2012. Vol.3, Special Issue, 890-895
Published Online October 2012 in SciRes (http://www.SciRP.org/journal/ce) http://dx.doi.org/10.4236/ce.2012.326134
Copyright © 2012 SciRes.
Designing Relevant and Authentic Scenarios for Learning
Clinical Communication in Dentistry Using the
Vicki J. Skinner, Dimitra Lekkas, Tracey A. Winning, Grant C. Townsend
School of Dentistry, The University of Adelaide, Adelaide, Australia
Received September 14th, 201 2 ; revised October 17th, 2012; accepted October 25th, 2012
A clinical communication curriculum based on the principles of the Calgary-Cambridge approach was
developed during the revision of the 5-year Bachelor of Dental Surgery program (BDS) at The University
of Adelaide, Australia. To provide experiential learning opportunities, a simulated patient (SP) program
using clinical scenarios was developed. We aimed to design the scenarios to reflect communication de-
mands that student clinicians commonly encounter, that integrated process and content, and which stu-
dents would perceive as authentic and relevant. Scenarios were based on data from focus groups with re-
cent graduates and interviews with clinic tutors. The scenarios combined content (e.g. medical history)
and process (e.g. questioning and relationship skills) at a level suitable for junior students. Students
evaluated scenario-based materials and SP activities in a survey comprising Likert-scale and open-ended
questions. Students rated the materials and SP activities positively; open-ended comments supported the
ratings. Scenario-based materials and activities based on student-clinicians’ experiences, were perceived
as relevant, realistic, and useful for learning. A curriculum designed on Calgary-Cambridge principles
helped address student learning needs at particular stages of their program.
Keywords: Clinical Communication Skills; Simulated Patients; Dentistry; Calgary-Cambridge
As part of an overall revision of its five year Bachelor of
Dental Surgery (BDS) program, the School of Dentistry, at The
University of Adelaide, South Australia is implementing a new
clinical communication curriculum in Years 1 - 3. This fits with
the recognition of both the importance of patient-centred com-
munication in health-care and the need for explicit communica-
tion teaching in health-care professions. The immediate and
long-term benefits of patient-centred communication include a
range of positive outcomes for patients, such as greater satis-
faction with care, better diagnosis and treatment, better health
outcomes, better adherence to health-care regimens, and fewer
patient complaints (Little et al., 2001; Maguire & Pitceathly,
2002; Stewart et al., 1995). Furthermore, patient-centred com-
munication is considered a core component of best practice
dental education (Sanz et al., 2008). The bodies responsible for
quality assurance of dental curricula in Australia and in the UK,
the Australian Dental Council (ADC), and the General Dental
Council (GDC) respectively, have included communication as a
major competence for dental graduates, both in its own right
and for underpinning other domains of patient-centred care
(ADC 2010; GDC, 2010). Our intent is that the new communi-
cation curriculum must use an accepted framework or model
for clinical communication skills teaching and learning, it must
include evidence-based teaching/learning methods, and it must
fit the local curriculum context as well as meeting students’
needs. For this study our goal was to provide authentic and
relevant learning activities for Year 2 (junior) dental students.
