Sir Ken Robinson at IMSH 2019
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

I had the privilege of attending my first International Meeting on Simulation of Healthcare, or IMSH, presented by the Society of Simulation in Healthcare. Aside from ambling along the riverwalk in sunny San Antonio, the highlight of the conference for me was The Lou Oberndorf Lecture on Innovation and Healthcare Simulation presented by Sir Ken Robinson. Sir Ken is an educator, writer, researcher, adviser and speaker; also known as the Grandfather of the TED Talk. Indeed, he is the most watched speaker in TED’s history. His 2006 talk, “Do Schools Kill Creativity” has been viewed online over 40 million times and seen by an estimated 350 million people in 160 countries. He was also the most humorous speaker; I believe he has another career in stand-up comedy. He introduced himself by saying, “I don’t have a background in medicine or tech…so perhaps you have the wrong keynote speaker.” His background however, is incredibly impressive.
Sir Ken highlighted the connection between innovation and education. He emphasized the importance of play for children and adults. Children are now averaging 7 hours a day of screen time, which has replaced their time to run around outside and simply play using their imaginations. Creativity and imagination are what fuels innovation, and we will need that to support our ever-growing population (a staggering 7.5 billion). He made connections between this need for innovation and aspects of simulation: using the theatre (in which he also has a background) as a place to exercise role-play; using virtual reality to reinforce the concept that we live in our perceptions; designing tools to extend our reach, like simulation technology. Above all, he urges us not to lose the human connection in simulation – a concept with which we SP Educators can agree.

Blurred Boundaries: Sexuality and Power in Standardised Patients’ Negotiations of the Physical Examination
Lead Author: Grainne P. Kearney
Submitted by: Mary Launder, Rosalind Franklin University of Medicine and Science

Working with standardised or simulated patients (SPs) is now commonplace in Simulated Learning Environments. Embracing the fact that they are not a homogenous group, some literature suggests expansion of learning with SPs in health professional education by foregrounding their personal experiences. Intimate examination teaching, whether with or without the help of SPs, is protected by a particular degree of ceremony given the degree of potential vulnerability. However, other examinations may be equally intrusive for example the close proximity of an eye examination or a chest examination in a female patient. In this study, we looked at SPs’ experiences of boundary crossing in any examinations, sensitised by Foucault’s concept of the clinical gaze. We wished to problematise power relations that construct and subject SPs as clinical tools within simulation-based education.

Lead Author: David P. Taormina, MD
Submitted by: Kerensa Peterson, Northwestern University

Researchers at NYU-Langone Multi-center Academic University Hospital system embarked on a study that took place over a 2-year period. Forty-eight Unannounced Standardized Patient (USP) encounters were completed by residents in orthopaedics. Since the ACGME requires residency training programs to assess core competencies and track resident longitudinal development, they needed to be able to systematically and reliably assess residents using objective assessment tools.

Author: Bonnie North
Submitted by: Dan Brown, Emory University School of Medicine

In a January 18, 2018 interview, Lake Effect host Bonnie North spoke to Prof. Katherine Watson, a lawyer, ethicist, and improviser about her work in medical improv. In this summary of the interview, Watson defends the need for medical improv, saying that providers “need to be trained…to not just respond to what they think is going to happen, but to respond to what is actually happening,” and expounds on how improv training helps providers think the way a doctor needs to.

Lead Author: HyeRin Roh
Submitted by: Kerensa Peterson

There are many evaluation tools that SPs have used to rate medical students’ communication skills.  At times SP ratings differ from the ratings of medical faculty because SPs experience an interaction differently than an observing faculty member.  This study used the frequency of students’ communication behaviors as an objective measure.

Lead Author:  Ali A. Alsaad
Submitted by: Mary Launder, Rosalind Franklin University of Medicine and Science

At our institution, the traditional IM curriculum in clinical reasoning and critical thinking skills focused on the learner interacting with a simulation mannequin. Feedback from this experience was mixed, with the learners often pointing out that the interaction with the mannequin was unrealistic. We hypothesized that using an SP instead of a mannequin would not only give a more realistic experience but would also improve medical knowledge acquisition. Therefore, the aim of this study was to compare residents’ performance in management of four scenarios depicting patient clinical deterioration utilizing either a high-fidelity simulation mannequin or SP.

By: Michelle Andrews
Submitted by: Todd Lash, Publications Committee Chair

When an inmate needs to see a medical specialist, getting that care can be complicated. Prisons are often located in rural areas far from medical centers that have experts in cancer, heart and other disease treatments. Even if the visit just involves a trip to a hospital across town, the inmate must be transported under guard, often in shackles. The whole process is expensive for the correctional facility and time-consuming for the patient. Given the challenges, it's no wonder many correctional facilities have embraced telemedicine. They use video conferencing to allow inmates to see medical specialists and psychiatrists without ever leaving the facility.

Lead author: Mark Starmach
Submitted by: Dyan Colpo, Cleveland Clinic, Simulation and Advanced Skills Center

First, you withdraw.
Life shrinks down to the size of your home, then to your bedroom, then to your bed—sometimes over months, but more often over weeks.
Old joys stop having the same pull.
You eat less, drink less. Have less interest in speaking.
As your body’s systems start shutting down, you have less and less energy.
You sleep more and more throughout the day.
You start to slip in and out of consciousness and unconsciousness for longer periods of time.
Staying alive starts to feel like staying awake when you are very immensely tired.
At some point, you can’t hold on any longer.
And then you die.
A calm fall into a cosmic sleep.
But that’s not even the half of it.
“There are four ways people tend to die,” the older woman opposite me says as she reaches for a napkin and a ballpoint pen.

