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.

Affiliate News: Society For Simulation in Healthcare Names Board Members
Submitted by: Valerie Fulmer, ASPE President

WASHINGTON, D.C. January 20, 2018: The Society for Simulation in Healthcare (SSH) announced today its 2018 board of directors. Read the full release at PRWEB here.

General Interest: ‘What did the doctor say?’ - A Simple Question with a Difficult Answer
By: Richard Klasco and Lewis H. Glinert, The Washington Post
Submitted by: Ken Conselyea, , SP Ohio State University

Few simple questions are as difficult to answer as the perennial “What did the doctor say?” The words are so natural as to be virtually automatic. They spring from our lips, almost of their own accord, whenever a loved one returns from a doctor’s visit. Whether we recognize it or not, the answer has the potential to make us face our own mortality. Read the full article in The Washington Post 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.

General Interest: The word is out! ASPE Standards of Best Practice publication receives praise from Advances in Simulation Journal
By: Valerie Fulmer, ASPE President

Many of you know of our recent Standards of Best Practice (SOBP) publication in the international journal Advances in Simulation. These standards establish a baseline for best practice in SP methodology essential to this new field and all programs working with SPs. A living document, the SOBP will continue to blossom and grow to serve this community of SP educators and others around the world.

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.

General Interest: UofL School of Medicine to Host IMPROV FOR CLINICIANS Clinic with The Second City
By: Rob Stein, NPR
Submitted by: Michael Maury, UCSD School of Medicine

Here is another example of how theatrical improvisation is being used to help clinicians improve their communications skills. This article calls attention to students at the University of Louisville School of Medicine who teamed up with a Second City comedy troupe to partake in its “improv for Clinicians” workshop. "Improv for Clinicians" is meant to mirror the clinical experience that students, residents and faculty experience at the UofL School of Medicine, but with an entertaining and humorous twist.”  Might all medical schools benefit from similar workshops? Read about the event that occurred last fall at Broadwayworld.com here and let the creative ideas flow.

Media Article: Med School's “SP Dave” Wins Growing Bolder Award for Improving Community Health
Submitted by: Todd Lash, Publications Committee Chair

A standardized patient who has helped educate medical students since University of Central Florida’s medical school opened in 2009 was honored December 6 for helping build a healthier community. David Shaheen, a retired NASA bookkeeper known at the medical school as “SP Dave,” received a “Boldy” award from Growing Bolder, an Orlando-based media group dedicated to inspiring people to live extraordinary lives as they age. Growing Bolder promotes bold, healthy aging in multiple media platforms, including television, radio, magazine and social media. Read the full article in UCF Todayhere.

Media Article: Standardized Patients Teach Skills and Empathy
By: Dinah Wisenberg Brin
Submitted by: Valerie Fulmer, ASPE President-elect

From his first month as a student at the University of Arkansas for Medical Sciences (UAMS) in Little Rock, Ark., Grant Cagle learned how to drape a patient, take a medical history, perform physical exams, deliver bad news, and more. And he was able to learn and practice these clinical skills—and make mistakes—without affecting actual patients. Read the full article in at AAMC Newshere.

General Interest: Words That Keep Mental Health Stigma Alive
By: Angela E. Gambrel
Submitted by: Dan Brown, Emory School of Medicine

This is a companion/follow-up post to the blog entry posted on December 18 regarding the misuse of mental health terms. This piece delves into an interested historical perspective on how “lunatic,” “imbecile,” and other words now used exclusively as insults were once medical terms. Read the full article at HealthyPlace.com  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.

General Interest: You, Me and Them - Experiencing Discrimination in America - Scientists Work To Overcome Legacy of Tuskegee Study, Henrietta Lacks
By: Rob Stein, NPR
Submitted by: Michael Maury, UCSD School of Medicine

This article gives us good food for thought. That is, what are we doing as Standardized Patient Educators to take a stand for equality in health care? Are we creating SP cases that represent all people of various ethnicities and cultural backgrounds? Or, are we only creating cases that are easier for us to cast based on our current SP pools?

General Interest: HealthySimulation.com Relaunches Medical Simulation Resource Website and Newsletter
Submitted by: Lance Bailey

After seven months of hard work, the newly redeveloped Healthcare Simulation resource website HealthySimulation.com has finally launched! Not only has the website, newsletter, and branding been updated with a modern professional aesthetic, but also has given brand new functionality to better serve you the latest in medical simulation news, product information, conference coverage, research highlights, tutorial insights, and more! Features on the website include searching and posting for medical simulation jobs, finding healthcare simulation vendors, submitting articles to share with a global community, and subscribing to the Healthy Simulation Newsletter. Read about the relaunched website and new features here.

General Interest: Innovative UCSD Program Aims to Draw Compassion Out of Future Doctors
By: Kinsee Morlan
Submitted by: Michael Maury, UCSD School of Medicine

As Standardized Patient Educators one of our many tasks is to foster and build empathy within our student doctors. We can accomplish this in many different ways. Since many of us in the SP world come from theatrical backgrounds, we are aware of the value of the performing arts in building compassion toward others. We know that acting and theatre has a built-in empathic element which can be passed on to any learner who is open and willing to partake whole-heartedly in theatre games and improvisational exercises. What if there were other artistic endeavors that could accomplish this goal as well? In fact, there are such opportunities and in this article, author Kinsee Morlan describes an artist-in-residency program at the UC San Diego School of Medicine that has students sketch live nude models, real human skeletons and eventually cadavers helping them focus on details that build their abilities for empathy and compassion. Created by artist Joyce Cutler-Shaw and now currently taught by Larry and Debbie Kline, “the goal of the drawing class is not to turn doctors into artists, but to build empathy through art. The students will go on to be doctors, and the goal is to make them doctors who care.” Read the full article in Voice of San Diego here.

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.

General Interest: Essential Reflective Writing Resource: Pulse--Voices from the Heart of Medicine
By: Paul Gross, MD, as submitted to DR-ED Listserv
Forwarded with permission by: Todd Lash, Publications Committee Chair

Pulse--voices from the heart of medicine, an online publication launched by Department of Family Medicine at Albert Einstein College of Medicine in 2008, now has over 11,000 subscribers.