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Suicide is a major cause of preventable mortality and primary healthcare professionals, including pharmacists, require appropriate training to communicate with and support people at risk of suicide. Mental Health First Aid (MHFA) training teaches participants how to communicate with and support people experiencing suicidal thoughts. The purpose of this paper is to use a novel MHFA assessment approach involving simulated role-plays enacted by people with a lived experience of mental illness and explore MHFA participants’ and simulated patients’ views of participating in simulated role-plays of mental health crises.

MHFA is embedded into the Sydney School of Pharmacy curriculum. Post-MHFA training, pharmacy students were randomly allocated to participate in or observe a simulated role-play of one of three suicide crisis scenarios, with a person with a lived experience of mental illness. Two purpose-designed, semi-structured interview guides were used to conduct student focus groups and interviews with simulated patients to explore their views. Focus groups and interviews were digitally recorded, transcribed verbatim and thematically content analysed using a constant comparison approach.

In total, 22 pharmacy students participated in two focus groups and three simulated patients participated in interviews. Five themes emerged including: the benefits of participating; the value of having a lived experience; challenges with suicide assessment; communication; and the value of immediate feedback and debrief.

Students and simulated patients both benefited from participating in the role-plays. Students valued practicing their MHFA skills post-training with simulated patients with lived experiences. This unique approach to post-training assessment provides an opportunity to practice skills realistically and authentically, in a safe, learning environment.

The aim of the study was to explore aspects of learning in terms of gain in knowledge, confidence and empathy with immersive virtual reality (VR) from the patient perspective in undergraduate nursing students.

A pilot study integrating immersive VR experiences during clinical courses was facilitated based on the INACSL (2016) standards for simulation practices with a convenience sample of 165 nursing students in three levels of cohorts, using two different VR scenario simulations. Quantitative and qualitative data were collected through pre- and post-surveys.

Student participants embodied patients with chronic disease using immersive VR. Findings showed substantial gains in most measures of knowledge, confidence and empathy, with slightly less difference seen in lower level nursing students particularly with empathy and understanding.

Embodiment through immersive VR scenarios was shown to increase learner development. The positive findings from the pilot study justified continuance of integration of immersive VR in nursing education, recommending further use and research.

Simulated learning for nursing has known benefits on knowledge and understanding. Immersive VR is gaining recognition within nursing education as a method to enhance cognitive and affective knowledge. This paper hopes to add insights on the impact of immersive VR for student learning and encourage discussion about the future for innovative immersive teaching and learning approaches for experiential learning.

This study aims to compare Finnish medical students' perceptions of the suitability of three experiential methods in learning interpersonal communication competence (ICC). The three methods it seeks to explore are: theatre in education; simulated patient interview with amateur actors; and role‐play with peers. The methods were introduced in a pilot course of speech communication.

Students (n=132) were randomly assigned to three groups. The data were collected via questionnaire and focus group interviews, and analysed using qualitative content analysis and cross‐case analysis.

Most of the medical students thought these methods were suitable or very suitable for learning ICC. The methods had five similar elements: the doctor's role, the patient's role, reflective participation, emotional reactions and teachers' actions. Being in a doctor's role, realistic scripts and patient‐roles, observing the interaction and reflection in small groups were the most helpful elements in these methods.

The results of this study show that simulated patient interview with amateur actors, role‐play with peers, and TIE are very suitable methods for practising professionally relevant ICC in the context of doctor‐patient encounters from the medical students' perspective.

Designing digital artifacts is not a linear, straightforward process. This is particularly true when applying a user-centered design approach, or co-design, with users who are unable to participate in the design process. Although the reduced participation of a particular user group may harm the end result, the literature on solving this issue is sparse. In this article, proxy design is outlined as a method for involving a user group as proxy users to speak on behalf of a group that is difficult to reach. The article investigates the following research question: How can roleplaying be embedded in co-design to engage users as proxies on behalf of those who are unable to represent themselves?

The article presents a design ethnography spanning three years at a cancer rehabilitation clinic, where digital artifacts were designed to be used collaboratively by nurses and patients. The empirical data were analyzed using content analysis and consisted of 20 observation days at the clinic, six proxy design workshops, 21 telephone consultations between patients and nurses, and log data from the digital artifact.

