International Journal of Healthcare Simulation

Background:

The COVID-19 pandemic resulted in an unprecedented shift from face-to-face to online teaching with a subsequent deleterious impact on the quality of teaching delivery within medical education ^[1]. Human interactions such as history-taking are challenging to recreate without the nuances of face-to-face teaching. We present the first instance of a gamified online interactive history-taking simulation, in this case specifically designed for secondary school students interested in a career in medicine. Effective history-taking is a fundamental determinant of patient care and by developing this simulation we are focussing on the proximal determinants of patient care. We believe that this unique approach is translatable to undergraduate and post-graduate medical education, resulting in wider and longer-lasting beneficial impacts on both education and clinical care.

Aim:

Our aim was to demonstrate the feasibility of utilizing a novel approach to interactive, online simulated history-taking.

Method/design:

The session was designed for students attending a virtual work-experience programme and is founded upon gamification principles. History-taking is a humanistic social process requiring effective communication skills and recognition of verbal and non-verbal cues. The session enabled students to directly instruct a passive clinician to take a history from a simulated patient actor, incorporating both verbal and non-verbal actions. This novel teaching method is analogous to Freire’s work, highlighting the importance of the learner being an active participant, thus enabling experiential learning ^[2].

Implementation:

This interactive approach required a simulated patient actor, a passive clinician and a verbal instructor to be present. Students were presented with a case scenario and viewed the interaction between the simulated patient actor and passive clinician online via a video conferencing service (in this case, Zoom). Students provided instructions to the passive clinician using the typed chat function. These typed instructions were relayed by the verbal instructor to the passive clinician via an earpiece and the passive clinician would then embody these instructions. This allowed students to work as a group to directly elicit a history and witness their instructions being actioned. Examples of instructions included questions to verbalize, adjustments to body language and alteration of the tone of voice. Following good student instruction, the passive clinician gradually grew in competence and confidence throughout the scenario, thus allowing real-time, interactive feedback of their history-taking approach. The session concluded with a reflection of the communication traits that helped to gain an effective history from the patient using a debrief model.