Health professionals who have experienced ill-health appear to demonstrate greater empathy towards their patients. Simulation can afford learners opportunities to experience aspects of illness but to date there has been no overarching review of the extent of this practice or the impact on empathic skills. Our aim was to determine from the evidence – what is known about simulation-based learning methods of creating illness experiences for health professions and the impact on their empathic skills.
Arksey and O’Malley’s methodological framework informed our scoping review of articles relevant to our research question. Three databases (Medline, Embase and Web of Science) were searched in November 2020 and a sample of 516 citations were exported to Covidence Systematic Review Software© for screening. Following review and application of our exclusion criteria, 79 articles were selected in February 2021 to be included in this review.
Of the 79 articles, 52 [66%] originated from the USA, 37 (47%) were qualitative based and 17 (28%) used a mixed-methods model. 77 (97%) of the articles explored the impact on learners with the majority (85%) reporting positive impact and range of emotions evoked. For instance, loss of independence throughout paralysis or impairment simulations left the majority of participants feeling vulnerable – ‘somebody they did not want to be, something negative’. Often learners gained a greater sense of empathy towards their patients, generating a range of measures that they could translate into practice to demonstrate a more holistic approach (providing more time, conveying reduced amounts of information). However, some studies observed more negative effects and additional debriefing was required post-simulation. For example, auditory hallucination studies reported a decrease in intention to help or interact with individuals with a mental illness, they did not engender goodwill or a desire to have contact, but rather facilitated social distance and negative emotions, as well as an increased willingness to apply forced treatment. A sense of suspicion and less positive attitudes towards older adults was likewise observed in some simulations of old age. Learners were noted to internalize perceived experiences of illness and to critically reflect on their empathic role as healthcare providers.
Implications for practice:
A diverse range of simulation methods and techniques, evoking an emotional and embodied experience, appear to have a positive impact on empathy and could be argued as offering a complementary approach in healthcare education; however, the long-term impact remains largely unknown.