General Interest:  Why Doctors Are Running Out Of Empathy:  Inside the “Sickness-Billing Industrial Complex”
Lead author:  Alex Mohseni
Submitted by:  Dyan Colpo, Cleveland Clinic, Simulation and Advanced Skills Center

Walking up to the door of the waiting room, I knew what lay behind it. The gnawing torment would start the day before, or sometimes two days prior. Three parts nausea, two parts dread, and a dash of anxiety — the recipe was always the same. Just add an organic grass-fed doctor, and you have yourself a nice little snack for the healthcare system to chew up and unceremoniously spit out.

General Interest: Stigmatizing Language in Medical Records Affects Future Treatment
By: Cecilia Pessoa Gingerich
Submitted by: Todd Lash, Publications Committee Chair

A study from Johns Hopkins University School of Medicine found that the presence of stigmatizing language in a patient’s medical records affected a physician’s clinical decision-making later on. Researchers found that reading a vignette about a hypothetical patient with sickle cell disease that contained stigmatizing language affected how study participants treated that patient’s pain, as compared to participants who read a neutral vignette of the same patient.

Journal Article: Promoting Empathy Among Medical Students: a Two-site Randomized Controlled Study
Lead Author: Celine Buffel du Vaure
Submitted by: Kerensa Peterson, Northwestern University

Two universities in Paris took part in this randomized controlled trial. The results? The use of Balint groups may promote empathy among medical students. Self-reported empathy at follow-up was significantly higher among the fourth-year medical students who participated in Balint groups. There are interesting results in this study when looking at student characteristics, such as education level of parents, gender, anticipated specialty choice and living status.

General Interest: Should you stop shaking hands with your patients?
By: John Murphy
Submitted by: Anna Lank, C3NY – Clinical Competence Center of New York

What’s the polite thing to do when you meet someone? You look them in the eye and shake their hand, right? But these days, when hospitals and offices are oozing with indestructible bacteria and patients are trigger-happy with lawsuits over perceived offenses, should you still be touching your patients’ hands?

Journal Article: Smoking Cessation Counseling: A Simulation Enhanced Curriculum to Improve Motivational Interviewing in Pediatric Residents
Lead author: Sarah Schaefer, MD
Submitted by: Dan Brown, Emory University School of Medicine

Recognizing the lack of education and experience in smoking cessation counseling among pediatric residents, a team of doctors and educators at University of Alabama at Birmingham developed a curriculum using standardized patients to teach evidence-based counseling techniques and resources such as “The 5 A’s,” nicotine replacement therapy, telephone hotlines, and motivational interviewing.

General Interest: Let’s talk about it: Death
By: Meghan Knoedler
Submitted by: Mary Launder, Rosalind Franklin University of Medicine and Science
Recognizing the global need for improved dialogue around end of life care, Salzburg Global Seminar convened 66 leaders from 14 countries around the topic “Rethinking Care Toward the End of Life.” The highlights from the session on end of life care, co-led by Mayo Clinic and The Dartmouth Institute for Health Policy and Clinical Practice, include a need for increased education and training for medical professionals. The goal is to find a way to have difficult conversations regarding death and smoothing the transition from a more curative notion of health care to an approach driven more by palliative care and quality of life.

Read the full article in Advancing the Science/Mayo Clinic Medical Science Blog here.

Journal Article: Recruiting Participants into Pilot Trials: Techniques for Researchers with Shoestring Budgets
Lead authors: Rodney P. Joseph, Colleen Keller and Barbara E. Ainsworth
Submitted by: Michael Maury, UCSD

As pointed out in the abstract, “Limited research has focused on recruitment strategies for health promotion researchers conducting small-scale pilot studies.” The authors lay out five key recruitment techniques that can be utilized to succeed in recruitment efforts when working on a budget. These techniques are: 1) leverage existing social networks and personal contacts, 2) identify and foster collaborations with community gatekeepers, 3) develop a comprehensive list of potential recruitment platforms and venues, 4) create recruitment materials that succinctly describe the purpose of the study, and 5) build respectful and trusting relationships with potential participants. As Standardized Patient Educators, we often find ourselves in a similar situation in which time and fiscal support are minimal. These five key techniques may be utilized to assist each of us in our own programs at our various institutions.

Hosts: Tom Shives, MD and Tracy McCray, Mayo Clinic Radio
Submitted by: Mary Launder, Rosalind Franklin University of Medicine and Science

Dr. Michael E. Wilson, a critical care specialist at Mayo Clinic, offers suggestions on how to have conversations about death and dying. This interview originally aired via Mayo Clinic Radio Aug. 25, 2018.

Lead authors: Anthony L. Back, MD
Submitted by: Mary Launder, Rosalind Franklin University of Medicine and Science

Few studies have assessed the efficacy of communication skills training for postgraduate physician trainees at the level of behaviors. We designed a residential communication skills workshop (Oncotalk) for medical oncology fellows. The intervention design built on existing successful models by teaching specific communication tasks linked to the patient's trajectory of illness. This study evaluated the efficacy of Oncotalk in changing observable communication behaviors.

Lead author: Hartley Jafine
Submitted by: Michael Maury, UCSD

In this article author Hartley Jafine articulates the idea that “Medicine… is a performance. And the skills actors and improvisers learn are equally important for any health-care role.” Jafine relays his experiences as a facilitator of theatre courses within undergraduate health sciences and medical education to enhance the clinical skills of students and train better health-care professionals. Throughout this reflection piece, Jafine highlights the importance of using Applied Theatre arts programs in healthcare education. Jafine says, “Acting cuts through stereotypes” and improvisational play gives learners a safe place where they are free to fail without consequence.

