Kimberly Stewart

Simulating the longitudinal doctor-patient relationship:

experiences of simulated patients in successive consultations

Kimberly Stewart
Case Review
University of Texas at El Paso

Kimberly Stewart

The aim of this study was to explore the experiences of simulated patients (SPs) in a
longitudinal program compared to a single case consultation. This study is of importance because
there is very little literature on consecutive consultations between SP and students. This is
relevant because consecutive consultations influences patients and doctors relationships on a
regular basis, and the goal is to prepare students for real life practice.
For this particular study the qualitative methodology was appropriate for qualitative study
because the researchers interpreted their findings through subjective experiences of the simulated
patients. Their findings were interpreted with quotes and phrases rather than statistical numbers.
As the researcher states, this was appropriate because an SP is the only individual who
experiences the consultation as a patient and can provide insight to that experience. Their insight
can best be relayed using qualitative methodology.
The research design was appropriate for a qualitative research study because findings
were interpreted through focus groups for the 23 SPs who participated in the newer program to
explore their opinions, experiences, and feelings on the longitudinal SP program. To begin the
interview the researchers used pre-established open-ended question to initiate the discussion.
Recruitment and Participant strategies were clearly explained; of the 32 SPs in the
program, those who attended 3 out of the 4 consultations were invited to discuss their opinions at
the focus group. 31 of the participants performed at least 3 times and were all willing to attend.
However, 6 were unable to attend because of prior plans and 2 participants never showed which
reduced the participants from 31 to 23. The focus group consisted of 8 men, ages 36-77, and 15
women, ages 50-71. Of the 23 participants all but 1 had prior experience to the single case
consultation which is important because the goal of the study was to compare and contrast single
case consultation to longitudinal consultations.

Kimberly Stewart

Data collection was addressed in the article by explaining that very little research had
been done on this particular study. The methods were clearly stated by identifying four focus
groups which were held in a semi structured interview with pre-established open-ended questions
in order to initiate discussion that lasted 1.5-2 hours. Data was collected in a recording studio at
the faculty of medicine which was audio-taped for transcription. The interviewers explained that
all ideas were welcome and that there were no right or wrong answers. This is important for
open discussions in order to eliminate hesitation by participants.
Relationship between researcher and participants was not clearly stated in this study. Due
to this, there could have been bias influencing the answers of SPs. The questions asked were
open ended which let the participant describe their own opinions, but questions were asked in
focus groups that could have possibly swayed others opinions and answers to questions. The
researcher did not identify potential bias nor implications of any changes for further research. In
a study, it is important to identify potential weaknesses in order to enhance future studies.
All SPs who participated in the study said that they would participate again. None of
them experienced any difficulties in maintaining role over consultations. However workload was
much larger because of mandatory attendance. Participants were not forced to participate in this
study. Those who participated did so because they were able and willing. The researcher states
that there were no conflicts of interest and that ethical approval was not required for the study
conducted.
Data was categorized by 3 dependent raters. There were several quotes and broad
answers identifying participants opinions and feedback. In the findings, there was no evidence
found that contradicted the researchers arguments. The researcher explained the possibility of
conducting research on the students opinions of the longitudinal program rather than just

Kimberly Stewart

interviewing the SPs. The research is very enthusiastic about the new findings since multiple
consultations are much more realistic than single case practice. This research is important
because the patient-doctor relationship is a critical component in providing adequate care.
Future studies could possibly conduct interviews on a one-on-one basis rather than within focus
groups so that SPs are not swayed by the opinions of others. This is something the researcher
does not identify and could become be an issue.
The findings were not explicit because the outcome of a consultation depended on both
student and the SP. The researcher provides adequate discussion into these outcomes by
providing both positive and negative examples of how students and SPs reacted in different
scenarios. The researcher explains how many of the research questions were answered.
However, by answering these questions newer ones have been created which require all new
research in order to be answered.
The researcher states that the most important issue to emerge from the study is that SPs
are now able to provide feedback based upon longitudinal care. The researcher goes on to
explain that while the findings support the study there are areas which require further study. For
instance, the students opinions on longitudinal care remain unknown which would require
follow-up research of which quantitative analyses would play an important role. Also, the use of
longitudinal simulations for a specific purpose remains to be defined. In order to accomplish
this, validation research would need to be conducted based upon the considerable costs of the
study. The researcher recommends a smaller scale study as being more practical and feasible.

Kimberly Stewart

References
Linssen, T., van Dalen, J., & Rethans, J. (2007). Simulating the longitudinal doctor-patient
relationship: experiences of simulated patients in successive consultations. Medical
Education, 41(9), 873-878. Retrieved February 16, 2011 from the EBSCOhost database.