The curriculum required a clear framework; however, the
dental education literature lacks accounts of whole-program
communication curricula or frameworks. Only a few dental
institutions have published accounts of discrete communication
modules or courses (Croft et al., 2005; Hannah, Millichamp, &
Ayers, 2004). Therefore, frameworks from medical education
were considered. The common attribute of most is to link
communication skills to the clinical tasks for which they are
used (Kalamazoo Consensus Statement, 2001). We selected the
Calgary-Cambridge approach because it is evidence-based,
well-explicated, and extensive resources for curriculum plan-
ning are available (Kurtz, Silverman, & Draper, 2005; Silver-
man, Kurtz, & Draper, 2005). We then adopted its three key
principles of curriculum design. First, that communication
learning ought to occur in a whole curriculum, not as an iso-
lated module, and second, that communication learning ought
to be programmed vertically so that learners have recurring
opportunities to revisit and extend their learning of core skills
(Kurtz, Silverman, & Draper, 2005: pp. 213-231). Finally, the
Calgary-Cambridge approach addresses communication skills
and clinical tasks by explicitly integrating communication proc-
ess and clinical content (Kurtz, Silverman, Benson, & Draper,
2003), which met our goal to integrate the students’ clinical
learning with requisite communication skills throughout the
curriculum. A recent paper in dentistry, by Haak et al. (2008),
described the adaptation of the Calgary-Cambridge Observation
Guides to design and implement a dental communication mod-
ule (Kurtz & Silverman in Haak et al., 2008). Using a random-
ised controlled trial pre- and post-test design, the researchers
showed that the intervention group exhibited better patient in-
terview skills than the control group when both were rated by
V. J. SKINNER ET AL.
trained observers. Although the Calgary-Cambridge communi-
cation framework has medical education origins, Haak and
co-authors (2008) noted its applicability to dentistry due to its
inclusion of the patient examination, which is an integral part of
all dental encounters.
The teaching/learning approaches in the new curriculum in-
cluded sessions in Year 2 with simulated patients using forma-
tive verbal feedback, video of student performance, and check-
lists. Teaching and learning methods for communication skills
training can include didactic teaching, observation, role-mod-
elling, practice with simulated patients, and video-taped prac-
tice with simulated and/or real patients (Carey, Madill, &
Manogue, 2010; Maguire & Pitceathly 2002; Rider & Keefer,
2006). However, communication skills learning is best sup-
ported by methods requiring active involvement and immediate
feedback (Maguire & Pitceathly 2002; Rider & Keefer, 2006),
and by assessment methods that are aligned with the intended
objectives of the teaching and learning program (Cegala &
Broz, 2002). The use of simulated patients is highly recom-
mended for undergraduate learning (Croft et al., 2005; Hannah,
Millichamp, & Ayer, 2004; Rider & Keefer, 2006) and assess-
ment using patient feedback and dentally-relevant checklists is
also advocated (Carey, Madill, & Manogue, 2010; Theaker,
Kay, & Gill, 2000). Simulated patients used in an English-
speaking educational setting are also useful for supporting spe-
cific target groups, such as students from diverse backgrounds
or students whose primary language is not English (Chur-Hansen
& Burg, 2006).
The communication curriculum also had to fit the needs of
our students and the patients they care for. As noted previously,
the communication curriculum was to be embedded throughout
the program to match students’ developing needs as they pro-
gressed through their degree, and material was to recur verti-
cally in different and more demanding contexts to allow stu-
dents to consolidate their skills (Kurtz, Silverman, & Draper,
2005: pp. 216-219). In the five-year Adelaide BDS program,
students begin clinic experience and provide patient care from
Year 1 (refer Table 1). After commencing clinic experience in
the second week of their first year of dentistry, students initially
provide simple preventive care for each other. In their second
year, students progress to providing preventive care for family
and friends who elect to attend the student clinic as patients.
Then in their third year, students commence caring for patients
whom are eligible for publicly funded dental care via the Ade-
laide Dental Hospital (ADH), which is part of the South Aus-
tralian Dental Service. Year 3, 4 and 5 students, under tutor
supervision, provide complete courses of comprehensive care
for their patients, some of whom may be in pain or anxious, or
who have been on public dental waiting lists for varying peri-
ods of time.
Therefore, a particular goal of the BDS communication cur-
riculum was to complement and augment junior students’ pa-
tient care with colleagues, family, and friends to help them
prepare for comprehensive hospital patient care in senior year
levels. We also aimed to provide a safe setting for junior stu-
dents to practise communication in preparation for comprehen-
sive patient care. To meet these goals of integrating process and
content, and longitudinally embedding and vertically spiralling
communication skills into the curriculum, we implemented
simulated patient activities in Year 2. The simulated patient
activities built on previous clinical communication sessions in
Semesters 1 to 3 of the BDS, which had comprised whole class
lecture-discussion sessions and application in case-based tuto-
rial discussions and in student clinic sessions. The aim of the
project described here was to design authentic and relevant,
integrated scenarios for use in simulated patient sessions and in
teaching videos to support the simulated patient sessions to be
implemented with junior students in 2011. The research ques-
1) What are the communication demands of situations that
our student clinicians commonly encounter when treating pa-
tients in the dental hospital?
2) What clinical situations are best suited to develop scenar-
ios to consolidate and extend students’ learning from Years 1
and 2 to Year 3?
3) Do Year 2 students perceive the scenario-based materials
and activities as realistic, relevant, and useful to their develop-
ment as clinicians?
