Using simulation to teach medical students assertiveness and negotiation: an example from a psychiatry placement


  1. Dr Emma Vaccari
  2. Dr Nupur Tiwari


10BB Simulation 2


University of Southampton - United Kingdom


It is important to offer medical students ample opportunity to practice communication skills. A recurrent feedback theme from the Southampton psychiatry placement is the need for more contact with acutely unwell patients. We identified assertiveness and negotiation as useful transferable skills to manage potentially challenging interactions in this context. 

Summary of Results

Learning Points:

  • Importance of careful selection and preparation of simulated patients
  • 3 minutes are sufficient for each student-simulated patient interaction


  • The psychiatry placement in medical school offers an opportunity to combine teaching of specific clinical presentations with advanced transferrable communication skills.
  • It is possible and valuable to challenge students in their early clinical years with difficult simulated scenarios, ensuring it is done in a safe and structured environment. (Note, these third year students were self selecting)
  • Not all simulated patients are able to to portray acutely unwell psychiatric patients.
Summary of Work

We organised a student selected module for third year medical students. This ran on a rolling basis for different groups as an afternoon small group session. We collected feedback and used it to improve the next session.


  • Role play with simulated patients - strict timing
  • Safe environment
  • Emphasis on feedback
    • ​Multisource: from students, simulated patients and facilitators
    • Pendleton's rules1

2 simulated patients:

  • a sexually disinhibited manic patient - requiring assertive behaviour to maintain appropriate consultation.
  • a suspicious acutely psychotic patient - requring negotiation to create a safe feeling environment in which the consultation can take place.


Extreme Psychiatry for unknowingly planting the seed that grew into Ultimate Psychiatry.

Dr Robert Gordon for facilitating the last Ultimate Psychiatry session in 2015


1)  Pendleton D, Schofield T,Tate P, Havelock P. The Consultation:An Approach to Learning and Teaching. Oxford: Oxford University Press; 1984



Summary of Results
Summary of Work

From handout given to students

Communication Skills in difficult situations2,3


  • Risk assessment - ?presence of team member
  • Early defusing
  • Leave consultation and return later


  • Stay calm
  • Good verbal communication
  • Good non-verbal communication
  • Empathy
  • Active listening
    • Remember
    • Reflect
    • Clarify
    • Summarize
  • Negotiation
    • Aim for win-win
    • Respect
    • Focus on interests, not positions
  • Assertiveness

Reflect and learn

  • Learn about your strengths and weaknesses
  • Debrief with supervisor/colleague/friend


Assertiveness toolkit:

  • Negative enquiry
  • Constructive criticism
  • Fogging
  • Say “No”
  • Broken record



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