Royal College of Surgeons in Ireland
s12909-021-02776-8.pdf (809.33 kB)
Download file

A realist evaluation exploring simulated patient role-play in pharmacist undergraduate communication training

Download (809.33 kB)
journal contribution
posted on 2021-07-30, 16:07 authored by Aisling Kerr, Judith StrawbridgeJudith Strawbridge, Caroline KelleherCaroline Kelleher, James BarlowJames Barlow, Clare Sullivan, Teresa PawlikowskaTeresa Pawlikowska
Background: Effective communication between pharmacists and patients is essential and improves health outcomes. Simulated patients (SPs) are trained to reproduce real-life situations and can help pharmacy students to develop and adapt their communication skills in a safe, learner-centred environment. The aim of this research was to explore how SP and pharmacy student role-play supports communication training.

Methods: A mixed methods realist evaluation approach was adopted to test an initial theory relating to SP role-play for pharmacy students. The intervention tested involved complex communication cases in a men’s and women’s health module in year three of a new MPharm programme. This SP session was the first such session, of the programme which exclusively focused on complex communication skills for the students. Data collected comprised video-recordings of both training and mock OSCE sessions, and from student focus groups. Communication videos were scored using the Explanation and Planning Scale (EPSCALE) tool. Scores from SP and mock OSCE sessions were compared using the Wilcoxon-signed rank test. Focus groups were conducted with students about their experience of the training and analysed thematically, through a realist lens. Data was analysed for Context-Mechanism-Outcome configurations to produce modified programme theories.

Results: Forty-six students (n = 46/59, 78 %) consented to their video-recorded interactions to be used. Students identified contextual factors relating to the timing within the course and the setting of the intervention, the debrief and student individual contexts. Mechanisms included authenticity, feedback, reflection, self-awareness and confidence. Negative responses included embarrassment and nervousness. They distinguished outcomes including increased awareness of communication style, more structured communication and increased comfort. However quantitative data showed a decrease (p < 0.001) in communication scores in the mock OSCE compared with scores from training sessions. Modified programme theories relating to SP training for pharmacy students were generated.

Conclusions: SP role-play is a valuable communication skills training approach. Emphasis should be placed on multiple stakeholder feedback and promotion of reflection. Time limits need to be considered in this context and adjusted to meet student needs, especially for students with lower levels of communication comfort and those communicating in languages different to their first language.


RCSI University of Medicine and Health Sciences



The original article is available at

Published Citation

Kerr A, Strawbridge J, Kelleher C, Barlow J, Sullivan C, Pawlikowska T. A realist evaluation exploring simulated patient role-play in pharmacist undergraduate communication training. BMC Medical Education 2021 21(1):325.

Publication Date

7 June 2021

PubMed ID



  • School of Pharmacy and Biomolecular Sciences
  • Chemistry
  • Centre for Simulation Education and Research
  • Health Professions Education Centre
  • Health Psychology

Research Area

  • Chemistry and Pharmaceutical Sciences
  • Population Health and Health Services
  • Health Professions Education


Springer Science and Business Media LLC


  • Published Version (Version of Record)