Clinical simulation and shared decision-making

Practicing multidimensional integrative medicine

James Fleck, MD, PhD: Anticancerweb 22 (02), 2022

One of the best ways to teach healthcare professionals and extend medical knowledge to patients and families is through clinical simulations. These are stories that reflect the real world and reveal medicine in its multidimensional approach. The plot facilitates the understanding of the physical, emotional, cognitive and social components of coping with the disease. The patient is always the protagonist and the physician is the one who tells the story, assuming a supporting role, but guaranteeing the rational of the proposed interventions. Clinical simulations represent the best form of cognitive approach to the patient, an essential condition for obtaining informed consent and practicing shared decision-making. 

Medical students find in the daily life of the medical character a set of challenges faced in the doctor-patient relationship, experiencing technical, ethical and emotional dilemmas. When reading a clinical simulation, the medical student naturally seeks an identification with the fictitious doctor. This subjective choice confirms the self in its professional mission and reinforces the importance and practice of the empathic behavior. It translates into a perfect balance between sensitivity and reasoning. Gradually, the student comes to understand empathy as a cognitive attribute and exercises it in the daily activity of the medical character. Patients often use human values to help them cope with the disease. The student learns how patients use specific human values to help their relationship with the physician. The fictional doctor is always sensitive to the patient's emotional flow, identifying the anchor human value capable of sustaining and guiding the patient's care. The simulations describe the pattern of clinical expression of the most frequent malignant tumors. The medical student quickly recognizes the multiple dimension in the clinical presentation of disease, which supports the development and use of diagnostic and therapeutic algorithms. Oncogenesis recalls nature, revealing self-similarity. There are general and repetitive patterns of clinical expression for each primary tumor, followed by well-defined subclasses, supported by imaging and laboratory techniques in both microscopic and molecular environments. A precise relationship between macro and micro characteristics of the disease is explored in each clinical simulation, promoting in the student a gradual feeling of proficiency in medical practice. Clinical simulations strengthen self-confidence. Each simulation clearly shows that accurate diagnosis and successful recommendations are a natural consequence of the sustained practice of medicine. However, the student soon recognizes that identifying the tumor phenotype is not the most difficult challenge. Much more complex is making recommendations according to the psychological and social condition experienced by the patient. Here, medicine becomes art. Sensitivity is a non-cognitive attribute and represents the main background for successful medical practice. Students find in clinical simulation an opportunity to reflect on their own level of sensitivity, encouraging the expression of this attribute in the successful practice of medicine. Clinical simulations provide an early experience of what will happen in the real world, better preparing medical students for the expected challenges in the doctor-patient relationship.

Patients and families also benefit from clinical simulation. After being informed of the diagnosis, they can select the most appropriate story, choosing between the primary tumor location or identification with a specific anchor human value, used by the protagonist to lead the doctor-patient relationship. The choice centered on the primary tumor refers to a cognitive intervention. The patient learns the clinical expression of the disease, the sequential stages of diagnosis and therapeutic options. The option for a specific anchor value refers to a subliminal intervention, strengthening the patient for proper emotional coping with the disease. Each patient needs a particular timing to assume cancer diagnosis. However, the urgency of oncological recommendations finds in clinical simulations a valuable tool for prompt understanding of the disease. Subliminal intervention helps the patient at turning points. These are very special moments when the patient stops complaining and starts to collaborate with the doctor in the effective resolution of the problem.

Clinical simulations are also valuable tools for creating collective intelligence. You can actively participate in this journey. Browse published clinical simulations and comment on their usefulness in medical practice. You can find several clinical simulations at by clicking on the book section shown in the menu.


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2. Photo by Annie Spratt on Unsplash (modified)