The article shows that simulated consultations, with nurses roleplaying as proxies for patients ignited and initiated the design process and enabled an efficient in-depth understanding of patients. Moreover, the article reveals how proxy design as a method further expanded the design. The study findings illustrate: (1) proxy design as a method for initiating design, (2) proxy design as an embedded element in co-design and (3) six design guidelines that should be considered when engaging in proxy design.

The main contribution is the conceptualization of proxy design as a method that can ignite and initiate the co-design process when important users are unreachable, vulnerable or unable to represent themselves in the co-design process. More specifically, based on the empirical findings from a design ethnography that involved nurses as proxy users speaking on behalf of patients, the article shows that roleplaying in proxy design is a fitting way of initiating the design process, outlining proxy design as an embedded element of co-design.

The changing clinical landscape in psychiatry, both before and after the pandemic, has impacted students’ direct contact with psychiatric patients. It is imperative, therefore, that medical education keeps pace with evolving clinical pathways to ensure that clinicians are always appropriately trained not just for common presentations but also for low-prevalence, high-risk situations. Simulated-based training is well established. However, it is not without its limitations, many of which could be overcome with the use of virtual simulation. This study aims to analyse the use of virtual simulation within medical education to train clinicians in psychiatric assessments.

A scoping review was undertaken with a comprehensive literature search of the six most relevant online peer-reviewed databases, including PubMed, PsycINFO, CINAHL, Medline, EMBASE and Cochrane. All published papers in English that discussed simulation in teaching psychiatric assessments were included.

Virtual patients can be used for educational, diagnostic and therapy purposes attributable to advances in speech-recognition technology. Virtual simulations are well received and positively affect clinicians’ knowledge and skill development. Educational faculties should consider using virtual simulation technologies to improve learning outcomes. Further studies should enhance the fidelity and quality of virtual assessment simulation situations, mainly focusing on the virtual patient’s empathy, gesturing and body language to enable this evidence-based tool to be used effectively and efficiently for the benefit of future patient care.

The changing clinical landscape in psychiatry, both before and after the pandemic, has impacted students’ direct contact with psychiatric patients. This scoping review has reviewed the use of virtual simulation-based education to train clinicians for psychiatric assessments. To the best of the authors’ knowledge, this work has not been conducted before.

Two different systems for streaming patients were considered to improve efficiency measures such as waiting times (WTs) and length of stay (LOS) for a current emergency department (ED). A typical fast track area (FTA) and a fast track with a wait time threshold (FTW) were designed and compared effectiveness measures from the perspective of total opportunity cost of all patients’ WTs in the ED. The paper aims to discuss these issues.

This retrospective case study used computerized ED patient arrival to discharge time logs (between July 1, 2009 and June 30, 2010) to build computer simulation models for the FTA and fast track with wait time threshold systems. Various wait time thresholds were applied to stream different acuity-level patients. National average wait time for each acuity level was considered as a threshold to stream patients.

The fast track with a wait time threshold (FTW) showed a statistically significant shorter total wait time than the current system or a typical FTA system. The patient streaming management would improve the service quality of the ED as well as patients’ opportunity costs by reducing the total LOS in the ED.

The results of this study were based on computer simulation models with some assumptions such as no transfer times between processes, an arrival distribution of patients, and no deviation of flow pattern.

When the streaming of patient flow can be managed based on the wait time before being seen by a physician, it is possible for patients to see a physician within a tolerable wait time, which would result in less crowded in the ED.

A new streaming scheme of patients’ flow may improve the performance of fast track system.

The purpose of this paper is to use Lean Six Sigma (LSS) to reduce patient waiting time in a Kuwaiti private hospital obstetrics and gynaecology clinic.

The define, measure, analyse, improve and control methodology was used. The “define” stage involved identifying patients’ needs, system capabilities and project objectives. The “measure” stage assessed the system’s current state through data collection on waiting times. Dunnett’s test, control charts and process capability analysis were used to ensure data accuracy. In the “analyse” stage, an Ishikawa diagram and Pareto chart were constructed, showing that overbooking appointments, doctors’ unscheduled breaks and doctors not arriving on time were the root causes of the problem. The “improve” stage used an Arena simulation model to represent current and improved system status. The proposed solutions were implemented and monitored in the “control” stage.