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

The growing need for palliative care (PC) among patients with serious illness is outstripped by the short supply of PC specialists. This mismatch calls for competency of all health care providers in primary PC, including patient-centered communication, management of pain and other symptoms, and interprofessional teamwork. Simulation-based medical education (SBME) has emerged as a promising modality to teach key skills and close the educational gap.

Authors: Derek W. Brown, Todd F. Atwood, Kevin L. Moore, Robert MacAulay, James D. Murphy, Arno J. Mundt and Todd Pawlicki
Submitted by: Michael Maury, UC-San Diego

Most of the time in the medical profession, the responsibility of patient care and empathic interaction falls mainly on the doctors and nurses. Yet, a responsibility like this must be shared by all individuals on the team. In this research study, the authors sought to “develop a training program designed to meet the specific needs of medical physicists as they transition into a clinical role with direct patient care responsibilities.” Please read on for information about the developed program that “incorporates an array of established education techniques and provides a comprehensive, accessible, means of improving medical physicists’ patient communication skills.”

Lead Author:  Dixon Chibanda
Submitted by:  Dyan Colpo, Cleveland Clinic, Simulation and Advanced Skills Center

Dixon Chibanda is one of 12 psychiatrists in Zimbabwe -- for a population of more than 16 million. Realizing that his country would never be able to scale traditional methods of treating those with mental health issues, Chibanda helped to develop a beautiful solution powered by a limitless resource: grandmothers. In this extraordinary, inspirational talk, learn more about the friendship bench program, which trains grandmothers in evidence-based talk therapy and brings care, and hope, to those in need.

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

When I was a third year medical student on my pediatric inpatient rotation, I thought I had mastered family centered rounds. I would stand in the patient’s room, position myself in front of the patient and family, and present from my notes to the attending physician, occasionally glancing at the family. At the very end, I would turn to the family and say something along the lines of, “Any questions, Ms. Lopez?” It was not until years later that I realized how flawed my model of family centered care was.

By: Brendan Pauley
Submitted by: Michael Maury, UC-San Diego

Often times, when I am doing my best to explain my profession as a Standardized Patient Educator to friends or with people I meet, I am interrupted by my wife who exclaims, “Your explanation is too complicated.” She then proceeds to tell it in her own words which are much easier to understand. I was drawn to this article because it reminds me that most of the world still does not know that what we do is actually “a real thing.” In this article, author Brendan Pauley gives a wonderful summary of Simulation and Standardized Patient Education through the observation of the Interprofessional Center for Experiential Learning and Simulation (iCELS) at the University of Massachusetts Medical School in Worcester, MA. Pauley reports that Ray King, education Program Specialist at iCELS puts it well when he says, “SPs are better than reviewing cases, talking with proctors, or reading a textbook.” While many of us know and deeply understand the importance of our work as SPEs, it is nice to have a kind and simple reminder of the magic we create in medical education. If you would like another way to explain, simplistically, this SPE profession (like I certainly do) please read further.

By: Sian Leah Beilock
Submitted by: Dan Brown, Emory University School of Medicine

In this TED Talk, Sian Leah Beilock borrows from her history of playing soccer to discuss strategies for performing under pressure. As SP Educators, we are frequently working with medical students who are under immense pressure, and we often hear from their instructors that their performance on the test doesn’t reflect their skill as a student. Beilock addresses factors for “choking,” such as contagious anxiety and overthinking things that should be on autopilot, and suggests strategies for overcoming the pressure. Passing along these strategies, such as jotting down worries or practicing under performance conditions, could help the students perform more to their potential.

Journal Article: Standardized patients in psychiatry – the best way to learn clinical skills?
By: Monika Himmelbauer, Tamara Seitz, Charles Seidman, and Henriette Löffler-Stastka
Submitted by: Mary Launder, Rosalind Franklin University of Medicine and Science

Standardized patients (SP) have been successfully utilized in medical education to train students’ communication skills. At the Medical University of Vienna communication training with SPs in psychiatry is a mandatory part of the curriculum. In the training, the SP plays the role of four different patients suffering from depression/suicidal tendencies, somatoform disorder, anxiety disorder, or borderline disorder while the student attempts to gather the patient’s medical history. Both the instructor and SP then give the student constructive feedback afterwards.

General Interest: The Art of Storytelling in Clinical Data Communication – What We Can Learn from Batman and the Joker?
Lead author: Angela Ward
Submitted by: Michael Maury, UCSD

Author Angela Ward asks the question, “What can we learn from Batman and the joker, the greatest hero/villain pairing of all time?” In this article she explores the impact that stories we tell ourselves and others have on our psyches and how certain narratives effect our decisions and behaviors as humans. By connecting the power of storytelling to the practice of effectively communicating clinical data, Ward lays out a foundation to connect clinical data with clinical practice successfully. She writes, “If we are to have any success in bridging this gap between clinical data and clinical practice, we have to do more than just exchange information.  Effective communication strategies should not only understand the challenges and the impact on the audience, but the solutions provided should also appeal to both hearts and minds or, to put it another way, to our behavior.”

Research Article: Exploring patient-centeredness: The relationship between self-reported empathy and patient-centered communication in medical trainees
Lead author: Marianna D. LaNoue
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

Patient-centered communication can lead to better clinical outcomes as well as greater patient satisfaction and perceived quality of care. Based on evidence suggesting a relationship between empathy and patient-centered communication, this study explored the relationship between 3rd year medical students’ self-reported empathy and their verbal performance during an OSCE in which communication was coded from audio tapes of the interactions. This study provides evidence that ‘patient-centered’ features of trainee-provider communication are related to the self-reported empathy of those same students.

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.