High fidelity trainee simulation to improve trainer performance.

Using trained actors to simulate trainee doctors in difficulty is a cost-effective communication skills teaching tool that can be enhanced by techniques that are familiar to hi-fidelity electronic simulation. Simulation has two broad strands: the first exchanges the patient for an actor in the clinical encounter, and the second introduces some form of technology to the encounter. The strand concerning actors is well developed, and generally focuses on 'the consultation'. Where simulation draws on technology, the spectrum is broad: it may be relatively low-tech, for example computer-based scenarios to test prescribing, through to more high-tech approaches to learning practical skills using sophisticated manikins that replicate patient signs and symptoms. Over the years simulation has radically changed medical training, and is set to continue to do so in the future.Actors have been used for many years to contribute to the training and assessment of medical students, specialty trainees and established doctors. Their role to date has largely been limited to playing patients in scenarios.This innovation in communication skills teaching seeks to draw on both strands of simulation. It sees actors playing general practice (GP) trainees to enhance the continuing professional development of established GP trainers, in contrast to the more usual use of actors playing patients. It also makes use of the control mechanisms afforded by technological simulation in fine-tuning role-play scenarios.By using actors, the scenarios can be played up or down in order to challenge participants and maximise their learning. More research is needed to develop this approach further in other medical education contexts.