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An Overview of How to Encourage the Standardized Patient (SP) Teaching Methodology – From the Perspective of a SP and SP Trainer

By: Wu Jiansheng
Submitted by: Todd Lash, Publications Committee Chair

As one of the first generation of Standardised Patients in China, perhaps Asia as well, I have been working in the clinical skills training center in West China Medical School of Sichuan University for 25 years. I would like to share with you how I joined this little-known and somewhat mysterious field, participated in this form of teaching, and progressed from a normal SP to a SP trainer. It is noted that the Standardised Patient (SP) was first introduced by Howard Barrows in 1963. In 1993, West China School of Clinical Medicine, Sichuan University was the first to do the training courses and trained the first group of SPs. In 2003, China Medical Board (CMB) America organized a “Student Evaluation Plan Program”; 8 Chinese medical schools joined and imported the training program to China.

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A Good Physician — On Complacency and Communication

Author: Michelle M. Kittleson, M.D., Ph.D.
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

“I recently cared for a 45-year-old man for over a month and never spoke to him.” This moving reflection from Dr. Kittleson details her realization about the lack of communication with her patient awaiting a heart transplant who is also deaf. “I fell into a complacency born of pragmatism and confidence in my abilities: I knew I was providing the best medical care, so I ignored the importance of direct communication.” This personal story highlights the need for direct doctor-patient communication no matter what perceived barriers exist – a concept for which SP educators continue to advocate.

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Perceptions of a longitudinal standardized patient experience by standardized patients, medical students, and faculty

Lead author: Lauren Block
Submitted by: Mary Launder, Rosalind Franklin University of Medicine and Science

Background: Longitudinal standardized patient (LSP) experiences mimic clinical practice by allowing students to interact with standardized patients (SPs) over time. LSP cases facilitate practice, assessment, and feedback in clinical skills and foster an appreciation for the continuum of care.

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A Pilot Project Exploring Medical Students’ Barriers to Screening for Intimate Partner Violence and Reproductive Coercion

Lead Author: Sarah E. Stumbar, MD, MPH
Submitted by: Catherine Hagele, Perelman School of Medicine at the University of Pennsylvania

Why is it that most health care practitioners do not routinely screen patients for intimate partner violence (IPV)? This third-year family medicine clerkship included a pregnancy options counseling OSCE aiming to explore students’ internal barriers to screening patients for IPV. Even though the educational module included scripted screening questions, students reported a major barrier to screening was difficulty finding the words with which to ask the questions, thereby suggesting that these kinds of practice encounters may be more effective, offering a performance model that can support skills acquisition.

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Communication Skills and the Problem with Fake Patients

By: George Gillett, Fourth Year Medical Student
Submitted by Kathy Herzberger, Loma Linda School of Medicine

George Gillett, who was a fourth year medical student when he wrote this article, expressed an interesting perspective regarding empathy and standardized “fake” patients. Included in this discussion is a suggestion from Anu Atluru, MD that “improv’s fundamental principles of honesty and spontaneity” might be helpful in teaching students how to acknowledge feelings without the rote “I’m sorry to hear that…” The opinions expressed are certainly issues to ponder as we develop future communication curriculum and assessment.

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Maximizing the Acquisition of Core Communication Skills at the Start of Medical Training

Lead Author: Hasan Mohiaddin
Submitted by: Marsha Harman, Rush University

How does contact with actual patients affect how medical students develop communication skills, and how does it impact their performance in an SP encounter? First year medical students at Imperial College London learn communication skills through lectures, small group teaching, and SP encounters. This study compared two groups of first-year students; the study group experienced repeated contact with real patients as part of a volunteer organization aiming to reduce isolation in elderly inpatients, while the control group received only the formal curriculum on communication.

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The Link Between Health Literacy & Cancer Communication

Author: Peggy Eastman
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

In an era of increasingly complex advances in oncology, how can health professionals help cancer patients with low health literacy better understand their diagnoses and treatment options? In an effort to improve cancer communication strategies with patients, the National Cancer Policy Forum (NCPF) convened a meeting of invited speakers in Washington, D.C. At the meeting, the point was repeatedly made that skills in cancer communication can be taught and learned, and it is the responsibility of health professionals to make sure all their patients (including those with low health literacy) truly comprehend the information they are being given. We as SP Educators know that SP methodology is an excellent tool for practicing these communication skills.

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Assessment of Clinical Empathy Among Medical Students Using the Jefferson Scale of Empathy-Student Version

By: Shahid H. Mirani, Noor A. Shaikh, and Amber Tahir
Submitted by: Dan Brown, Emory University

This study was conducted among medical students of Ghulam Muhammad Mahar Medical College, using a self-administered and self-perceived inventory called the Jefferson Scale of Empathy-Student Version. It compared the empathy scores by gender, by year of medical school, and by career preference. Its findings were comparable to similar studies, in that empathy scores decline over the course of medical school. The study concludes that it is “very important that we pay attention to nurture our medical students to have empathy rather than lose it under the stress of academic performance.”

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Integrating Opioid Use Disorder Training in Physician Assistant Education

By: Madeline Morr
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

At the American Academy of Physician Assistants (AAPA) annual meeting, held May 18 to 22, 2019 in Denver, Colorado, research was presented about physician assistant (PA) students and training on opioid-use disorder (OUD). Students in the didactic Behavioral Medicine course at Mercer College of Health Professions in Atlanta, Georgia, participated in a lecture series on OUD that included standardized patients to simulate a realistic presentation of patients with clinical pain complaints and provided screening, diagnosis, and counseling techniques. Students in the clinical course received the same instruction following completion of their core clinical rotation. Faculty observers provided students with feedback on patient interaction, empathy, use of professional medical terminology, opioid risk and benefit assessment, universal monitoring strategies, and including patients in the treatment decision-making process. These students reported improved confidence following the OUD instruction.

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Incorporating Sex and Gender into Culturally Competent Simulation in Medical Education

Lead author: Gillian A. Beauchamp
Submitted by Dan Brown, Emory University

Recognizing through a thorough search of existing sex- and gender-based medical simulation education literature that there is a lack of literature addressing the incorporation of sex and gender aspects of medicine into simulation-based training, the authors discuss the need for further sex- and gender-competent simulation, and outline strategies, considerations, and guidelines for including these topics into medical curriculums.

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Entitlement: The Big Problem in Medical Education We Will Not Talk About

By: Lester Liao
Submitted by: Kathy Herzberger, Loma Linda School of Medicine

Entitlement is a problem in medical education that has received relatively little attention. First, it is felt by educators, who often feel pressured to conform curricula and evaluations to satisfy learner demands and administrative pressures lest their careers are penalized. Second, entitlement affects the medical system, as entitled physicians are less empathetic and focus more on personal goods rather than patient needs. This shifts the humanistic basis for medicine. Thirdly, entitlement is problematic for learners, as constant accommodations ironically undermine self-reliance and adaptability. Constantly meeting these demands can diminish gratitude and overall happiness. To address this issue, learners must acknowledge the problem and seek remedies to it themselves, as top-down interventions will likely be rebuffed. Rather than focusing solely on the learning environment, solutions should also empower learners to engage their environment in effective and productive ways. This should include correcting cognitive distortions that lead learners to expect administrative interventions in all circumstances perceived as harmful. Other solutions include practicing gratitude and developing work friendships. While certainly not all learners are entitled and some environmental amendments should be made, learners and educators must realize that entitlement is shaping medical culture and collectively take steps to mitigate its negative effects.

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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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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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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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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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