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The Reliability of 2-Station Clerkship Objective Structured Clinical Examinations in Isolation and in Aggregate

Lead author: Aaron W. Bernard
Submitted by Kathy Herzberger, Loma Linda School of Medicine

The Frank H. Netter MD School of Medicine established 2-station OSCEs at the end of each clerkship to determine if these could replace the 5-7 station end-of-third-year examinations that are more common among medical schools. The goal was to assess reliability of these OSCEs in isolation, as well as in aggregate. They concluded that 2-station clerkship OSCEs have poor-to-fair reliability, but the aggregating data from all six of the clerkship OSCEs resulted in good reliability. Their article provides a nice discussion of their methods, experience, and findings. As a school that runs an OSCE after every clerkship I found their article interesting and applicable.

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An Arm and a Leg: An Actor Walks into a Doctor’s Office

Host: Dan Weissmann
Submitted by: Marsha Harman, Rush University

Researcher Saul Weiner has been sending fake patients — actors, wired for sound — into real doctors’ offices, to learn about what actually happens, especially: How well doctors really listen to their patients.  He’s tallied up what doctors miss (a lot), and how much it costs (ditto).  In today’s episode, we hear what actually happened in one of those “secret shopper” doctor visits — with the doctor and the actor who played his patient reading from the transcript of their visit, and then unpacking what went wrong.

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The Effectiveness of Using Human Patient Simulation Manikins in the Teaching of Clinical Reasoning Skills to Undergraduate Nursing Students: A Systematic Review

Lead Author: Lapkin S

Submitted by: Mary Launder, Rosalind Franklin University of Medicine and Science

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Aphasia Simulation: A Perspective from the Student and Standardized Patient

Lead author: Suzanne Moineau
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

The aim of this study was to examine student ability, perceptions of competency and effectiveness of simulation methodology for conducting language screenings on individuals with aphasia. Graduate students enrolled in a mandatory course on acquired language disorders completed a variety of simulated learning experiences using videos, high-fidelity manikins, and standardized patients, in preparing them for clinical practice with persons with aphasia. 5-point Likert scales and open-ended survey questions relating to student and standardized patients’ perceptions were administered. Results demonstrated a strong positive perception that simulation promotes student understanding of assessment procedures and aids in the development of clinical judgment.

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Interprofessional Education: A Poverty Simulation with Elementary Teachers and Social Work Students

Lead Author:  Annie J. Keeney
Submitted By: Amber Snyder, M.S., University of Pittsburgh

Poverty is demonstrably a determinant of heath. Approximately 43.1 million people in 2017 lived in poverty in the United States. Social workers consistently interface with individuals living in poverty, which requires a level of empathy and compassion. Learning strategies for adult learners can provide opportunity for skills-based learning to occur prior to interaction with clients in the field. Simulation training has been identified as an effective method for building empathy, knowledge, and skill.

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Long-Term Outcomes of a Simulation-Based Remediation for Residents and Faculty With Unprofessional Behavior

By: Jeannette Guerrasio, MD, and Eva M. Aagaard, MD
Submitted by: Marsha Harman, Rush University

Remedial training methods for physicians who struggle with unprofessional behavior are often ad hoc, are poorly described, and have unknown long-term results. In 2012, a think tank of experts on professional behavior identified a need for the academic community to develop evidence-based interventions to remediate lapses in professional behavior. In this article, we describe the simulation-based remediation methodology used to address individual skill deficiencies in struggling residents and practicing physicians at the University of Colorado School of Medicine. The study assessed the long-term effect of simulation used for specific unprofessional behaviors in residents and faculty referred for remediation.

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It’s Not All Brain Surgery: Future Doctors Should Be Tested for Empathy, Study Says

By: Kate Thayer
Submitted by: Kerensa Peterson, Northwestern University

Standardized patient educators understand the importance of empathy and the role it plays in patient-doctor relationships.  Many SPEs believe that empathy can be taught, and medical educators throughout the world have acknowledged empathy’s role in the healing process of their patients.  A researcher from Thomas Jefferson University in Philadelphia now poses the question should we be assessing for empathy as part of the medical school admissions process?  This article discusses some of the debate around this provocative question.

