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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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New Fort Worth Med School Turns to Coaches to Preserve Student Empathy

By: Christopher Connelly
Submitted by: Michael Maury, UC-San Diego

“Medical school is draining. It’s a mix of sleepless nights spent studying, a lot of student debt, massive pressure to succeed, and learning to treat difficult patients over long hours at the hospital. This recipe for mastering medicine been used to train generations of physicians, but it bakes in a problem: Over the course of their studies, medical students tend to become less empathetic. The issue is that empathy is increasingly valued as an essential tool for physicians, says Dr. Danika Franks, assistant dean of students for the Texas Christian University-University of North Texas Health Science Center School of Medicine in Fort Worth.” Author Christopher Connelly reports how Dr. Franks and her school are looking to foster more empathy within their students as they progress through their studies.

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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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Standardized Patients Teach Skills and Empathy

Lead author: Dinah Wisenberg Brin
Submitted by: Mary Launder, Rosalind Franklin University of Medicine and Science

This is a great article to pass along to anyone interested in what the world of simulation is about as well as its positive outcomes.

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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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ASPE SOBP Receive Special Contribution Award

Submitted by: Todd Lash, Publications Committee Chair

The ASPE Standards of Best Practice (SOBP) received a special contribution award for advancing SP methodologies in China. The award came from the China SP Practice Teaching Guidance Committee (CSPC) and the China International Association for Promotion of Science and Technology (CIAPST).

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Where Improv Meets Dementia: Play Along With Your Partner's Strange Conversation

By: Gary Rotstein
Submitted by: Michael Maury, UC-San Diego

Author Gary Rotstein states in this article, “Performers in improvisational sketch comedy learn basic guidelines: Speak in positives, think of your partner, listen well, give helpful prompts” and “don’t be long-winded.” He goes on to say, “Caregivers for those with dementia rarely hear that same advice, but they should — it might ease a lot of stress on both sides.” Many of us in Medical Education have seen the benefits and value of utilizing humanitarian practices such as improvisational theatre to better communication between patients and caregivers. Could the art-form of improv be utilized to better communication with patients living with dementia? Please read on to see how improvisational theatre skills have worked for Rachael Wonderlin and Christopher Wright of the “Agreeing to Remember” workshops at Steel City Improv Theatre in Pittsburgh, PA. Read the full article in the Pittsburgh Post-Gazette here.

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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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Having the Talk: When Treatment Becomes End-of-Life Care

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

Conversations about end-of-life care are among the most important interactions doctors and patients have. But for health care providers of all ages, backgrounds, and specialties, they may also prove to be the most challenging.

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You’re Not as Good as You Think (at Communicating)

By: Valerie DeBenedette
Submitted by: Michael Maury, UC-San Diego

The author of this article, Valeria DeBenedette, puts it simply, “Having a lot of clinical knowledge in rheumatology is good. But a boatload of knowledge may not mean much if you aren’t getting it across to the patient so that he or she understands”. For those of us in Standardized Patient education, we know that clear communication is key to a patient’s adherence and will help boost one’s confidence in their health care. We provide opportunities for future doctors to practice these communication skills, but are our efforts enough? As DeBenedette writes, “Communication skills are taught in medical school, often with standardized patients played by actors”. She goes on to report that Dr. Susmita Pati, M.D., chief medical program advisor at the Alan Alda Center for Communicating Science at Stony Brook University, states “but those [SP encounters] are ideal situations and not real life.” Perhaps we have some questions to ponder. Is there something more we could be doing to help mold future physicians into compassionate, clear communicators as they sharpen their clinical skills?

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From Medical Education to Medical Controversies, Humanities Are Key, New Chair Says

By: Carolyn Kimmel
Submitted by: Michael Maury, UC-San Diego

At Penn State College of Medicine, Bernice Hausman is fortunate to be the Chair of the Department of Humanities. As she says, “Generally, medical schools may have one course in the humanities. Not many have an entire department.” And, perhaps more medical schools ought to consider growing their humanities in medicine programs. In this article, author Carolyn Kimmel reports on the importance of the humanities in medical education. She writes, “as Dr. Graig Hillemeir, Penn State College of Medicine dean, Penn State Health CEO and Penn State senior vice president for health affairs” puts it “Since its inception in 1967, the College of Medicine’s Department of Humanities has been a pioneering model for the importance of cultivating physicians who can bridge science with a sophisticated understanding of community, ethics and the whole person.” With our world transforming and ever-changing, it is important for our future doctors to be well versed in treating the whole person by connecting with their patients human to human. As Hausman states, “Doctors aren’t just dealing with biochemical pathways and biological diseases. They’re dealing with human beings who have lives, and they need to understand motivations and behaviors that are culturally based — linked to belief systems, traditions and social networks.” Classes in the humanities is a great way to cultivate such lessons in our medical students.

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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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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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OUWB’s Standardized Patients help train next generation docs

By: Andrew Dietderich
Submitted by: Todd Lash, Publications Committee Chair

During a recent presentation, Jeanne Schulte, coordinator, OUWB Clinical Skills Training & Simulation Center, acted like a doctor who asked a mock patient the wrong questions at the wrong times — and in doing so, did her job just right. The reason? Schulte and the “patient” were demonstrating the purpose of the 35 Standardized Patients (SPs) employed by Oakland University William Beaumont School of Medicine. Their presentation took place during OUWB’s Mini-Medical School, held at the beginning of the year for parents of first-year med students.

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How Can Doctors Find Better Ways to Talk – and Listen – to Patients Close to Death?

By: Michael Erard
Submitted by: Marsha Harman, Rush University

Two brothers are combining palliative care expertise, linguistics and AI to encourage more effective conversations between doctors and people receiving end-of-life care. Bob Gramling received over $1 million from the American Cancer Society to undertake what became the most extensive study of palliative care conversations in the US. The resulting database contains over 12,000 minutes and 1.2 million words of conversation involving 231 patients. This is the basis of the Vermont Conversation Lab, which Bob created to analyze these data and find features of those conversations that make patients and family members feel heard and understood.

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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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