USE OF SIMULATED CLIENTS IN MARRIAGE AND FAMILY THERAPY EDUCATION

Journal of Marital and Family Therapy, Jan 2007 by Hodgson, Jennifer L, Lamson, Angela L, Feldhousen, Elizabeth B

Knowledge of how one should manage suicidal, homicidal, child maltreatment, and domestic violence situations is paramount in the training of marriage and family therapists (MFTs). Simulated patient modules were created to help clinical faculty address these crisis situations in a protected learning environment. The modules were implemented by the MFT faculty in collaboration with the Office of Clinical Skills Assessment and Education at East Carolina University's Brody School of Medicine. Qualitative data over the course of 2 years revealed six thematic domains regarding therapists' performance, therapists' emotions, the simulation experiences, and lessons learned. Educational, clinical, and research recommendations include tools to implement simulation exercises into marriage and family therapy programs as well as suggestions to assess for teaching effectiveness.

In the medical field, a form of instruction that has become increasingly more common in the training of physicians is the use of standardized or simulated patient (SP) scenarios. Typically, an SP scenario involves any "medical encounter conducted purely for educational purposes" (Adamo. 2003, p. 262), in which "participants have the opportunity to interact with patients in a controlled learning environment" (Donovan, Hutchison, & Kelly, 2003, p. 125). The most common terms for these scenarios are standardized or simulated, and these terms will be used in this article interchangeably.

Standardized patient encounters allow faculty to assess their students' clinical skills in a safe environment with no chance of harming an actual patient and provide students with an opportunity to transition to working with real patients (Barrows, 1993). Moreover, investigators (Colliver & Williams, 1993) suggested that the use of SPs was "as good or better an assessment of clinical performance than conventional methods," such as the use of "physician observers" (p. 455), or "paper and pencil examinations" (p. 457) that measure knowledge of clinical skills.

As a result of the success and effectiveness of the medical community's use of SPs, investigators and educators have begun to incorporate standardized patients or clients in other fields as well (Larson et al., 1999). However, the use of standardized clients outside of the medical setting has been limited. When simulations are used in nonmedical training, instructors commonly request that former students play the role of standardized clients (Crosble-Burnett & Eisen, 1992; Moss, 2000). This has presented concerns when students from previous cohorts portraying standardized clients did not have the adequate training, objectivity, or benefit of being unknown to the therapist in the simulated client scenario. This has the potential to create a less than optimal instructional experience. The utilization of standardized patients from an outside source (e.g., medical school clinical skills office; experienced community mental health professionals) may create a more realistic simulation than using students from the same peer group. Learning from the success that medical schools have reported, family therapy training programs could certainly benefit from more authentic methods of preparing students for clinical work (e.g., ethical and legal dilemmas), in addition to the incorporation of more standardized didactic teaching methods.

For example, in the field of family therapy, there are four types of clinical crises that most novice as well as seasoned therapists find challenging. In no particular order, they are domestic violence (DV), child maltreatment (CM), homicidal ideation (HI), and suicidal ideation (SI). When managing and treating these four situations in a therapeutic setting, there are many important assessments and legal steps that therapists must remember and incorporate into their work.

Given the seriousness of these situations, and the fear they inspire in practicing therapists, it may be helpful to have therapists in training first address these issues using a standardized teaching methodology. It is quite possible that students enrolled in a marriage and family therapy (MFT) master's program will never encounter one or more of the four crises mentioned during their training experience; however, employers will expect them to know how to manage these clinical situations personally and professionally. However, since this is a novel teaching methodology in the field of MFT, it is important to understand how it has been beneficial to other disciplines, particularly the medical field, which has the greatest amount of experience with it.

Benefits of Using Standardized Patients

One of the strongest arguments for using standardized patients in the medical field is the importance of providing medical students with standardized patient problem scenarios that are presented in an unvarying, scripted fashion, regardless of who is portraying the role (Barrows, 1993). According to Barrows, another reason for using SPs includes the availability of SPs to portray any illness and present the same problem multiple times to different students. The use of standardized patients also decreases the mistreatment of real patients by providing a transition from didactic learning to working with actual patients in a clinical setting. In addition, SPs give students the opportunity to refine their examination and communication skills while increasing confidence in their abilities.