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St. Luke’s Unveils Mobile Simulation Lab and Other Company News

By: The Morning Call
Submitted by: Michael Maury, UC-San Diego

What if we could take this Simulation show on the road? Maybe it’s time to go mobile. St. Luke’s University Health Network has just unveiled a customized 2020 Freightliner M2 truck to serve as a mobile training unit. The 34-foot-long truck, called the Simulation in Motion Medical Education Lab, will bring training sessions to network campuses and sites, allowing staff to practice hands-on skills with state-of-the-art technology in a realistic and safe environment.

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How Does Health Care Simulation Affect Patient Care?

Lead author:  Joseph O. Lopreiato, MD, MPH
Submitted by:  Dyan Colpo, Cleveland Clinic, Simulation and Advanced Skills Center

Health care simulation programs have spread to many parts of the United States health care system, including hospitals, medical and nursing schools, community college programs, and clinics. Many educational and training units use simulation to help teach new skills, refresh old skills, and promote teamwork in the delivery of health care.

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Effectiveness of high fidelity simulation versus low fidelity simulation on practical/clinical skill development in pre-registration physiotherapy students: a systematic review

Lead author: Fiona Roberts, Kay Cooper
Submitted by: Mary Launder, Rosalind Franklin University of Medicine and Science

To evaluate the effectiveness of high fidelity simulation (HFS) versus low fidelity simulation (LFS) on practical/clinical skill development in pre-registration physiotherapy students the authors employed a three-step search strategy.

Evidence suggests that improved skill development in university can reduce anxiety in practice, improving performance of skills and overall learning at clinical placement for health professions students. However, evidence indicates that the clinical environment is most effective for learning. As a result, there has been increased interest in the use of HFS where students can test knowledge and skills in an increasingly self-directed way. No previous reviews on the effectiveness of HFS on skill development in physiotherapy students were identified.



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Dementia Education Workshops to Support Caregivers

By: Diane Weidner
Submitted by: Loïc Simard-Villeneuve, McGill University

A new workshop was created in September 2017 at the Steinberg Centre for Simulation and Interactive Learning (McGill University, Montreal, Canada). The goal of the workshops is to give caregivers information on the progression of the illness explained by either a neurologist or a geriatrician, to help them navigate the health system through the different stages of the illness and to provide a simulation that portrays the physical and psychological risks of living at home with dementia.

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LGBTQ Patients Reveal their Exhausting, Infuriating, and Surprisingly Common Struggles at the Doctor’s Office

By: Caroline Praderio
Submitted by Kathy Herzberger, Loma Linda School of Medicine

INSIDER interviewed a group of individuals from the LGBTQ community to explore their experiences with the healthcare system, in particular, doctor visits. Unfortunately, it is apparent that all too often these individuals are receiving inadequate healthcare, if they receive healthcare at all, as some providers refuse to treat them. As medical educators, we have a powerful platform to address these health disparities and biases with our students. Although there are many frustrating and heartbreaking experiences reflected upon in this article, The National LGBT Health Education Center and The Gay and Lesbian Medical Association offer hope of future change providing education and a database of LGBTQ-welcoming physicians.

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NPR - Hidden Brain; You 2.0: The Empathy Gym

Author: Shankar Vedantam
Submitted by: Catherine Hagele, Perelman School of Medicine at the University of Pennsylvania

Some people are good at putting themselves in another person's shoes. Others may struggle to relate. But psychologist Jamil Zaki argues that empathy isn't a fixed trait. On this episode of Hidden Brain, they talk about calibrating our empathy so we can interact with others more mindfully. This podcast focuses on how to exercise our empathetic muscles and cultivate one of our most precious human abilities. Empathy, at a deep level, is the understanding that someone else's world is just as real as yours. Empathy is like a muscle — it can be strengthened with exercise and it can atrophy when idle. The pros and cons of empathy in the medical profession are discussed.

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Twelve Tips on How to Provide Self-Regulated Learning (SRL) Enhanced Feedback on Clinical Performance

Lead Author: Heather Leggett
Submitted by: Kathy Herzberger, Loma Linda School of Medicine

As someone who is always open to new ideas that enhance my feedback skills, I found this article on providing feedback utilizing a 12-step process that encourages self-regulated learning thought-provoking. The comparisons between types of learners is particularly interesting. As the authors state, the provision of self-regulated learning (SRL) enhanced feedback on performing clinical skills and making a clinical diagnosis recognizes the importance of feedback. In contrast to the broader concept of self-directed learning, SRL has a specific focus on the individual learner’s approach to achieve a task, including their planning, self-monitoring, and future adaptations. The key SRL processes can be identified using structured microanalysis during the clinical task and feedback using the tips outlined in this article. It is essential that SRL enhanced feedback is integrated with best practices on providing feedback to ensure that its potential is achieved.

