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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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An Arm and a Leg: An Actor Walks into a Doctor’s Office

Host: Dan Weissmann
Submitted by: Marsha Harman, Rush University

Researcher Saul Weiner has been sending fake patients — actors, wired for sound — into real doctors’ offices, to learn about what actually happens, especially: How well doctors really listen to their patients.  He’s tallied up what doctors miss (a lot), and how much it costs (ditto).  In today’s episode, we hear what actually happened in one of those “secret shopper” doctor visits — with the doctor and the actor who played his patient reading from the transcript of their visit, and then unpacking what went wrong.

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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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It’s Not All Brain Surgery: Future Doctors Should Be Tested for Empathy, Study Says

By: Kate Thayer
Submitted by: Kerensa Peterson, Northwestern University

Standardized patient educators understand the importance of empathy and the role it plays in patient-doctor relationships.  Many SPEs believe that empathy can be taught, and medical educators throughout the world have acknowledged empathy’s role in the healing process of their patients.  A researcher from Thomas Jefferson University in Philadelphia now poses the question should we be assessing for empathy as part of the medical school admissions process?  This article discusses some of the debate around this provocative question.

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St. Luke’s Unveils Mobile Simulation Lab and Other Company News

By: The Morning Call
Submitted by: Michael Maury, UC-San Diego

What if we could take this Simulation show on the road? Maybe it’s time to go mobile. St. Luke’s University Health Network has just unveiled a customized 2020 Freightliner M2 truck to serve as a mobile training unit. The 34-foot-long truck, called the Simulation in Motion Medical Education Lab, will bring training sessions to network campuses and sites, allowing staff to practice hands-on skills with state-of-the-art technology in a realistic and safe environment.

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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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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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Dementia Education Workshops to Support Caregivers

By: Diane Weidner
Submitted by: Loïc Simard-Villeneuve, McGill University

A new workshop was created in September 2017 at the Steinberg Centre for Simulation and Interactive Learning (McGill University, Montreal, Canada). The goal of the workshops is to give caregivers information on the progression of the illness explained by either a neurologist or a geriatrician, to help them navigate the health system through the different stages of the illness and to provide a simulation that portrays the physical and psychological risks of living at home with dementia.

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LGBTQ Patients Reveal their Exhausting, Infuriating, and Surprisingly Common Struggles at the Doctor’s Office

By: Caroline Praderio
Submitted by Kathy Herzberger, Loma Linda School of Medicine

INSIDER interviewed a group of individuals from the LGBTQ community to explore their experiences with the healthcare system, in particular, doctor visits. Unfortunately, it is apparent that all too often these individuals are receiving inadequate healthcare, if they receive healthcare at all, as some providers refuse to treat them. As medical educators, we have a powerful platform to address these health disparities and biases with our students. Although there are many frustrating and heartbreaking experiences reflected upon in this article, The National LGBT Health Education Center and The Gay and Lesbian Medical Association offer hope of future change providing education and a database of LGBTQ-welcoming physicians.

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NPR - Hidden Brain; You 2.0: The Empathy Gym

Author: Shankar Vedantam
Submitted by: Catherine Hagele, Perelman School of Medicine at the University of Pennsylvania

Some people are good at putting themselves in another person's shoes. Others may struggle to relate. But psychologist Jamil Zaki argues that empathy isn't a fixed trait. On this episode of Hidden Brain, they talk about calibrating our empathy so we can interact with others more mindfully. This podcast focuses on how to exercise our empathetic muscles and cultivate one of our most precious human abilities. Empathy, at a deep level, is the understanding that someone else's world is just as real as yours. Empathy is like a muscle — it can be strengthened with exercise and it can atrophy when idle. The pros and cons of empathy in the medical profession are discussed.

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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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