Training deaf persons as standardised patients
Article first published online: 20 OCT 2009
© Blackwell Publishing Ltd 2009
Volume 43, Issue 11, pages 1098–1099, November 2009
How to Cite
Lowenstein, T., Lockwood, E. M. and Yudkowsky, R. (2009), Training deaf persons as standardised patients. Medical Education, 43: 1098–1099. doi: 10.1111/j.1365-2923.2009.03491.x
- Issue published online: 20 OCT 2009
- Article first published online: 20 OCT 2009
Context and setting Hearing loss is the sixth most common chronic condition in the USA, affecting 9% of the population. Deaf persons encounter pervasive communication barriers, which lead to lack of information access and negative health care experiences, and have poorer health and less frequent doctor visits than the majority population. Effective communication with deaf patients is essential to safe, efficient and patient-centred care.
Why the idea was necessary In the USA, many profoundly deaf individuals use American sign language (ASL) as their first language, yet few doctors use ASL interpreters and medical students and residents are not trained to work effectively with ASL interpreters. The aim of this pilot study was to explore the feasibility of training deaf persons as standardised patients (SPs) to aid in the instruction and assessment of residents’ communication and interpersonal skills (CIS).
What was done An SP trainer and a doctor, assisted by an ASL interpreter, trained two deaf university students to portray a patient, complete assessment instruments, and provide verbal feedback to residents. Training followed our usual SP training protocol, which included the reviewing and rating of previously recorded encounters of (hearing) SPs portraying the same case. Double the usual time was scheduled for training to allow time for ASL interpretation. The pilot occurred in the context of a mandatory formative assessment of neurology residents’ CIS consisting of six 10-minute SP encounters. The piloted case required residents to obtain informed consent for a lumbar puncture. No additional time was provided for the encounter.
Evaluation of results and impact Training the SPs to portray the case accurately, rate the residents using our standard communication scale and provide effective feedback did not require utilising the additional training time allotted because ASL interpretation occurred simultaneously rather than being delivered in alternation with the speaker as in other language interpretations. The primary training challenge involved reviewing the pre-existing videos because it was difficult for the SPs to simultaneously observe the video and the interpreter.
Each of the deaf SPs encountered two neurology residents. Two of the four residents were female; three were in the third year of training and one was in the second year. All residents had prior experience working with an interpreter with hearing patients who did not speak English; only one had previously worked with a deaf patient. We observed several errors typical of working with interpreters. None of the residents established whether the patient and interpreter were related and they often used medical terminology without explanation for the interpreter. Working with an ASL interpreter was unique in that the deaf patient looked at the interpreter while the doctor was speaking, making it difficult for the doctor to maintain eye contact. The SPs were able to assess and complete all items of the CIS checklist and rating scale. Residents agreed that verbal feedback was helpful. Both SPs and residents recommended longer encounters and longer feedback sessions.
Training deaf SPs is feasible and has the potential to help residents improve communication, become cross-culturally sensitive and provide effective health care for deaf patients.