Media Article: Standardized Patients and the Art of Medical Maladies
By: David Owens
Submitted by: Anna Lank, Managing Director C3NY

Natalie Wilder was sitting on a couch in a greenroom, using her iPhone to apply for a part in a film. Back in June, she starred in a one-woman play, “Fresh Hell: The Life and Loves of Dorothy Parker,” at the Oldcastle Theatre Company, in Bennington, Vermont. In an hour, she was going to reprise a different solo role, one of dozens she’s performed multiple times in recent years. “Today, I have lower-back pain,” she said, as she scrolled through her calendar. Read the full article in The New Yorker here.

Research Article: The Effects of Using High-fidelity Simulators and Standardized Patients on the Thorax, Lung, and Cardiac Examination Skills of Undergraduate Nursing Students
Lead author: Hilal Tuzer
Submitted by: Michael Maury, UCSD School of Medicine

Are standardized patients more effective than high-fidelity simulators in training thorax-lungs and cardiac examinations? This research article describes a study in which fifty-two 4th year nursing students took part in an exercise that compared the effects of each type of training. Read the full article in Nurse Education Today here.

Research Article: Physical Examination Skills Training: Faculty Staff vs. Patient Instructor Feedback—A Controlled Trial
Lead author: Markus Krautter
Submitted by: Todd Lash, Publications Committee Chair

Krautter et al conducted a randomized controlled study comparing feedback of PIs and faculty staff following a physical examination assessed by students and video assessors. Standardized patients acting at Patient instructors (PIs) and faculty staff physicians separately delivered feedback to 40 medical students that had performed a physical examination on the respective PI while the physicians observed the performance. The physical examination was rated by two independent video assessors to provide an objective performance standard. Feedback of PI and physicians was content analyzed by two different independent video assessors based on a provided checklist and compared to the performance standard. There was no statistical significant difference concerning overall matching of physician or PI feedback. The study demonstrates that trained PIs are able to provide feedback of equal quantitative value to that of faculty staff physicians with regard to a physical examination performed on them. However, both the students and the video raters judged the quality of the feedback given by the physicians to be significantly better than that of the PIs. Read the full article in PLoS One here.

Research Article: Teaching Medical Students to Express Empathy by Exploring Patient Emotions and Experiences in Standardized Medical Encounters
Lead author: Roger Ruiz-Moral
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

This study, conducted at Universidad Francisco de Vitoria in Madrid, Spain, looks at how well third-year medical students pick up on patients’ non-verbal and contextual clues as an opportunity to express empathy. The students attended a didactic and then had two SP encounters. SPs were scripted to give “tracking clues” based on how the students responded. This training program was largely successful in teaching students to carry out a deeper exploration of patients’ beliefs, fears and expectations, and thus express more empathetic statements to the patients. Read the full article in Patient Education and Counseling here.

Media Article: Comparing Physical Exam Education at U.S. Medical Schools
By: Anna Williams
Submitted by: Valerie Fulmer, ASPE President

The resources used to teach the physical exam to pre-clerkship medical students vary widely across U.S. medical schools, according to a new study published in the journal Academic Medicine. Toshiko Uchida, MD, director of Clinical Skills Education, was the first author of the study. “The physical exam is a crucial skill for physicians, and several studies suggest that poor physical exam skills can lead to lower-quality care and medical errors,” said Uchida, also an associate professor of Medical Education and of Medicine in the Division of General Internal Medicine and Geriatrics. “But every medical school curriculum is unique, and very little is actually known about how medical schools teach the physical exam.” Read the media article in the Northwestern Medicine News Center here, or read the research article in the Journal of the Association of American Medical Colleges here.

Research Article: The Influence of Physician and Patient Gender on Risk Assessment for Lung Cancer Resection
Lead author: Mark K. Ferguson MD
Submitted by: Todd Lash, Publications Committee Chair

Patient gender was evaluated for treatment recommendations regarding surgical therapy for lung cancer. Gender-neutral vignettes representing low-risk, average-risk, and high-risk candidates for lung resection were paired with concordant videos of standardized patients (SPs). Cardiothoracic trainees and practicing thoracic surgeons read a vignette, provided an initial estimate of the percentage risk of major adverse events after lung resection, viewed a video (randomized to male or female SP), provided a final estimate of risk, and ranked the importance of the video in the final risk estimate. There was a significant difference between male and female physicians in the absolute change in estimated risk with male physicians having larger changes than female physicians. Differences in estimating complication risk for lung resection candidates are related to physician and patient gender that may create inequities in treatment recommendations. Read the research article in the Annals of Thoracic Surgery here.

Research Article: An Informed Consent Program Enhances Surgery Resident Education
Lead author: Sarah E. Koller MD
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

At teaching institutions, informed consent for an invasive procedure is often obtained by first-year residents. However, trainees commonly do not receive formal instruction in this area before residency, relying on observation of other residents. The authors at Temple University created an informed consent educational program, which included a didactic component, a role-play about informed consent, and a simulation exercise using standardized patients. Residents became more confident in their ability to obtain informed consent after participating in this program. Read the full article in the Journal of Surgical Education  here.

