Standardized Patients in Medical Education: A Review of the Literature

Standardized Patients in Medical Education: A Review of the Literature
Authors: Flanagan O L, Cummings K M
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

The research questions posed for this review were as follows: do medical students in their first two years of education who have practiced skills using SPs have more self-confidence in their ability to perform skills on real patients than those students who did not use SPs? Do medical students in their third and fourth years of medical school have higher clinical competency with sensitive patient examinations after using SPs in their first two years of medical education than those students who did not use SPs? And finally, do medical students who have used SPs for discussing sensitive issues have better interpersonal skills when they encounter real patients in the clinical setting than those who have not used SPs? I’m going to take a leap and say yes.

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Using Simulation-Based Learning with Standardized Patients (SP) in an Implicit Bias Mitigation Clinician Training Program

Using Simulation-Based Learning with Standardized Patients (SP) in an Implicit Bias Mitigation Clinician Training Program
By: Jennifer Tjia et al
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

This article describes the design, implementation, and response to a simulation-based training program on implicit bias awareness and mitigation skills. Two aspects of this undertaking really stood out to me. First, the SPs were recruited from the local community and were involved in case development to ensure that the scenarios were realistic and relevant to the community's needs.  Second, the program creators revised the structure of the program based on participant responses to create a more safe environment and a more robust learning experience.

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An Interactive Online Interprofessional Opioid Education Training Using Standardized Patients

An Interactive Online Interprofessional Opioid Education Training Using Standardized Patients
By: Connie M. Remsberg et al
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

Opioid pain management is complex and requires a collaborative approach. To prepare health professions students to care for patients who have chronic pain, the authors developed an interprofessional education (IPE) session for delivery using a virtual platform that featured a standardized patient (SP) interaction. The low-stakes, formative training has been developed to enable health profession students to learn from each other about how to provide collaborative care to a patient taking opioids for chronic pain. Since the widespread adoption of videoconferencing technology for teaching and learning is relatively new, this format provides a unique opportunity for IPE. This online IPE opioid education training session, which targets learners from nursing, pharmacy, medicine, physician assistant, and social work, dedicates specific time to the following elements: IP team collaboration to assess and interview an SP with chronic pain who takes opioids, IP team care planning and discussion, and development of a written IP treatment plan submitted as a formative assignment. Other programs may find this IPE training useful specifically because it addresses one of the biggest hurdles in IPE by providing a model for connecting geographically separated students through videoconferencing technology.

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Which Teaching Method Is More Effective in a Communication Course – Role-Playing Versus Simulated Patients, Taught by Tutors or Faculty Staff? A Randomized Trial

Which Teaching Method Is More Effective in a Communication Course – Role-Playing Versus Simulated Patients, Taught by Tutors or Faculty Staff? A Randomized Trial
Lead Author: Julia Herchenröther
Submitted by: Amy Lorion, National Board of Osteopathic Medical Examiners

The article details the results of a study created “as part of the medical history-taking course … that aimed to establish if lecturers or tutors led to better results in student performance. The study also aimed to investigate if the use of simulated patients or role-playing with fellow students led to better communication skills in the students.” The authors find that “in history-taking courses students who trained an increased number of times with SP benefited more from instruction by a university lecturer and that groups led by peer tutors benefited more from the use of RP,” with “RP” referring to the role-playing with fellow students.

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An Effective Gender-Affirming Care and Hormone Prescribing Standardized Patient Case for Residents

An Effective Gender-Affirming Care and Hormone Prescribing Standardized Patient Case for Residents
Lead Author: Ben J. Hersh, MD
Submitted by: Amy Lorion, National Board of Osteopathic Medical Examiners

Recognizing the impact of physician inadequate training in gender-affirming care, the authors piloted a formative SP case for gender-affirming care with 20 family medicine residents. As the authors describe their results: “Self-reported knowledge and awareness increased after standardized patient case participation in multiple skill areas related to providing gender-affirming care. Faculty observers informally reported that the session increased their knowledge and comfort as well.” They recommend the use of such training to improve health care equity for transgender and gender-expansive individuals, although they caution those designing such training to “be certain to review terminology to reflect the ongoing changes specific to the LGBTQIA+ community,” noting that they had “needed to alter the language we used to reflect the changing climate” through their case development process.

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Conscious Engagement within Patients’ and Simulated Participants’ Personal Space: Medical Students’ Perspective

Conscious Engagement within Patients’ and Simulated Participants’ Personal Space: Medical Students’ Perspective
Lead Author: Chara Banks
McGovern
Submitted by: Amy Lorion, National Board of Osteopathic Medical Examiners

Banks-McGovern et al. capture the significance of their study in the first sentences of their abstract: “#MeToo prompted a shift in acceptable societal norms, sparking global recognition of the complexities of entering another’s personal space. Physical examinations are an integral part of medicine yet have the capacity to encroach upon patient’s personal space, whether in simulated or clinical environments. Examinations may be misconstrued as inappropriate advances, with negative effects for both patient and doctor.” As they note in the article, simulation and SPs can play a role in providing medical students with necessary “experience of and teaching on the crucial expertise behind a safe and mutually respectful physical examination.”