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Standardized Patient Assessment Of Learners In Medical Simulation

By: Holly Gerzina
Submitted by: Valerie Fulmer, President, ASPE

Performance-based assessment is consistent with outcomes-based education, whereby learners can demonstrate the performance of tasks, approach to tasks, and professionalism. Specifically, standardized patient-based performance assessment has advanced to include undergraduate and graduate medical education and is commonly used to evaluate both the technical and nontechnical skills necessary for the safe and effective practice of medicine. A standardized, objective, and structured method of assessment is critical for quality and accountability in medical education and transition to clinical practice. Miller’s prism of clinical competence provides a framework for simulation-based performance assessment of cognition and behaviors that demonstrate knowledge, skills, and attitudes on the continuum from novice to expert medical professional. Similarly, the Kirkpatrick model provides an adaptable framework to evaluate learners acquisition of knowledge, skills, and attitudes in the simulation lab and the subsequent transfer to clinical practice and actual patient outcomes. Thus, medical learners are commonly required to demonstrate acquisition of skills and competence via simulation before integration into clinical practice. Specifically, standardized patient methodology applied to performance-based assessment has been shown to provide a means of valid standardized objective assessment of learning and clinical skills before clinical practice.

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Pediatric Resident Experiences Discussing Sexuality in a Clinical Simulation

Lead author: Patrick Clements
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

In 2013 the AAP Committee on Adolescence published “Office-Based Care for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth”. This policy highlighted the importance of creating an inclusive environment for LGBTQ youth in the pediatrician's office, emphasizing patient confidentiality and the use of inclusive language. To help improve pediatric resident competency in these areas, this group from Riley Hospital for Children and Indiana University School of Medicine created a clinical simulation where residents had to discuss sexuality with a teenage standardized patient. The purpose of this project was to assess the usefulness of simulation to teach these skills, and then identify resident educational gaps for further curriculum development.

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In Transition: The Transgender Community Waits for Healthcare to Catch Up

By: Jessica Santina
Submitted by: Loic Simard-Villeneuve, McGill University

A group of first-year medical students sits before a panel of invited guests. It’s part of a daylong Practice of Medicine workshop focused entirely on LGBTQIA health care. The first panelist, a transgender woman, starts things off. "How many of you," she begins, scanning the room, "have had to call at least a dozen different doctors’ offices just to see if anyone would even take someone like you as a patient?"

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Self-Injuring Young Girls Overestimate Negative Feedback in Social Media Simulation

Author: Irene Perini
Submitted By: Amber Snyder, M.S., University of Pittsburgh

Adolescent girls who self-injure feel that they receive more negative feedback than they actually receive, and are more sensitive to "thumbs down" responses, compared to other adolescent girls. These are the findings presented by Irene Perini, researcher at Center for Social and Affective Neuroscience (CSAN) at Linköping University, in a recently published article.

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Undercover in a Hospital Bed: Secret Shoppers Pretend to be Sick to Help Make Hospitals Safer for Everyone Else

By: Tim Lahey, M.D.
Submitted by: Marsha Harman, Rush University

The woman on the gurney held the scratchy emergency room blanket closer to her chin. “What’s in the syringe?” she asked. The nurse frowned. “Don’t you want the medicine your doctor ordered?” The woman took a deep breath and kept asking questions. She had more than just self-interest on the line. She was a “secret shopper,” a consultant pretending to be a patient in order to evaluate the quality and culture of care in a hospital.

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Learning Empathy and Self-Advocacy by Teaching Communication to Medical Professionals

By: Tannaz Motevalli
Submitted by: Kerensa Peterson 

People get involved in standardized patient work for many reasons. Some reasons are deeply personal. Many SPs have had experiences with the medical system, either as patients or care-givers and then search for ways to give back to that community of healthcare providers. Tannaz Motevalli not only talks about what drew her to this work but also how being an SP has shaped her relationships with her current doctors.

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