar helped the actors with clinical presentations. Following the simulation, all students were invited to participate in online focus groups. Thematic analysis was used to analyse data [3].

Results:

13 students participated in 3 focus groups. Physiotherapy participants reported the simulation supported the development of many skills including clinical reasoning, independent thinking, problem solving and teamworking. Although stressful, the simulation felt safe. It was an enjoyable and valuable learning experience. The acting students’ realistic portrayal of patients enhanced the session, and the physiotherapy students reported quickly ‘buying into’ patient characters, irrespective of the acting students’ age. Patient perspective feedback was particularly helpful, even though acting participants reported they found this aspect challenging. Acting participants also felt the simulation experience enabled them to create different, emotional characters and use improvisation skills to challenge the physiotherapy students as the scenarios developed (Table 1).

Discussion:

Results of this study add depth to the literature on simulation in physiotherapy education. It supports the use of acting students as SPs, offering an effective and cost-effective alternative to professional actors.

Ethics Statement:

As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

References

1. Lowe CM, Heneghan N, Herbland A, Atkinson K, Beeton K. KNOWBEST: The KNOWledge, BEhaviours and Skills required of the modern physiotherapy graduate including the future role of practice based learning. Chartered Society of Physiotherapy; 2022.

2. O’Shea O, Mulhall C, Condron C, McDonough S, Larkin J, Eppich W. A qualitative study of physiotherapy educators’ views and experience of practice education and simulation-based learning. 2023. International Journal of Healthcare Simulation. https://ijohs.com/article/doi/10.54531/HKOI8650

3. Braun V, Clarke V. Thematic Analysis: A Practical Guide. 7 ed. Los Angeles: Sage Publications; 2022.

Supporting Documents – Table 1-A21

Table 1.

Themes identified through thematic analysis.

Physiotherapy students’ perceptions of the simulated learning experience
Themes	Participant quotes
Simulation helped develop professional skills	“I had to really actively think on my feet” (P4)“It was great to collaborate with other people” (P1)“We had to problem solve” (P7)
Emotional aspects of sim	“It was amazing” (P4)“I was a bit more scared actually because it was more real” (P5)“A real confidence booster” (P7)
Environmental fidelity increased learning	“It was a fantastically safe space” (P1)“As close to a real clinical setting as it could be” (P2)“My first real experience of a hospital ward” (P3)
Simulation as an educational/ learning experience	“So many things were learnt” (P8)“The point was to learn and that was clear” (P6)“I did get valuable learning from watching” (P1)
Physiotherapy students’ perceptions of acting students portraying SPs
Skills of acting students in portraying patients	“The acting was absolutely incredible and far exceeded what I was expecting” (P2)“The acting students were taking their roles really seriously” (P9)“I found very easily that I slipped into looking at him as though he was an 82-year-old” (P11)
Enhanced learning experience	“Actors made it feel real” (P4)“It immediately put you in that professional frame of mind” (P2)“Looking at patient care, patient-centred care and how we’re actually treating the patient” (P5)
Comparisons with peer-on-peer scenarios	“If you do like mess up and you’re working with a friend, it’s like, yeah, OK we’ll give you a little bit of help” (P4)“There was a sense of realism from the acting patients that maybe we wouldn’t have got from like our peers” (P10)
Acting student opinions of the simulation experience.
Simulation as a learning experience for actors	“I found it harder to criticise them” (P12“It was certainly different to things I’ve done in the past” (P13)“I couldn’t overdo it, but I couldn’t underplay it either” (P12)“I found being that vulnerable quite difficult, even though it was fake” (P12)
Professionalism of physiotherapy students	“There was a lot of trust involved, but there wasn’t any point where I felt I wasn’t safe with it” (P12)“I didn’t feel like I needed that safety net of the lecture” (P13)“They all did brilliantly” (P12)
Actors reacting to changing situations	“Ohh, this is too easy for them. And so I made it more difficult” (P13)“I made it harder in the afternoon” (P12)