In the rest of this paper we describe under Methods and Re-
sults sections headed “Scenario development” how research
questions 1 and 2 were addressed. Under Methods and Results
sections headed “Scenario evaluation”, we show how research
question 3 was addressed.
The scenarios were based on research evidence of communi-
cation demands of the clinical situations that BDS students
commonly experience during patient encounters in the ADH.
Therefore, to address research question 1, a qualitative approach
was used. Ethics approval was obtained to gather data through
focus groups with recent BDS graduates and semi-structured
interviews with clinic tutors. The recent graduates had com-
pleted their final examinations two months previously and were
at the time working in the ADH as house dentists. Nine house
dentists took part in focus group discussions. Each focus group
Patient care provided by students throughout the Adelaide dental program.
Year Semester Clinic patients Care provided
1 - 2 1 - 3 Student colleagues Preventive care of a healthy patien t
2 4 Family & friends Preventive care of patients with early oral health problems
3 5 - 6 ADHa. patien ts Comprehensive simple cour se of care e.g., restorative and periodontal care
4/5 7 - 10 ADH patients Comprehensive, complex course of car e e.g., complex general restorative and peri odontics, fixed
and removable prosthodontics, endodon t ics; medically compromised patients
ote: a.ADH: Adelaide Dental Hospital (patients are eligible for publicly funded dental services via the South Australian Dental Service).
Copyright © 2012 SciRes. 891
V. J. SKINNER ET AL.
took 30 - 45 minutes and was audio-recorded. The clinic tutors
were involved in supervising patient care provided by Year 3 -
5 BDS students in the ADH. Sixteen clinic tutors participated.
Each interview took 20 - 30 minutes and was audio-recorded.
The core question for the focus groups and interviews was:
What situations do students commonly encounter in clinics that
have presented a communication challenge for them? (i.e. re-
search questions 1 and 2). Participants were asked to describe
the features of the situations, such as precipitating factors, pa-
tient behaviours, and how these situations made the students
feel. The data analysis had two objectives: to list and group the
situations in order to identify a set of core types of encounters;
and to describe some key features of these types of situations
that could be used for scripting scenarios.
To address research question 3, a survey was used. Partici-
pants were Year 2 students in the 2011 cohort. Ethics approval
and students’ consent were obtained to match students’ survey
responses to the formative assessment data that were also col-
lected during the activities (to provide immediate feedback the
simulated patients, the tutors and the students all completed
checklists about each encounter; students were also given a
digital video file of their interaction with the simulated patient).
In a class of 79 students, 67 consented to the data-matching
(85% response rate). The results of the consenting students’
survey evaluations relating to students’ perceptions of realism,
relevance, usefulness, and impact are reported here.
The students completed a survey about the clinical commu-
nication activities after they had taken part in all the clinical
communication activities using the scenarios (in videos or
simulated patient role-plays). The survey comprised 15 ques-
tions: 13 Likert-scale response items and two open-ended ques-
tions. The scale items, which were rated using a 1 to 5 scale,
where 1 was “strongly agree” and 5 was “strongly disagree”,
addressed elements of program organisation, students’ percep-
tions of the scenarios/videos, and students’ perceptions of the
impact of the program. The open-ended questions asked stu-
dents what aspects of the materials and activities had been most
useful for their learning, and what would improve the materials
The focus group and interview data presented a range of
situations that commonly arose in student clinics and details
about the communication demands associated with them. These
situations represented differing levels of complexity (from a
clinical and a communication perspective) and from them we
selected three core situations, which are described in detail
below, from which to design the scenarios. To address research
question 2, the criteria for selection were that the situation was
most likely to be encountered in Year 3, the situation was ap-
propriate to introduce in Semester 4 in Year 2, and the range of
situations and scenarios would provide comprehensive experi-
ence to help Year 2 students prepare for Year 3. These scenar-
ios provided the basis for the video scripts and the simulated
patient role-play guidelines. The other, more complex situations
were reserved for development into scenarios for Year 3 stu-
dents. The core situations selected for Year 2 included interact-
ing with: 1) a friendly or talkative patient, because this has
potential to distract the student from his or her clinical task or 2)
an anxious patient, because this is quite common in dentistry,
or 3) an annoyed or complaining patient, because this can per-
manently damage the dentist-patient relationship. The Year 2
scenarios were based on these core situations and enriched by
adding detail from the data about specific aspects of patient
dialogue and behaviour. For example, the recent graduates had
described how patients who were anxious behaved and inter-
acted in a number of different ways. Among these, some pa-
tients were quite frank about their dental anxiety and welcomed
the opportunity to talk about it with their student clinician,
while others attempted to mask their anxiety with humour or
The next step in scenario development was to integrate proc-
ess and content according to the Calgary-Cambridge approach
(Silverman, Kurtz, & Draper, 2005). For each clinical situation,
the aim was to identify clearly the clinical goal, then what
clinical content knowledge and skills were required to achieve
that goal, and what communication skills would support the
accomplishment of the goal. The title of each scenario reflected
the overall clinical goal, which was chosen to incorporate both
the patient’s and the student’s needs in each type of situation;
within the overarching goal we embedded specific clinical
skills. The data-based scenarios were titled: “Balancing needs”;
“Building confidence”; and “Defusing situations”.