A sigma-level improvement of 300 per cent (0.5–2.0) was realized for appointment patients on Saturdays, with a 67 per cent reduction in waiting time. For walk-ins, the sigma level improved by 288 per cent (0.8–3.1), with a 55 per cent reduction in waiting time. For weekday appointments, the sigma level improved by 111 per cent (0.9–1.9), with a 63 per cent reduction in waiting time. For walk-ins, the sigma level improved by 69 per cent (1.6–2.7), with a 46 per cent reduction in waiting time. A cost–benefit analysis estimated the present project value at $656,459, leading to a total of $5,820,319 in savings by 2025.

This paper fulfils the need for process improvement, increasing patients’ satisfaction and hospitals’ profitability using LSS.

A major challenge in teaching medicine in a rural setting is that long geographical distances separate students, instructors, and educational resources. Clinical schools within the University of Sydney Medical Program are geographically dispersed and face similar challenges. As a result, a virtual ophthalmology clinic (VOC) was developed (Succar et al., 2013) and it is being delivered online to enable equitable access and consistency in the foundations of ophthalmology education for rural-based students. The program allows students to sharpen their clinical reasoning skills by formulating a diagnosis and treatment plan on virtual patients with simulated conditions. To evaluate the educational effectiveness of VOC, a randomized controlled trial was conducted with the University of Sydney medical students (n = 188). The pre- and post-test and student satisfaction questionnaire were administered. Twelve months later, a follow-up test was conducted to determine the long-term retention rate of graduates. On the basis of a statistically significant improvement in academic performance and highly positive student feedback, it became clear that the online delivery of VOC can serve as a model for higher education institutions creating an all-inclusive learning environment experienced by rural students and staff regardless of location and distance, while making a positive impact on learning.

The purpose of this study is to gain insight into the interaction-sensitive skills medical practitioners enact as they manage multiple organizational factors in the context of discharging patients.

For that purpose, we carried out a cognitive ethnographic study in a Danish hospital, where we video-recorded three pre-ward round meetings, five discharge conversations and conducted seven semi-structured interviews. Fieldnotes and interview transcripts were analyzed using the method Cognitive Task Analysis, and video-recordings were analyzed via the interactivity-based approach Cognitive Event Analysis.

Our findings show that practitioners coordinate multi-scalar resources (e.g. verbal patterns and cognitive artifacts) in order to discharge patients in a safe and integrated way, which we propose amounts to the social and intercorporeal ability to align simultaneously emerging factors, like organizational procedures in the hospital, artifacts in use, sociocultural resources and the individual medical expertise of the practitioner in the emerging social interaction with the patient. In pursing this claim, we investigate the linguistic and cognitive processes emerging in a single case study of a nurse who discharges a patient. We propose that the interaction-sensitive skill which enables the nurse to solve the task of discharging the patient can be characterized via hybrid cognition.

Thus, the value of the article is dual: On the one hand, it empirically contributes with knowledge of the complex organizational structures that constrains micro-level medical interactions in discharges, and on the other, the article contributes theoretically with a hybrid cognitive framework that allows organizational researchers to understand and assess complex cognitive and linguistic processes that goes into the social micro-coordination in complex organizational-medical task.

L. Dee Fink proposes that different and more significant kinds of learning should be created in higher education to transition student outcomes from simply “learning” to “significant learning,” and these new types of learning should be situated within significant learning experiences (Fink, 2003). Fink also identified a taxonomy of significant learning that included six components: integration, foundational knowledge, application, human dimension, caring, and learning how to learn. Using Fink’s Taxonomy of Significant Learning as a framework, the authors will share the development of a course on navigating the US Healthcare System that resulted in significant learning outcomes for students completing the first semester of a four-year Doctor of Pharmacy curriculum. Each learning experience will link to a component of the taxonomy and will serve as the mechanism for the authors to share the development and implementation associated with each aspect of the semester-long course. The assessment structure of the course is described in detail. The authors present one or more learning experiences to illustrate each component of Fink’s Taxonomy. Finally, lessons learned from the development and implementation of the course are presented to guide programs considering implementation of a similar significant learning experience.