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IMSH 2024 Plenary Session: Kindra Hall, The Lou Oberndorf Lecture on Innovation and Healthcare Simulation

IMSH 2024 Plenary Session: Kindra Hall, The Lou Oberndorf Lecture on Innovation and Healthcare Simulation
By: Kerensa Peterson, UCR SOM Center for Simulated Patient Care

Kindra Hall says she’s made a career out of telling stories. Why does storytelling work so well? And why is a storyteller giving a lecture on innovation and healthcare simulation? Ms. Hall had many answers for the audience during her address at the IMSH 2024 conference. Any time a word becomes a “buzz word,” like “storytelling,” it begins to lose its meaning. Ms. Hall impressed upon the audience that great storytelling requires an investment of time and energy. Stories connect people. They stick in our brains because our brains are programmed to meet the storyteller halfway by empathizing and creating or remembering our own stories as we listen to others tell theirs. 

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Meet the Paid Medical Actors at Jefferson Health Trying to Unionize Amid Budget Tightening

Meet the Paid Medical Actors at Jefferson Health Trying to Unionize Amid Budget Tightening
By: Kristen Mosbrucker-Garza
Submitted by: Amy Lorion, National Board of Osteopathic Medical Examiners

Philadelphia’s public radio station recently published an article on a unionization movement among SPs working at the local Thomas Jefferson University system. The author interviewed union organizers and addresses their concerns in light of SP pay at other area organizations, the work the SPs do, Jefferson Health’s finances, and union advocacy in other fields. Published by a general news organization, the article brings wider attention to debates within the field over SP work and proper remuneration.

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Social Determinants of Health: A Multilingual Standardized Patient Case to Practice Interpreter Use in a Telehealth Visit

Social Determinants of Health: A Multilingual Standardized Patient Case to Practice Interpreter Use in a Telehealth Visit
Lead Author: Gigi Guizado de Nathan
Submitted by: Amy Lorion, National Board of Osteopathic Medical Examiners

Guizado de Nathan et al. describe a piloted simulation for teaching students the use of medical interpreters, a pilot created in recognition that the “growing diversity of the United States population and strong evidence of disparities in health care make it critically important to educate health care professionals to effectively address issues of culture.” They designed a telehealth case that includes an SP and a simulated medical interpreter, both bilingual, in a scenario that requires the student to both identify the need for an interpreter and to communicate with the patient through that interpreter.

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IMSH 2024: Opening Plenary Speaker Michael Bonner

IMSH 2024: Opening Plenary Speaker Michael Bonner
By: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

IMSH 2024 in San Diego kicked off with a bang! The opening Chad Epps Memorial Lecture came from Michael Bonner, a dynamic keynote speaker who has been seen on The Ellen Show, NBC Nightly News and Time for Kids. He is the CEO of Bonnerville, the Michael Bonner Foundation, and a middle school teacher. He discussed what he calls Black Swan Events – unexpected moments that throw you off and become a catalyst for innovation. Covid is an example – think of all the companies that didn’t exist before that life-changing event. He shared 3 points that we all need for success: Intentional Relationships, Strategic Collaboration and Relentless Determination. Michael inspired this audience of over 4,000 people and made us laugh. I can only imagine how inspiring he is to his middle school students. Learn more about Michael Bonner and his work here.

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An Objective Structured Clinical Exam on Breaking Bad News for Clerkship Students: In-Person Versus Remote Standardized Patient Approach

An Objective Structured Clinical Exam on Breaking Bad News for Clerkship Students: In-Person Versus Remote Standardized Patient Approach
Lead Author: Lona Prasad, MD
Submitted by: Amy Lorion, National Board of Osteopathic Medical Examiners

This article describes what happened when a breaking-bad-news OSCE was moved from in-person to virtual delivery due to COVID restrictions. The OSCE involves a miscarriage case, a distressing situation that, as the authors note, “calls for communication that incorporates patience and empathy.” The authors understandably wondered what would happen when moving such a scenario to what can be an impersonal technological tool.