“Balancing needs” focuses on student-patient interaction
during history-taking with a patient who is very friendly or
talkative. It refers to the twin clinical goals of the situation,
which are relationship-building via conversation, and focused
information-gathering via the history questions. The demand on
the novice student is to effectively balance the need of the pa-
tient for conversation with their own need as clinician to obtain
information in an efficient and timely manner. “Building con-
fidence” refers to the essential requirement for the student to be
calm and confident when interacting with a patient who is anx-
ious, in order to support the patient to be calm and have confi-
dence in their student clinician so that treatment can commence.
“Defusing situations” addresses the need for the student to have
skill at managing their own thoughts and feelings in order to
interact effectively with a patient who directs their displeasure
at the student clinician. This is also to enable care to proceed.
Table 2 summarises the title or core goal of each scenario, and
the roles of the student and the patient in each. Table 3 illus-
trates the process and content skills embedded in each scenario.
Table 4 shows how the materials and activities were used in
A large majority of students gave positive ratings to all items
relating to the authenticity, usefulness, and relevance of the pro-
gram and scenarios. Responses to items included: “The videos
used in class seminars were realistic” 3.8 ± 0.8; “The videos
used in class seminars helped my learning” 3.8 ± 0.7; “The
simulated patient scenarios were relevant” 4.0 ± 0.5; “The
simulated patient program is relevant to my future experience in
clinic as a dentist” 4.1 ± 0.7. Figure 1 shows the number of
students per rating point for each of these i tems. The majority of
students also positively rated the impact of the program on their
ability and confidence for clinical communication with patients.
This was addressed by items “My ability to communicate effec-
Copyright © 2012 SciRes.
V. J. SKINNER ET AL.
Summary of the title/core goal and the patient and student roles in each of the three scenarios.
Title/goal Summary Simulated patient role Student role
Balancing ne eds Medical h is t ory with a patient who
is talkative & friendly Talkative, as ks questio ns, e .g. “Why are y ou as king m e
that?” “Do you enjoy ...?” Maintaining rapport and
staying on track
Building confidence An interview with a patient who is
anxious Openly anxious OR masks anxiety with
humour/bravado or delaying tactics Maintaining rapport & being
Defusing situations Discussing treatment plans with a
patient who is annoyed Complai ns about waiting or the proposed treatment
plan e.g. “Why can’t you do all my filling s today?” Maintaining rapport & being
Summary of the process and content s k i lls embedded in each of the three scenarios.
Title/goal Process skills Clinical content
Balancing needs Patient-centred approach e.g. provid ing cont ext
for the questions, giving clear e xpl anat ions Medical history for dentis try knowledge: what questions ar e
asked, what follow-up questions are required
Building confidence Re lationship-building e.g. acceptance, empathy Applying knowledge of dental anxiety; patient managem ent
Defusing situations Relationship-building e.g. acknowledging,
conflict management Providing appropriate explana t io ns o f clinical plans
Student activities using the scenar i o- b a s e d v i de o s a n d s imulated patient sessions: outl i n e p r o v i d e d t o s t u d e n t s .
