Abstract Title
Teaching with adolescent simulated patients, what can we learn from medical students ? A mixed methods study


Yusuke Leo Takeuchi
Oriane Aebischer
Anne-Emmanuelle Ambresin
Raphael Bonvin


10BB Simulation 2


University of Lausanne - Switzerland
Interdisciplinary Division for Adolescent Health, University Hospital of Lausanne - Switzerland


Teaching of communication and interviewing skills with adolescents to undergraduate students is essential as adolescents may be patients in various clinical settings beyond pediatrics and family practice.

Although training with adolescent simulated patients (ASP) has been proven effective to improve students’ skills with adolescents, the major challenge for teachers is to promote change of students’ skills and behavior in the clinical setting. A first essential step to address this challenge is the understanding of student’s views, expectations and needs regarding such training, and how training with ASP works. This in-depth exploration of students’ perspectives about training with ASP is the purpose of the qualitative part of this mixed methods study. This ePoster focuses on the qualitative part. 

Summary of Work

We conducted a qualitative study using grounded theory methodology. Data was collected through individual interviews and in-field observation. Study population consisted of fourth-year medical students participating in a workshop with ASP during spring or summer 2015. 

Data collection procedures are summarized in the following diagram :

Along with data collection, the analytic process with several steps of coding and memo writing was conducted according to the principles of iterative process and constant comparison specific to grounded theory methodology. 


Summary of Results

Five major themes emerged from the first two cycles of coding. Four themes relate to students’ expectations and/or needs regarding the workshop and more broadly the consultation with an adolescent. The fifth theme regards what students perceive of the contribution of the workshop. 


This study identifies important needs and expectations of students engaging for the first time in training with ASP.

Addressing and helping students wrestle with preconceptions and providing them a model to follow might help defuse their anticipated difficulties and find points of reference about adolescent patients. Getting students to identify potential issues of age difference and own adolescence experience has outmost importance to adopt the adequate position in the relationship with patients.

Efforts should also be done to optimize the authenticity of encounters through a minimisation of standardization of ASP in order to decrease the potential frustration resulting from the lack of real patients. Finally, as the observation of peers may partially address the lack of models, the group setting should be preserved with improvements regarding the size of groups and the duration of role-play.   

The implementation of these findings in adolescent health teaching curriculum could substantially improve students’ learning experience and therefore students‘ skills in adolescent health medicine.


Training with ASP at the University of Lausanne (Switzerland)

At the University of Lausanne, a 3-hour workshop adolescent simulated patients (ASP) was introduced during the fourth-year of medical school and is part of the whole undergraduate teaching curriculum of adolescence health medicine. Participation in this workshop is mandatory for all students. Students are divided in groups of eight to ten and each group encounters two ASP. During the workshop, one student interviews the ASP while the others act as observers. After a while, the role-play stops and a personal feedback is immediately provided to the student by the ASP, the teacher and sometimes by other students.


Details about the mixed methods study

This qualitative study is part of a mixed methods study with a convergent parallel design that aims to describe conditions for transfer regarding training with ASP. Training design and some trainee characteristics have an impact on transfer. This is the reason why we focused on these aspects in the qualitative part. The other part of the mixed methods study is a survey with sixth-year medical students that aims to investigate students’ perceptions of transfer and of conditions for transfer during their first experiences in the clinical setting.

Summary of Work

Grounded theory methodology

The aim of this methodology according to its initial developers Glaser and Strauss is to build an explanatory theory about basic social processes, that emerges from empirical data and is thus « grounded » in data. Grounded theory has evolved since then with the contribution of many researchers. Among new paradigms, Charmaz assumes that theory is constructed through the interaction of the researcher and the participants and in that way, it is crucial that the researcher’s position and perspectives are taken into account. This constructivistic methodological approach was used for this study.



According to purposeful sampling strategy, participants in the study were recruited among fourth-year medical students who would soon participate or had just participated in the workshop. Students from 6 different workshops were included. Data collection stopped when saturation of data was reached (when no new concepts emerged from data).


Data collection

Data collection consisted of individual interviews and in-field observation. 18 fourth-year medical students were included for interviews. We conducted a first interview a few days before the workshop and a second interview a few days after the workshop with 11 students. The objective of the first interview was to get students’ previous thoughts and needs regarding the workshop. 7 students participated in a unique interview after the workshop. A total of 29 interviews of 45-55 minutes were conducted. In-field observation was performed for 6 workshops by the first investigator (YLT). Field notes were collected about the course and dynamics of workshops. A total of 122 students participated in those 6 workshops.


Data analysis

According to the iterative process in grounded theory, data collection and a major part of data analysis were performed simultaneously, each informing the other. The analytic process involves successive steps of coding, along with memo writing in order to reach a higher level of abstraction and extract a theory from data.


Quality and validity

We use several strategies to ensure quality and validity of data. We use two sources of data (observation and interviews) according to the process called “triangulation”. Team analysis is performed at several steps of the analytic process. Furthermore, we will also conduct a participant validation of our analysis. 

Summary of Results

4 themes relate to students’ expectations and/or needs regarding the workshop and more broadly the consultation with an adolescent.


1) Anticipating the challenge

Students tend to have preconceptions on adolescents and adolescence most considering this period as significant with subjects difficult to address and potential difficulties of communication and interaction during the consultation. Therefore, they anticipate the encounter with an adolescent as a potential challenge and need some specific skills and experience to increase their confidence.


2) Feeling and tuning the distance

Students experienced their own adolescence only a few years earlier and have a small age gap with adolescents. This may lead some students to identify with adolescents. While this may foster communication and expression of empathy, some students may encounter difficulties in tuning the right distance in the relationship. They may for example be tempted to disclose their own experience as an adolescent to get closer or to behave like a friend. Nevertheless, most students seem to be aware of this issue.


3) Accepting the simulation

Fourth-year students are used to adult simulated and standardized patients. Accepting the simulation in this workshop may be important for their motivation and it depends on the way students get over disbelief. Some students report a remarkable authenticity of adolescents because they are indeed real adolescents and this can help suspend disbelief. Even if disbelief is present in a certain way, students may also get over it if they understand the role and the advantages of simulation as a preparation for real patients and not as a substitution.

4) Ambivalence about training group setting

Fragmentation of history taking that results from the small-group workshop setting may prevent students from performing more difficult tasks (like sexual history) and practicing a structured consultation. However, peers observation is highly appreciated as it brings new insights on how to take the history and communicate with adolescents.    


The fifth theme regards what students perceive of the gain from the workshop.


5) Having the first experience with adolescents

While some students report the acquisition of specific skills and knowledge a few days after the workshop, most describe a perceived contribution of the workshop on broader aspects. As their first practical experience, the encounter with ASP may have an effect on defusing several issues about adolescent patients for example the apprehension to address sensitive subjects, the low level of confidence, the preconveived image of adolescent patients etc. 

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