Research Article: Effect of a Simulation-based Workshop on Breaking Bad News for Anesthesiology Residents - An Intervention Study
Lead author: Vanda Yazbeck Karam
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

Breaking bad news (BBN) to patients and their relatives is a complex and stressful task. The ideal structure, training methods and assessment instruments best used to teach and assess BBN for anesthesiology residents remain unclear. The purpose of this study at the Lebanese American University and the University of Illinois at Chicago was to evaluate the effectiveness of an education intervention for BBN based on immersive experiences with a high fidelity simulator and role-play with standardized patients (SPs). A secondary purpose was to gather validity evidence to support the use of a GRIEV_ING instrument to assess BBN skills. Anesthesiology residents’ communication skills when BBN in relation to a critical incident may be improved with educational interventions based on immersive experiences with a high fidelity simulator and role-play with SPs. Read the full article in BMC Anesthesiology here.

Research Article: Training and Validation of Standardized Patients for Assessing Communication and Counseling Skills of Pharmacy Students - A Pilot Study
Lead author: Mahboobeh Khabaz Mafinejad
Submitted by: Todd Lash, Publications Committee Chair

Investigators at the Tehran University of Medical Sciences and the Karolinska Institute, Stockholm described a cross sectional and correlation study to determine the process of training valid simulated patients (SPs) for assessing communication and counseling skills of pharmacy students' performance. Three scenarios, along with corresponding checklists, were developed based on the usual medications of different diseases consisting of asthma, respiratory infections, and osteoporosis. The SPs' role-play performance was video-recorded and rated independently by two experts according to an observational rating scale to assess validity. Study validity was evaluated by statistical analysis. The role-play was repeated after 1 week with the same scenario and the same doctor, to assess test-retest reliability. The investigators concluded that trained SPs can be used as an effective tool to assess pharmacy students' communication and counseling skills. Read the full article in the Journal Research in Pharmacy Practicehere.

Research Article: Actual and Standardized Patient Evaluations of Medical Students’ Skills
Lead Author: Amelia L. Sattler, MD
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

It may be grating for many of us SP educators to hear the term “Actual Patient” as a way to distinguish from Standardized Patient, since we are all actual patients at some point and our feelings and feedback are valid. However, it is interesting to read this study that compared medical students’ ratings from SPs and the patients the students saw in their clinical rotations (APs). The authors of the study found that “feedback from APs provides unique perspectives, complementing those of SPs, and prompts insights into incorporating patients’ voices and values into training.” Read the full article in Family Medicine here.

Lead author: Frank Herbstreit
Submitted by: Todd Lash, Publications Committee Chair

The investigators compared standardized patient’s ability to transmit knowledge and skills compared with a more traditional teaching approach for emergency management skills. Medical students were randomized to receive either training on standardized patients simulating 3 emergency settings (“acute chest pain,” “stroke,” and “acute dyspnea/asthma”) or traditional small group seminars. The students were evaluated on their knowledge base before and after their respective training pathway. Teaching using standardized patients resulted in a small, but statistically significant improvement in objective structured clinical examination scores. There was no difference in the written examination scores. Read the full article in Medicinehere.

Lead author: David J. Ecker
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

Recently, a student-initiated movement to end the United States Medical Licensing Examination Step 2 Clinical Skills and the Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation has gained momentum. These are the only national licensing examinations designed to assess clinical skills competence in the stepwise process through which physicians gain licensure and certification. Therefore, the movement to end these examinations and the ensuing debate merit careful consideration. The authors, elected representatives of the Directors of Clinical Skills Courses, an organization comprising clinical skills educators in the United States and beyond, believe abolishing the national clinical skills examinations would have a major negative impact on the clinical skills training of medical students, and that forfeiting a national clinical skills competency standard has the potential to diminish the quality of care provided to patients. In this Perspective, the authors offer important additional background information, outline key concerns regarding the consequences of ending these national clinical skills examinations, and provide recommendations for moving forward: reducing the costs for students, exploring alternatives, increasing the value and transparency of the current examinations, recognizing and enhancing the strengths of the current examinations, and engaging in a national dialogue about the issue. Read the full article in the Journal of the Association of American Medical Colleges here.

Lead author: Joachim Graf
Submitted by: Todd Lash, Publications Committee Chair

The aim of this study was to analyze gender differences in communication skills of medical students in the context of an OSCE exam. A longitudinal trend study based on seven semester-cohorts, was analyzed to determine gender differences in medical students’ communication skills. The students (self-perception) and standardized patients (SP) (external perception) rated the communication skills using uniform questionnaires. Statistical analysis was performed by using frequency analyses and t-tests. Across all ratings in the self- and the external perception, there was a significant gender difference that favored female students performing better in the dimensions of empathy, structure, verbal expression and non-verbal expression. The results of male students deteriorated across all dimensions in the external perception over time. Recommendations were made regarding gender-specific teaching that considered the reported differences between female and male students. Read the full article in BioMed Central Medical Educationhere.

