Phenomenon: With increasing mobility of people across borders and medical tourism, more countries are called to make their healthcare environment ready to accept foreign patients. Patient communication skills in English are indispensable for healthcare professionals in non-English-speaking countries. This is not only in caring for foreign patients within the country but also contributing to the global health by practicing outside of the country. Although Japanese-speaking simulated patients have been involved in medical education in Japan since the 1970s and with Objective Structured Clinical Examinations formally implemented in 2005, very few medical schools have been working with English-speaking simulated patients (ESSPs).
Approach: A nationwide survey was conducted to investigate the involvement of ESSPs at medical schools in Japan. A questionnaire with closed and open-ended questions was mailed to the deans of 80 medical schools to determine the current ESSP involvement and the problems educators were facing in regard to working with or not working with ESSPs. The survey was conducted from November 2015 through March 2016. Data were analyzed to find problems regarding ESSPs so that their involvement could be enhanced toward developing medical students' patient communication skills.
Findings: Responses from 60 medical schools (75% response rate) were received and analyzed. Among them, 22 schools were working with ESSPs, and 23 schools were willing to introduce them into their programs. The background of ESSPs varied with international students or faculty often filling the role. Many ESSPs received less than two hours of training. ESSP programs were required in the preclinical years, and more often elective in the clinical years. Medical schools mentioned the difficulty of recruiting and training ESSPs and finding the funding to pay for their remuneration and travel expenses.
Insights: ESSPs were increasingly used in Japanese medical schools but they were haphazardly recruited from within the school or from the local community, not trained fully, and inconsistent performers. Nevertheless, an encounter with a non-Japanese English-speaking simulated patient was regarded effective in developing medical students' patient communication skills in English (language skills and cultural sensitivity). Ways must be found to assure the availability, quality, and sustainability of trained ESSPs so that more authentic practices and high-stakes skills exams can be introduced to ensure patient safety in the globalized world. As countries become more multicultural and international migration of healthcare professionals expands, ESSPs can be a valuable source for training and assessing international medical students and trainees' English-language patient interviewing skills. Regional hubs of ESSPs and the use of telehealth in collaboration with educators around the world could enhance the use of ESSPs worldwide.
Keywords: English-speaking simulated patients; cultural sensitivity; globalization; international medical students and trainees; patient communication skills.