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IMSH 2024 Plenary Session: Duncan Wardle, The Michael S. Gordon Center Lecture on Medical Education

IMSH 2024 Plenary Session: Duncan Wardle, The Michael S. Gordon Center Lecture on Medical Education
By: Samantha Syms, University of Miami Gordon Center

Duncan Wardle, Former Head of Innovation & Creativity at Disney began his plenary by asking the audience members to raise their hands if they considered themselves “creatives.” For those who did not raise their hands, he states that for adults, not being creative is an accepted fate. He then tasked participants to assume subject matter experts and exert our stance on eccentric issues: parachutes for elephants and sex therapy for bees and explain to our partners the importance of this topic. This activity illustrated the ability for us lean into our creativity without bounds and to be playful when developing big ideas.

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ASPE 2023 First-Time Conference Attendees’ Reflections

By: Amy Rush, Center for Healthcare Improvement and Patient Simulation at University of Tennessee Health Science Center

We all remember preparing for our first ASPE conference. What sessions will I attend? Will I be overwhelmed with too much to do? What if nobody talks to me? What if I don’t like the hotel coffee?

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ASPE Awards Given at the 2023 Conference

By: Amy Rush and Mary Launder

During the past year, many people contributed to the work of ASPE and our profession in several ways. At the 2023 ASPE Conference, we recognized some of these contributions with two award ceremonies.

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Co-Constructive Patient Simulation as an Experiential Tool for Continuing Professional Development in Healthcare

Lead Author: Marco Antonio de Carvalho Filho
Submitted by: Sharon Baker, Grand Valley State University

The authors of this study examined how to use an educational method called Co-Constructive Patient Simulation (CCPS) to improve professional development in healthcare. They participated in simulated scenarios aligned with their developmental stages and needs. This method integrates learning opportunities in clinical practice, amplifies learners’ critical reflection and autonomy and harnesses real-life challenges.
Read more about the study here.

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ASPE 2023 Opening Plenary Session – Improvisation and the Art of Medicine: Adaptable Skills for an Uncertain World

By: Samantha Syms, University of Miami Gordon Center 

Belinda Fu, MD, is a family physician, educator, and performing artist based in Seattle. During the ASPE 2023 opening plenary session, Dr. Fu asked us to consider how we can thrive in this uncertain world. She shared her experiences with improvisation as a physician, patient, educator, and actor, and explained the power of improv to transform the way we move through the world.

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Virtual Patient Simulation Offers an Objective Assessment of CME Activity by Improving Clinical Knowledge and the Levels of Competency of Healthcare Providers

Lead Author: Igal Iancu
Submitted by: Laura Harris and Carys Fritz, OHSU

This article describes how the authors utilized an innovative virtual patient simulation platform to develop successful impact measurement of the educational activities that can be applied to Continuing Medical Education (CME). The new platform is designed to assess learners’ knowledge and competency in the management of type 2 diabetes, high cholesterol, and high blood pressure.

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Are Evaluations in Simulated Medical Encounters Reliable among Rater Types? A Comparison between Standardized Patient and Outside Observer Ratings of OSCEs

Lead Author: Easton N. Wollney
Submitted by: Amy Lorion, NBOME

This article purports to be a comparison between two types of raters, SPs and “outside observers with training in healthcare communication,” with the evidence demonstrating that the SPs were more lenient in their scoring on both subjective items (e.g., “used effective body language”) and objective items (e.g., “The resident told the patient she should not start smoking again”). However, as the authors acknowledge partway through the article, there was another glaring factor: the SPs only scored the encounters live, based on memory, and the non-SP observers only scored the encounters via recorded videos; hence, “evaluator type was tied to evaluator method in this study.” This article is worth reading—the differences between the groups’ scores are telling and support several of the discussion points (e.g., cognitive load)—despite the mixed approach which undercuts the assertion that it’s a comparison of rater types per se.

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Perspective matters: assessment of medical students’ communication and interpersonal skills by simulated patients from the internal and external patient perspective

Lead Author: Sarah Prediger
Submitted by: Nicholas Gonzalez, Gordon Center for Simulation and Innovation in Medical Education, University of Miami Miller School of Medicine

In the realm of SP work, there may come variation in perspective. What one might determine is an effective patient encounter, another may interpret as one that was less effective or poor in nature. Sarah Prediger and Sigrid Harendza, of the University Hospital of Hamburg-Eppendorf, sought to shine a light on this and many other possible discretions in SP evaluation of communication and interpersonal skills. They had SPs assess medical learners from an internal- and external-patient perspective and discuss their findings of interest.

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Simulation Training in Suicide Risk Assessment and Intervention: a Systematic Review and Meta-analysis

Lead Author: Océane Richard
Submitted by: Michelle Fernandez, University of Miami

“The present study suggests that simulation-based training may be effective to change attitudes and skills for suicide risk assessment and crisis intervention, with promising preliminary results regarding changes in behaviors and patients’ outcomes. However, numerous limitations must be acknowledged, and many challenges remain. More research of higher methodological quality must be developed.”

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