Research Article: Standardized Patients' Perspectives on Workplace Satisfaction and Work-Related Relationships - A Multicenter Study
Lead author: Claudia Schlegel, MME, RN
Submitted by: Valerie Fulmer, ASPE President Elect

From the article: The use of standardized patients (SPs) in health care education has grown in the last 50 years. In addition, the requirements for SPs have increased steadily, and thus, the work of SPs has become more difficult and demanding. It has been claimed that SP programs are highly contextualized, having emerged from local, institutional, professional, and national conditions, but their effects on SPs have not been investigated. We have studied the effects of this job development on SPs and their programs. Read the full article in Simulation in Healthcarehere.

Research Article: Tracing the Prescription Journey - a Qualitative Evaluation of an Interprofessional Simulation-based Learning Activity
Lead Author: Caoimhe Cooke
Submitted by: Michael Maury, UCSD School of Medicine

“At Queen’s University Belfast (QUB), an innovative Interprofessional education (IPE) activity was developed for medical and pharmacy undergraduate students that aimed to develop a greater understanding of their roles and duties in community prescribing and dispensing. This study set out to evaluate the impact of such a simulation-based education (SBE) activity on students’ attitudes towards collaborative practice in prescribing and dispensing medication in the community.”

Research Article: Training Social Work Students to Recognize Later-life Depression - Is Standardized Patient Simulation Effective?
Lead author: Zvi D. Gellis
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

It gives me great pleasure to share this scholarly article with our ASPE membership, as the Penn Med SP Program was involved in the study. This has been a successful program for about 5 years. It involves 2nd year Master of Social Work students having discussions with geriatric SPs regarding late-life depression and chronic disease. Please see the abstract and link below for more information on this study.

Research Article: Communicating to Promote Informed Decisions in the Context of Early Pregnancy Loss
Lead Author: Maria Brann
Submitted by: Michael Maury, UCSD School of Medicine

In this research article, authors Maria Brann and Jennifer J. Bute of the Department of Communication Studies at Indiana University and Purdue University facilitated a simulation in which interns engaged with Standardized Patients portraying woman who had just experienced a miscarriage, in “minimum informed decision making (IDM).” They note that “As many as 25% of known pregnancies end in a miscarriage” and “evidence suggests that informed decision making does not occur in many cases of early pregnancy loss.” The purpose of their study was “to evaluate an OSCE program in which OB/GYN residents are trained using standardized patients to engage women in decision making during a pregnancy loss scenario.”

Research Article: Use of Simulation to Integrate Cultural Humility Into Advanced Health Assessment for Nurse Practitioner Students
Lead author: Abraham N. Ndiwane
Submitted by: Todd Lash, Publications Committee Chair

To access cultural issues and level of student satisfaction, the authors created an Objective Structured Clinical Examination (OSCE) offered to nurse practitioner students practice in simulation. This learning activity included pre- and post-assessments of knowledge on cultural content. Course content included an exemplar video and a simulation interview with an African American standardized patient. Standardized patient scenarios scored highest for satisfaction, followed by critical thinking, and with self-confidence scoring lowest. The favorable knowledge outcomes from this teaching intervention support future applications of OSCE methodology for teaching sensitive cross-cultural content. Read the full article in the Journal of Nursing Educationhere.

Research Article: Twelve Tips for Conducting Successful Multiple Patient Encounter Simulations (Simultaneous Simulations)
Lead author: Craig Brown
Submitted by: Todd Lash, Publications Committee Chair

The authors described twelve tips for conducting successful multiple patient encounter simulations (MPES), divided into pre-, intra- and post-simulation considerations. They conclude that with these twelve tips, educators can plan successful, fiscally responsible, well-organized, structured sessions for all learners (active and observing) that will achieve the learning outcomes desired using this advanced method of simulation. MPES offer a host of opportunities for learners and educators alike in ways that single patient encounter simulations cannot. Whilst this method of learning adds in increasing complexity for simulation designers, facilitators and learners by its inherent nature this should be embraced as a strength of this educational approach. Read the full article in Medical Teacherhere.

Research Article: Effectiveness of Mental Health Simulation in Replacing Traditional Clinical Hours in Baccalaureate Nursing Education
By: Denise A. Soccio, DNP, RN
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

The purpose of the current study was to (a) determine whether baccalaureate nursing students receiving mental health simulation as a replacement for 25% of traditional clinical hours have equivalent or greater mental health knowledge and self-confidence compared to those who did not receive this simulation; and (b) explore students' perceptions of their mental health simulation compared to traditional clinical hours. An evidence-based practice pilot study was conducted using a mixed-methods design. Quantitative data demonstrated that students who received mental health simulation as a replacement for 25% of traditional clinical hours have equivalent mental health knowledge and self-confidence as those who did not receive the simulation. Qualitative data indicated students found the simulation helpful in learning how to manage patient behaviors. The current study provides substantial evidence that simulation can be used as a replacement for 25% of traditional clinical hours in mental health nursing.Read the full article in the Journal of Psychosocial Nursing and Mental Health Services here.