Session type Session title Session outline
Class seminar Introduction/Balancing needs Introduce aims, objectives and outcomes of activities
Prepare for session 1: v iew and discuss video example scenarios
Tutorial 1 Balancing ne eds A talkative patient: Commencing a Hx and interacting with the patient AND staying on track,
obtaining required informa t io n
Class seminar Building confidence Whole-class discussion of tutorial 1
Preparation for sessi o n 2: view a n d di s cuss video exam p l e scenari os
Tutorial 2 Building confidence An anxious patient: Building o ne’s own and patient’s confidence befor e commencing examina t i on
Class seminar Defusin g situations Whole-class discussion o f tutorial 2
Preparatio n for session3: view and discuss video example scenarios
Tutorial 3 Defusin g situations A patient with a complaint: Managing self and patient in a potential ly unpleasant situation
Students’ ratings of realism, usefulnes s, and relevance.
tively with patients has improved after participating in the pro-
gram” 3.5 ± 0.8, and “I feel more confident communicating with
patients after participating in the program” 3.7 ± 0.8. Figure 2
shows the number of students per rating point for each of these
The students’ open-ended comments enriched and explained
the positive ratings (examples of student’s comments are pro-
vided in italics). A large number of comments referred to the
Students’ ratings of their ability and confidence.
videos used as a basis for class discussions in the seminars.
Students said they were useful because they gave various illus-
trations of dentist-patient encounters in each type of situation.
Students also noted that they could use or adapt these examples
for their own use.
Watching videos of scenarios and discussion with class af-
terward—the videos were scripted so you could have a pre-
dictable, common situation, to have the 1st exposure to patient
Copyright © 2012 SciRes. 893
V. J. SKINNER ET AL.
Watching video examples of good patient communication:
can learn good phrases & things to avoid.
The majority of positive comments related to various aspects
of the simulated patient scenarios and/or role plays with simu-
lated patients. Students valued the opportunity to work with
new and unfamiliar “patients” in addition to their familiar col-
leagues, family and friends. Some students also noted that this
was a safe environment for communication practice and learn-
ing from errors.
Getting to interact with a stranger, a very different feeling to
interacting with classmate.
We got to work with “patients” that were total strangers,
definitely prepares us for further years.
Having the opportunity to communicate with real patients
without the pressure.
Being able to make mistakes AND learn from them.
Students also wrote about the scenarios and their application
in role plays with simulated patients. The benefit of these was
two-fold: raising students’ awareness of situations they may
encounter in their future clinic, and providing a chance to prac-
tice interacting with patients in these situations.
Real life interactions with patient Raised up certain issues
that we were not aware of and we could discuss and make sug-
gestions of possible ways of managing patient.
Practicing communicating answers to patient’s con cern: think
of reasons to give patients with regards to treatment and pre-
pares us for clinical situations.
Situations were realistic and helped me learn practical skills,
a good thing to do before seeing real patients.
Gives an idea of what one can expect to encounter in clinic
terms of patient expectations and reactions.
Other positive comments related to the small group format.
Students noted that in addition to having their own experience,
it was useful to observe and learn from colleagues’ interactions.
Several students identified feedback from simulated patients,
tutors, and colleagues as useful for learning. There were no
negative comments about the scenarios, the videos, or the simu-
lated patient interactions. Negative comments referred to the
organisational aspects of the sessions, such as altering the tim-
ing to complement other learning activities.
Our overall goal was to develop a rationale for and then im-
plement clinical communication activities for Year 2 dental
students that would form part of a coherent communication
curriculum in which process and content integrate within ac-
tivities and there are recurring opportunities for students to
learn (Kurtz, Silverman, & Draper, 2005). In particular, this
project sought to develop authentic, relevant scenarios for this
component of the communication curriculum, and which were
suitable for Year 2 students in preparation for commencing
Year 3. The scenarios were used to produce teaching videos
that were the basis of class discussions to prepare students for
interacting with simulated patients, and to develop guidelines
for the simulated patient activities. To develop scenarios, the
focus group and interview data with recent graduates and clinic
tutors provided rich information about actual clinical encoun-
ters and the communication demands of these situations. An
obvious advantage of using data from recent graduates and
clinic tutors to develop the videos was to ensure the local rele-
vance of the scenarios. However, in addition, it was necessary
to develop materials that were suitable for the level of the Year
2 students. While there are high quality learning materials
available online about dental communication (e.g. University of
Michigan open resources at
http://open.umich.edu/education/dent), the clinical content is
generally too advanced or too specific for junior dental students
in the BDS program.
