Table 3 Data Extraction Table

Austin et al. [17]

USA

Nursing students

N = 263

Identify the Impact on health professionals & children following their involvement in disaster preparedness simulation

Qualitative evaluation

16 children 6–15 years

Multiple sessions targeting different areas of preparation & role practice

Parental interview to gain understanding of child & parent experiences;

Written evaluations from nursing students about nursing process, confidence & knowledge gain

Identified 3 main nursing roles during mass casualty; assessment, triage & interventions; work in multi-professional team to improve rapid assessment & decision making skills; improved confidence (52 % reported some confidence, 21 % very confident & 19 % slightly more confident); 42 % gained awareness of hectic nature of mass casualty

Parents reported children had an increased awareness of disaster-readiness;

Children loved the experience;

Parents felt education & preparation was excellent; Would allow child to participate again

Parental consent & presence;

School support;

Nurse dedicated to 1:1 support during Sim;

Avoidance of critical events;

‘Opt out’ option

Blake et al. [22]

Canada

Final year medical students N = 57 intervention group

N = 35 in control group

To determine if feedback from adolescent and mother leads to improvements in 4th year medical students’ psychosocial interviewing

To evaluate whether this skill persists in the long term (2–12 months post intervention, average 6.6 months)

Prospective randomized double blind study with 3 arms;

Intervention group received feedback from adolescent SP & SP mother after 2 interviews, 4 weeks apart. 2nd intervention group received feedback once after 2nd interview only.

3rd group did not participate in interview

9 SPs as mothers

10 female adolescent SPs

Standardized feedback training

Adolescents guided by SP mothers to give feedback

Adolescent focus group

Pre-test review by psychologist using modified Calgary-Cambridge guide of interview with adolescent and mother SP

Post-test review of second interview 4 weeks after pre-test

Evaluation of knowledge & psychosocial interviewing scores on 2 OSCE stations

Group who received feedback after 1st interview scored better on post-test;

Both intervention groups had higher scores in psychosocial inquiry station in OSCE but not in knowledge;

Adolescent interviewing

skills can be taught & retained up to a year.

Time spent recruiting

& training is important.

Blake et al. [23]

Canada

N = 54 final year medical students

To identify any adverse effects on adolescents who regularly undertake risk-taking roles; to capture the viewpoint of adolescents over time; to describe the training and monitoring process for adolescents as risk-taking SPs

Prospective study involving control groups

n = 11 female adolescents aged 13–15 Y

Control n = 6

SPs of same age & grades completed

Information session

SP:Pre & post Interviews using Achenbach’s youth self-report & Piers Harris Children’s self-concept scale;

Focus groups;

Parental interview & questionnaire

PRE: SCS &YSR not in clinical range of concern for study or control groups; Focus groups:

Develop attachment to SP mother; Wish to come out of character to give feedback;

Benefitted from experience but SP work did lose glamour and become a job

Parent interview: Saw as opportunity for adolescent empowerment & to better understand how difficult it is for doctors, no increased interest in risk-taking behaviours

Recruitment & screening important;

Debrief;

Exit strategy;

Paid

Bokken et al. [29]

Netherlands

2nd year medical students over 5 years

Evaluate the views of teachers, students & adolescent SPs regarding the SP program; Evaluate the extent to which all 3 felt the program had changed over 5 years; Evaluate the lessons learner 5 year experience of the SP program

Pre/post tst

n = 16 adolescent girls 13-19y

n = 2 males

Introduction session & feedback training

Students rated quality of SP role performance & feedback using Maastricht assessment of simulated patients (MaSP); Adolescent SP questionnaire about their experience; Faculty completed questionnaire about SP consultation, quality of feedback & role play & students reactions

Authenticity of encounter 7.5-8/10, adolescent SP fits role & stays in it; general performance of adolescent SP decreased over 5 years; Faculty saw encounter as authentic, able to address specific aspects of communication not able to be assessed in other ways, SPs able to give natural & spontaneous feedback

No personal disadvantage; Some difficulty with feedback; 8 role plays per day ideal; No differences in evaluation across 5 years

Parents advised by adolescent;

Paid;

Individualized role

Bokken et al. [30]

Netherlands

Medical students N = 341

Evaluation of effects on adolescent SP of performing a role, the quality of their role playing and feedback

Descriptive

evaluation

Adolescents aged 16–18

N = 12

Role developed with adolescents based on their own experience.

Role related & feedback training

Students rated quality of SP role performance & feedback using MaSP; Adolescent questionnaire about effects of SP role; Faculty evaluation of, quality of feedback & role play

Learners indicated satisfaction with quality of role play & feedback; Student doctor & observer rated SP performance differently; Teachers noted a positive & authentic experience & acknowledged students may feel attracted to SP

Positive experience; Easier playing a role close to own experience; Need more feedback training

Given letter for parents but not mandatory to give it to them;

Paid for their time

Brown et al. [18]

USA

Medical students & Residents

Description of a pilot program to aid in training residents & medical students in complex interviewing skills addressing adolescent mental health issues

Qualitative

Children & adolescents aged 9–19 years

2 training sessions

Not involved in case preparation

Resident & medical student questionnaire about the program & achievement of learning outcomes,

Focus groups with child–parent SP dyads focused on preparation for roles, reactions to participation, ability to give feedback, reactions to roleplaying with biological/SP mother

Learning outcomes achieved & mostly positive program feedback – 2 learners preferred SP approach whilst 3 preferred lecture format

