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Physician–patient interactions and communication with conscious patients during simulated cath lab procedures: an exploratory study
  1. Tanika Kelay1,
  2. Emmanuel Ako2,
  3. Christopher Cook3,
  4. Mohammad Yasin1,
  5. Matthew Gold3,
  6. Kah Leong Chan1,
  7. Fernando Bello1,
  8. Roger K Kneebone1,
  9. Iqbal S Malik1,3
  1. 1 Department of Surgery & Cancer, Centre for Engagement and Simulation Science, Imperial College London, London, UK
  2. 2 Barts Heart Centre, Barts Health NHS Trust, London, UK
  3. 3 Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Tanika Kelay, Imperial College London, London SW10 9NH, UK; t.kelay{at}


Background This exploratory study investigates the feasibility for observing and evaluating intraoperative communication practices using simulation techniques. Complex procedures are increasingly performed on patients under local anaesthesia, where patients are fully conscious. Interventional cardiac procedures are one such example where patients have reported high levels of anxiety undergoing procedures. Although communication styles can serve to alleviate patient anxiety during interventions, leading to a better patient experience, there has been little observational research on communication, while patient perspectives in intraoperative contexts have been underexplored.

Methods In this mixed-methods study, observational analysis was conducted on 20 video-recorded simulated scenarios, featuring physician operators (of varied experience levels), communication and interactions with a simulated patient (trained actor), in a controlled and highly realistic catheter laboratory setting. Two independent raters and the simulated patient embedded in scenarios retrospectively rated physician communication styles and interactions with the patient via four key parameters. Patient perspectives of communication were further explored via a quantitative measure of anxiety and semistructured qualitative interviews.

Results While independent ratings of physician–patient communications demonstrated few discernible differences according to physicians’ experience level, patient ratings were consistently higher for experienced physicians and lower for novice physicians for the four interaction styles. Furthermore, the patient’s anxiety scores were differentiable according to operators’ experience level. Thematic analysis provided further insights into how patient perspectives, including affective dimensions are characterised, and how physician interactions can amplify or attenuate feelings of anxiety through tone of voice, continuity in communication during the procedure, communicating while multitasking and connecting with the patient.

Conclusions Our findings indicate underlying patient assumptions about physicians’ experience levels, intraoperative communication styles and impact on anxiety. While observational methods can be applied to simulated intraoperative clinical contexts, evaluation techniques such as observational rating tools need to incorporate patient perspectives about undergoing conscious surgery.

  • communication
  • immersive simulation
  • simulated patients
  • patient perspectives

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  • Contributors The conception, design, coordination of the study, analysis of data and writing and preparation of the manuscript was led by TK. RKK, FB and ISM were involved in the overall conception of the study. EA analysed data with TK. KC, EA, MY and CC participated in the implementation of the study.

  • Funding This work was supported in part by the London Deanery Simulation and Technology-enhanced Learning Initiative (STeLI); Imperial College Healthcare NHS Trust Medical Education Directorate; and St Mary’s Coronary Flow Trust.

  • Competing interests None declared.

  • Ethics approval This study was deemed as exempt by the Imperial College Research Ethics Committee. The video recordings constituted part of a broader simulation training programme developed for the training of non-technical and technical skills in cardiology, in which all participants provided voluntary verbal consent for data to be utilised for research purposes and to inform the development of educational training frameworks for cardiologists and cath lab teams. All participants featured in photos provided voluntary written consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data sets for this study are available from the corresponding author on reasonable request.

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