By: Kim Tingley
Submitted by: Dyan Colpo, Cleveland Clinic, Simulation and Advanced Skills Center

In October 2014, my father was startled to receive a letter announcing the retirement, in a month’s time, of our family physician. Both he and his doctor were in their late 60s by then, and their relationship went back about 30 years, to the early 1980s, after my father followed his father and paternal grandparents, all from the Midwest, to Southwest Florida. How they began seeing the doctor is beyond memory, but as my father’s grandparents grew increasingly frail, his father frequently drove them to their doctor for checkups. At one of them, in the mid-’80s, the doctor suggested that it might be less strenuous for my great-grandparents if he met them in the parking lot. From then until they died, he came downstairs from his seventh-floor office with his black bag and climbed into the back seat of their yellow Oldsmobile 88 to give them their physicals. 

Interview By: Jonathan Singer, Ph. D., LCSW
Submitted by: Amber Snyder, University of Pittsburgh

This episode of the Social Work Podcast features an interview with Marion Bogo and Toula Kourgiantakis from the University of Toronto Factor-Inwentash Faculty of Social Work. The podcast discusses using simulation in social work education.

Lead author: Carmen N. Spalding
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

The ability to disclose medical errors (DME) effectively is crucial in Emergency Medicine (EM). The 2010 American College of Emergency Physicians Policy Statement on Disclosure of Medical Errors directs emergency physicians who determine an error has occurred to provide timely information about the error and its consequences to patients and their families. Despite this mandate, a disclosure gap exists in EM.

Lead Author: Erwin Jiayuan Khoo, MRCPCH, MBBS
Submitted by: Dan Brown, Emory University School of Medicine

Unique ethical concerns arise when using minors as standardized patients. In this article, the four authors each take a turn discussing the ethical implications of a particular case wherein a 6-year-old boy in Indonesia was used for two days of SP work. Each author also discusses principles at large, generally agreeing that standards need to be established and upheld when hiring child SPs, borrowing from established standards in research or film. They argue that considerations need to be made for the child’s benefit-to-burden balance, ability to revoke assent, potential trauma, and preference for active participation.

By: Blake Farmer
Submitted by: Todd Lash, Publications Committee Chair

Nursing requires hands-on training. But research has found that university curriculum often goes light on one of life's universal experiences — dying. So some colleges have gone to new lengths to make the training more meaningful. There's a sound near the end — the death rattle. People stop swallowing. The lungs fill up. There can be involuntary moaning. "So you get all that noise. And that's really distressing for family members," Professor Sara Camp of Nashville's Belmont University says.

By: Lauren Howe and Kari Leibowitz
Submitted by: Kerensa Peterson, Northwestern University

Two social psychologists from Stanford share some insights from their research about patient treatment outcomes in this short piece.  According to their research, it turns out that a doctor’s demeanor and the way in which they engage their patients can have a significant effect on their health.  The elements of communication that are often stressed during simulated patient encounters with medical students are the very things discussed in their research.

Lead author: Karen Mulligan
Submitted by: Dyan Colpo, Cleveland Clinic, Simulation and Advanced Skills Center

Clinical empathy is essential to the practice of medicine and is linked inextricably to the competence of a physician. It benefits both patient care and physician satisfaction yet the concept is often ill-defined. Recent studies have also shown that it is taught ineffectually at the undergraduate level and suggest that new methods be sought. Conducting interviews for qualitative research could provide the opportunity for medical students to explore patient experience, develop clinical empathy and compassion as well as gain research experience. Even the exercise of designing questionnaires for qualitative research could encourage students to engage with clinical empathy. 

By: Sarah Waller
Submitted by: Todd Lash, Publications Committee Chair

In the hallway of Samford University’s Experiential Learning and Simulation Center, a “standardized” patient stumbled to the ground to simulate a patient experiencing cardiac arrest. The Doctor of Physical Therapy student who was with him jumped into action and called a code. Within seconds, an interprofessional team of students gathered. Undergraduate nursing students took over CPR, Doctor of Pharmacy students prepared the needed medications and Master of Social Work students attended to the patient’s family. This is just one scenario that students were able to experience together during the College of Health Sciences’ annual Acute Care Simulation.

By: Helen Wilbers
Submitted By: Michael Maury, UC-San Diego

Gina Shannon, associate director at the Emory University School of Medicine’s Clinical Skills Center and ASPE member, spoke at Westminster College’s Hancock Symposium on Tuesday, September 11^th, 2018, about the purpose of simulated patients in Medical Education. As Wilbers lays out in this article, Shannon points out the importance of using SPs “to teach doctors to empathize and communicate with patients.” Wilbers writes that Shannon contemplated, "If a health care provider is with a patient and they aren't in agreement, where can that relationship go?" Wilber discusses how Shannon relies on her 7 years of theatre teaching and applying the rules of improv to the clinical setting. With an emphasis on the important improv tenet of ‘yes-and’ Shannon successfully guides doctors toward an acceptance and mutual agreement of what is being laid out by a patient. Shannon says, "If we're in a scene together the only way we can elevate the scene and keep it going is by agreeing."

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

Several studies have found that exams consisting of multiple-choice questions—particularly the United States Medical Licensing Examination—are not the best or only evaluation method for postgraduate residency selection. To that end, Dr. Senthil Rajasekaran and the team at Eastern Virginia Medical School is developing video vignettes of standardized patient encounters. He believes they are a practical, effective option for assessing a student’s clinical acumen.