Child: Fun; empowering; contribute to learning for doctors; financial benefit

SP & SP parent: Training was good preparation; Mixed reaction to providing feedback – some would prefer to give to faculty instead of directly to learner ; Varied opinion about biological/SP mother

No psychological follow up

Children made links with personal experiences

Don’t need own parent present

‘Opt out’ clause

Paid

Feddock et al. [19]

USA

Medical students N = 95 intervention

N = 91 control group

Determine effect of adolescent medicine workshop on knowledge & clinical skills

Randomised controlled trial Intervention:

Medical students participating in adolescent medical workshop

Control: Medical students in alternative workshop

End of year clerkship exam with adolescent SP encounters; 3rd year clinical exam; written exercise & questions specific to adolescent medicine on clerkship written exam

Performance of intervention group higher on clinical skills & written exam

Hanson et al. [24]

Canada

2nd year medical students

Evaluation of adolescent selection methods & simulation effects for low & high stress roles in a psychiatry OSCE

Randomised controlled trial

SP assigned to low stress/high stress role or control group

Secondary school age adolescents

Information & training session

Employment & psychological screening

Simulation impact questionnaire; Interview; Focus group; Adolescent self-perception profile; Achenbach behaviour questionnaires;

Parental version of simulation impact questionnaire;

3 months after participation – interview; project role questionnaire to identify comfort enacting various roles

Identify good/bad doctors; Importance of training for SP work; Some adverse effects on relationships with peers, parents & school performance; No pre/post change in self-perception or Achenbach questionnaire; Discomfort with sexually explicit questions

Parents reported no adverse effects, small increase in self-confidence, job skills & sense of responsibility

Adolescent & parent consent

Hanson et al. [25]

Canada

Evaluating safety of suicidality sim

Pre-post

N = 24

14–17 years

Information session

Screening

Group training

Suicidal ideation questionnaire; Reynolds adolescent depression scale; behavioural measures

No deterioration in mental health status; Suicidality role showed negative reaction with; 2 reports of brief depression

Consent

Ethics approval

MH specialist

Stress relief methods

debriefing

Hanson et al. [26]

Canada

N = 34 paediatric residents

Determine association between simulation discomfort & mental illness stigma

Randomised controlled trial

N = 24

14–17 years

Randomised to suicide/depression or cough scenario

4 hours training & rehearsal

Project role questionnaire

Discomfort with sex questions due to lack of knowledge; Adolescents experienced in mental illness roles anticipated greater comfort portraying subsequent stigma associated roles

Consent

Ethics approval

Lindsey-Lane et al. [20]

USA

Paediatric medical residents

N = 56

Obtain qualitative data about the appropriateness, feasibility & responses of child SPs in CSA

Observational

n = 11 aged 7–16

n = 9 adults paired with children

Training sessions until consistency gained between history, PE & professional skills

Adult SP: Patient encounter checklists; Child SP gave overall patient satisfaction rating on checklist; SP focus groups with child/adolescents or SP and real parents; Residents completed questionnaires related to realism & challenge

Residents ratings low for fairness (2.9/5), but higher for enjoyment (3.1), realism (3.9) & challenge (4.1)

Child & adult SP satisfaction ratings concordant; Parent Focus Groups gave positive feedback about learning, working hard at a real job; SP parents noted child SP had negative reactions if ignored or talked down to

Children found experience at times exciting, nerve wracking & boring, tiring by the end of 6 hours, but good to earn money

Careful selection, in-depth training and debriefing by individuals experienced in communication with children

Pullon et al. [27]

NZ

N = 69 medical students

Assess consultation skills teaching & risk of harm to involved adolescent SPs

Retrospective evaluation

Adolescent girls (14–18) n = 4

n = 3 adult SPs

Discussion about suitability of case

Training

Student self-evaluation, video tape review of consultations by tutor; Interviews with adolescent SPs; Retrospective student evaluation via focus group

Increased confidence in consultation skills, however no clear effect on clinical performance

Adolescents positive about role, no negative effects but able to identify possible harm if supports not put in place

Parental & student consent

Clear criteria of concern

Rowe et al. [28]

Africa

5 rural community & one city health service

To evaluate health care worker performance during consultations

Evaluation survey

6 children aged 6 m-59 m

5 SP mothers

SP mothers: 3 training days 3 months prior and a 2 day refresher just prior to study.

No child SP preparation identified

Survey result analysis – client survey & conspicuous observation

No serious problems for SPs

Ethics approval obtained

Tsai [12]

Taiwan

19 studies – English, searched via Medline

Review use of child SPs & difficulties in using children in assessment of competence

Systematic review

Children as SPs in clinical assessments

Children from infancy to adolescence can participate as SPs in clinical assessments; Children should have a substitute; Can provide feedback; More negative impacts for younger children; Use of children should be avoided for ethical reasons

Only work with children for assessments that cannot be measured by other methods

Woodward, & Gliva-McConvey, [21]

USA

Identifying the effects of simulation on children

Qualitative

retrospective

N = 7 Children 6-18

Random selection from existing pool of child SPs

Focus group

Important skills & information gained; Positive & negative outcomes for younger children; fun can disassociate from role; Mainly positive for older children; Help adults learn; Identify good & bad doctors

Mothers included if children <13

Role close to the child’s personality & developmental age. Greater risk in younger children. Methods to monitor effects on children