The activities based on the scenarios were intended as part of
the vertical spiral or helix structure of the curriculum (Kurtz,
Silverman, & Draper, 2005: p. 217), and to be realistic and
relevant. The preliminary data from the student evaluation of
the scenario-based activities show that students perceived that
the activities met this curriculum goal. The majority of students
were positive about the authenticity and relevance of the sce-
narios used in the videos and the simulated patient role-plays,
and considered the activities useful preparation for their future
clinic role. These active and experiential methods for learning
clinical communication were recommended in a recent review
of communication skills teaching and learning methods used in
UK and US dental schools (Carey, Madill, & Manogue, 2010).
The students in the present study commented about the benefit
of practising with strangers compared to familiar “patients”,
which suggests that the activities enabled them to revisit and
consolidate their skills from previous communication and clinic
activities in Year 1 and 2. A positive student endorsement of
scenario-based video and simulated patient teaching has been
reported by other dental educators. Hannah, Millichamp &
Ayers (2004) suggested that students evaluated clinical scenar-
ios positively because they provided a “realistic and challeng-
ing learning task” (p. 975). Other studies have reported that
students rate highly the value and relevance of simulated pa-
tient scenarios as preparation for their future clinic experiences
(Croft et al., 2005; Gorter & Eijkman, 1997). Comments from
students in the present study suggest that a major reason for this
is that scenario-based videos provided explicit strategies and
language that students could adopt or adapt to practice in the
role-pays, and then ultimately, in clinic with patients. The ma-
jority of students in this study perceived that their ability to
communicate with patients had improved and they felt more
confident about interacting with patients. Other dental educa-
tion studies have shown that students felt better prepared to
communicate with patients after taking part in explicit, experi-
ential communication skills sessions (Croft et al., 2005; Hannah,
Millichamp, & Ayers, 2004; Gorter & Eijkman, 1997).
A limitation of the present report for judging the impact of
the activities is that it only contains students’ perceptions. An
accepted framework for evaluating the impact of educational
interventions in health professions has been adapted from the
Kirkpatrick system of hierarchical outcomes (Beckman & Cook,
2007). In this hierarchy there are four ascending levels of evi-
dence of effectiveness: 1) reaction (satisfaction); 2) learning
(attitudes, skills, knowledge); 3) behaviour (impact on clinical
practice); and 4) results (impact on patients). The student sur-
vey addresses the reaction and students’ perceptions of learning.
To adequately understand the impact of the activities, further
information about the actual learning outcomes and students’
behaviour in clinic with patients is required. We have data on
learning, to be analysed, which includes students’ written
self-evaluations and the written feedback from the simulated
patients and tutors. We also have written responses to examina-
tion questions that address the first two levels on Miller’s (1990)
Copyright © 2012 SciRes.
V. J. SKINNER ET AL.
Copyright © 2012 SciRes. 895
four-level schematic (“knows”, “knows how”, “shows”, “does”)
for assessing clinical skills or competence: the level of knows
(knowledge of communication skills) and knows how (compe-
tence of how to apply communication skills). To be developed
are ways of linking the activities to the outcomes of students’
communication with patients in clinic and any resulting patient
oral health improvements, i.e. Kirkpatrick’s levels three and
four (Beckman & Cook, 2007), and ways of assessing these at
the level of what Miller (1990) called “production”: “shows”
and “does”. The materials and activities are being used again in
2012 as part of the communication curriculum, and further data
to understand their im pa c t are being collected.
The Calgary Cambridge approach provided a clear rationale
for planning a communication curriculum in dentistry and then
for designing activities to suit a particular niche within the cur-
riculum. Students considered that simulated patient activities
were useful for their learning needs in relation to patient com-
munication and the transition from providing care for familiar
patients, such as student colleagues, to public hospital patients
who were generally strangers, were implemented. Using sce-
narios based on local data, students perceived the scenarios to
be authentic, relevant, and useful for their learning and prepara-
tion for future clinical experiences.
The authors thank: the students and staff of the School of
Dentistry; Ms Karen Squires for administrative assistance; Mr
Corey Durward of the University Online Development Team
for video production; Mr Cory Dean, BDS Hons student, for
conducting focus groups and interviews (supported by a Uni-
versity of Adelaide Summary Vacation Research Scholarship).
The simulated patient program was developed and implemented
with a University of Adelaide Implementation Grant for Teach-
ing and Learning Enhancement.
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