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Introducing the ASPE Center Spotlight

By: Todd Lash, The Ohio State University

The Publications Committee is pleased to announce an exciting new feature on the ASPE eNews Blog: The ASPE Center Spotlight. Inspired by Bob Bolyard’s member liaison project in 2018, a looping slide presentation displayed at the ASPE conference that featured photographs and statistics from multiple centers and programs, the Publications Committee sought to transform the project as a way to foster community and connection among members beyond the conference. To this point, the Publications Committee will feature one center or program per month on the ASPE eNews Blog in 2020. The mission of the ASPE Center Spotlight is to connect SP programs and simulation centers, and promote interagency and interdisciplinary collaboration in SP and simulation methodology. In addition, photographs and statistics published on the eNews Blog will be added to the slide presentation that will be displayed each year at the ASPE conference.

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Improving Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning Health: Using a Standardized Patient Experience to Educate Advanced Practice Nursing Students

Lead Author: Elizabeth K. Kuzma
Submitted by: Catherine Hagele, Perelman School of Medicine at the University of Pennsylvania

Over the last few years, nursing education has begun to embrace the need for LGBTQ content in nursing curricula. When compared with their heterosexual and cisgender counterparts, individuals identifying as LGBTQ face notable health disparities including increased disease and mortality, poorer health outcomes and higher rates of certain illnesses as well as biopsychosocial disparities. This pilot project increased knowledge, comfort and skills relating to interactions with people who identify as LGBTQ.

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For Busy Medical Students, Studying Meditation for Two Hours May Be Just as Beneficial as Longer Course

Author: Neal Buccino
Submitted by: Catherine Hagele, Perelman School of Medicine at the University of Pennsylvania

For time-crunched medical students, taking a two-hour introductory class on mindfulness may be just as beneficial for reducing stress and depression as taking an eight-week meditation course, a Rutgers study finds. Researchers say many medical students would like to use meditation to avoid burnout and provide better medical care, but are daunted by the prospect of making time for a daily meditation routine. While this article focuses on medical students, there are many parallels between their stress and time-crunch that Standardized Patient Educators also experience.

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Use of Simulated Patient Encounters to Teach Residents to Respond to Patients Who Discriminate Against Health Care Workers

Lead Author: Ellen H. Eisenberg
Submitted by: Marsha Harman, Rush University

This article describes a workshop for first-year residents that used standardized patients to practice responding to patients exhibiting bias against members of the health care team. The workshop included a didactic session and four scenarios in which standardized patients portrayed patients with bias based on gender, class, or race.  Learners received feedback from a trained facilitator, peers, and the standardized patients. One hundred percent of the 19 learners who participated agreed that the simulated exercises were realistic and improved their readiness to address patient bias.

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Five Reasons It Can Be Hard to Talk to Your Doctor—And Four Ways to Do It Better

By: Gillian Rutherford, University of Alberta
Submitted by: Michael Maury, UC-San Diego

In her talk entitled “Co-Creating Care to Improve Medicine”, University of Alberta endocrinologist Rose Yeung shares that, “Miscommunication, or under communication, happens regularly between patients and their doctors, nurses, dietitians and even naturopaths.” Those of us in Medical Education understand this truth all too well. In this article, Gillian Rutherford points out why it may be difficult for most to speak with their doctor and lays out four ways in which we can overcome this challenge. Yeung mentions, “The patient and the professional are supposed to deliberate and come up with an acceptable treatment plan together.” Remembering that physicians and patients are in this health care experience together as a team, is just one piece to the solution. Please press on for more insights and ideas.

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Evaluating Shared Decision-making in Periviable Counseling Using Objective Structured Clinical Examinations

Lead Author: Brownsyne Tucker Edmonds
Submitted by: Kerensa Peterson, NBOME Chicago

Shared Decision Making (SDM) has been widely endorsed as a favorable practice for patient-centered care.  However, it is underutilized in clinical practice and has lacked tools for assessment.  There are studies which support the use of shared decision-making tools in advanced care planning, but few tools for SDM have been tested in a periviable setting.

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A Good Physician — On Complacency and Communication

Author: Michelle M. Kittleson, M.D., Ph.D.
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

“I recently cared for a 45-year-old man for over a month and never spoke to him.” This moving reflection from Dr. Kittleson details her realization about the lack of communication with her patient awaiting a heart transplant who is also deaf. “I fell into a complacency born of pragmatism and confidence in my abilities: I knew I was providing the best medical care, so I ignored the importance of direct communication.” This personal story highlights the need for direct doctor-patient communication no matter what perceived barriers exist – a concept for which SP educators continue to advocate.

