Table.

Themes and subthemes with illustrative comments

Theme	Exemplar comment
Physical discomfort
C-collar and back-board	I did not understand or appreciate that those C-collars are awful. If I was at all not in my right state of mind, and I was like at all trying to take charge of my healthcare, I probably would have actually considered taking that thing off. It was really, really uncomfortable and painful and digging into my ears
Other	The stickers on your chest, pulling those off, I was missing a patch of chest hair for months. Really painful and awkward.
Emotional stress
Long wait times	I mean I knew this was a simulation so I knew that somebody would come and get me eventually but I was thinking if I was just some person waiting for my family member, I would see people walk by and it was a long time and if I was probably really here I probably would have looked for somebody and been like “hey do you remember that I’m here?”
Lack of privacy	Patients can hear what you are saying. They don’t care about your Facebook because they are having one of the worst days of their lives.
Feeling vulnerable	When they take off your clothing to do the secondary survey ... I am like realizing that that has to be a very vulnerable feeling to be there with a sheet over and you and people you don’t even know rolling you ... that would be something I now acknowledge is very emotionally uncomfortable.
Feeling of anxiety	I don’t think I have ever really internalized that and thought about how anxiety provoking it could be for those patients. I provide them the verbal reassurance that we are there to take care of you but I don’t think I’ve ever really thought about how stressful that could be to like ask could I please use the bathroom.
Lack of accommodation (for patients and family)	We were in a hallway bed and I always felt like I was in the way. People were pushing beds up and down that hall in that space on the B-side and then there wasn’t a chair or anything to sit and I was just kind of dodging everybody constantly.
Feeling burdensome to staff	I felt very self-conscious and that I was asking for something really annoying and taking their time, but the nurse didn’t show any sign in her face or tone of voice whatsoever that it was annoying request and was totally professional about it.
Other	Feeling very frustrated and feeling very isolated.
Poor communication
Lack of communication	It’s very anxiety provoking especially when you are in that room initially waiting for information.
Poor communication skills	I never thought that there would be so much abrasiveness associated with being a family member at a hospital even when you are not peppering the staff with questions or raising your hands to ask.
Other	Having no concept of who was communicating with me.
Unfamiliar with overall process
Unclear about plan of care	There were a lot of things happening at the same time and I also didn’t see anybody, so I feel it was just, like there were a lot of things happening at once.
Disorientated to surroundings	I remember not being told where I was going and having no idea where I was.
Unclear expectations of time	There were certain times that we had no idea how long the current activity was going to last and what was up next.
Good communication content
Providing updates on care	I guess it made me more cognizant of trying to find family members or update them when people tell me that their family members are coming.
Setting expectations on the process	Lying out the visit, which is something I hadn’t developed as a first year what actually I can do, what like a typical plan for a patient looks like. But now letting people know about that I feel is really valuable.
Setting expectations on timing	I think setting expectations early on is really important and overestimating time waits is really important.
Theme	Exemplar comment
Good communication skills
Positive interactions with staff	They both have very warm personalities, which helped. Our questions were very well answered. Our concerns were addressed by the attendings. I did notice that your time with them is very, very short. Which is probably realistic, we probably spent less than two minutes with each of them combined ... so most of your time is with the nurses ... which you don’t always necessarily realize as a resident or as an attending -- you are not the most important person in the room, it is typically the nurse, and I think this highlighted that in many ways.
Making eye contact	Every time I have a patient in a C-collar I lean over and make sure that they can see my face and explain my role and who I am and all of the people that are around.
Other	Just reiterating good communication.
Good patient care
Patient advocacy	Acknowledging people’s discomfort… that this is a strange experience and be sure to ask questions of how I can make that better for them, just little things.
Responsive to needs and concerns	Just normalized for them if they haven’t eaten to speak up and don’t feel bad about it, don’t feel self-conscious about like bugging us and asking for help if they need anything just because that was something more comfortable from my experience I think to let them know that it’s okay to do.
Being cognizant of time	It changed how I think about my patients when it comes to time because I was sitting around waiting for so long. So I realize when something is taking forever, I don’t think that I did it previous to this experience, but I go in and say “I am sorry that this is taking so long.”
Limitations of the exercise
Difficult to simulate pain	I feel like pain is such a subjective thing and like we weren’t experiencing pain it was really hard to advocate for ourselves.
Prior knowledge or experience	I feel like it was biased though because we knew what that was because I’ve done it on the other side. It made sense so even if he wasn’t explaining it, I still understood.
Strengths of the exercise
Realistic exercise	I thought that was super valuable to know what it’s like to be on that backboard to be looking at the ceiling and have paramedics ask questions.
Role modeling	I just remember the whole time being impressed by [senior resident] really. Being like, I hope I can do that one day.
Future directions
Keep disorientation and anxiety	I think doing it early before people know the staff and know the location.
New ideas	I would tell us whether or not you want us to give a true history or not, just to clarify what we are supposed to be saying when people ask questions. I would definitely have us like keep wearing those fake clothes. That was really helpful. I think having it as real as possible, so if you want to place IVs, that would have been not outside the realm of possibility. I mean you put the cast on for Pete’s sake; you might as well do everything else real.
General support for exercise	Yes (response to: “Do you guys think that this simulation influenced how you care for patients?”) Yes (response to: “So should we do this next year with the interns?”)