Performance-related stress symptoms in simulated patients

During the first 4 years of the 6-year undergraduate medical curriculum at Maastricht University, the Netherlands, students practise clinical skills in simulated patient (SP) encounters at the Skillslab. Generally, these encounters are instructive and enjoyable for both students and SPs. However, in conversations with SP trainers, some SPs have mentioned experiencing adverse symptoms due to performing a patient role. Some published studies have reported similar findings in SPs. We explored the seriousness of this problem by surveying SPs on the occurrence and severity of stress symptoms related to performing patient roles. We also examined by which variables the symptoms were influenced.

An anonymous questionnaire was developed to investigate factors related to stress symptoms and the frequency and severity of stress symptoms. A burnout scale was also included in the questionnaire. All SPs who had performed between March 2000 and March 2001 were asked to participate.

The response rate was 84%. Of the SPs, 73% were found to have experienced stress symptoms, with a mean of 4 symptoms per SP. No significant correlations were found between the occurrence of symptoms on the one hand and factors that might influence symptoms or the burnout scale on the other hand.

An unexpectedly high number of SPs reported symptoms. Fortunately, the symptoms were relatively mild (2.2 on a 5-point scale). Future studies should address the connection between work as an SP and symptoms, and measures should be taken to prevent and treat the symptoms. Debriefing sessions might play a role in this respect.