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An Overview of How to Encourage the Standardized Patient (SP) Teaching Methodology – From the Perspective of a SP and SP Trainer

By: Wu Jiansheng
Submitted by: Todd Lash, Publications Committee Chair

As one of the first generation of Standardised Patients in China, perhaps Asia as well, I have been working in the clinical skills training center in West China Medical School of Sichuan University for 25 years. I would like to share with you how I joined this little-known and somewhat mysterious field, participated in this form of teaching, and progressed from a normal SP to a SP trainer. It is noted that the Standardised Patient (SP) was first introduced by Howard Barrows in 1963. In 1993, West China School of Clinical Medicine, Sichuan University was the first to do the training courses and trained the first group of SPs. In 2003, China Medical Board (CMB) America organized a “Student Evaluation Plan Program”; 8 Chinese medical schools joined and imported the training program to China.

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Why We Forget What the Doctor Told Us (and What to Do About It)

Author: Cleveland Clinic Health Essentials
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

Has your mind ever gone blank after leaving your doctor’s office? You may be trying to remember the specific instructions or the answers to your “what if questions” - “What if I don’t feel better after a couple of days?” “What if I miss a dose of my medication?” “What if I feel worse in the middle of the night?”

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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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Ethical Concerns When Minors Act as Standardized Patients

Lead author: Erwin Jiayuan Khoo
Submitted by: Joe Miller, University of Minnesota

Abstract: When minors are asked to assist medical educators by acting as standardized patients (SPs), there is a potential for the minors to be exploited. Minors deserve protection from exploitation. Such protection has been written into regulations governing medical research and into child labor laws. But there are no similar guidelines for minors’ work in medical education. This article addresses the question of whether there should be rules. Should minors be required to give their informed consent or assent? Are there certain practices that could cause harm for the children who become SPs? We present a controversial case and ask a number of experts to consider the ethical issues that arise when minors are asked to act as SPs in medical education.

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How Architects Ruined Healthcare

By: Joshua Landy
Submitted by: Joe Miller, University of Minnesota

If everyone who stays at a particular hotel gets sick, you don’t need to be an epidemiologist to wonder if the hotel is the problem. So if physicians across the country are reporting record levels of burnout, we might ask if hospitals are the problem. Could the workplace itself somehow be toxic to its workers? If so, it’s probably not due to asbestos in the walls or toxic black mould. It’s because a well-intentioned effort to make things better for patients ended up making them worse for everyone.

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Training Improves the Standardization and Professionalism of SPs - Reflections on the ASPE Courses in China

By: Shi Shuwen, Zhejiang University School of Medicine

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Fostering Translation and Communication in Medicine and Beyond

By: Yoo Jung Kim
Submitted by: Michael Maury, UC-San Diego

Medicine has its own language. If we are not fluent in this language, we must translate before relaying or receiving any message to or from another. Much like the barriers that may come from the language of computers or of music or any foreign language that is not primary, there can be a particular communication hurdle that makes translating or conversing extra challenging. In this article, Yoo Jung Kim explores the difference between translation and communication. She says “There is much of both in medicine. Medicine has a particular language of its own, one that is accessible only to people who have dedicated years of their lives in studying its use. There is a vast knowledge gap between a typical practitioner and patient, so even when taking care of a native English speaker, it’s not enough to “translate” medical jargon in the vernacular. Instead, optimal communication requires tailoring the information to suit the patient’s needs and background.” She continues saying “Communication involves the extra step of providing just the right amount of information with the right combination words”. Communication is an art form and one that we as Standardized Patient Educators must master in order to guide medical students as they master this skill set.

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A Culture of Safety From Day 1: An Institutional Patient Safety Initiative to Support Incoming Interns

Lead author: Kinga L. Eliasz, PhD
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

On the first day of residency, incoming interns must understand the specific ways their new institution creates a culture of safety. To support transitioning trainees, this group at NYU Langone Health developed an authentic, large-scale immersive patient safety simulation called First Night-on Call (FNOC). This is a 4-hour immersive simulation during which new interns, in groups, were challenged to conduct an ethical informed consent, activate a rapid response team (escalation), document a clinical encounter, conduct an effective patient handoff, and participate in patient safety rounds.

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Specific Feedback Makes Medical Students Better Communicators

Lead Author: Cosima Engerer
Submitted by: Kerensa Peterson, Northwestern University

We are all aware of the important role feedback plays in teaching communication skills. However, there is little research that has systematically investigated specific structures for giving feedback in order to produce evidence on the most effective way to provide feedback. There are several fascinating and challenging methodological insights and limitations in this work. Researchers at the Technical University of Munich, Germany sought out to prove that utilizing structured, and behavior-oriented feedback was the most effective way to provide feedback. While their results confirmed that this feedback is a powerful tool, they agreed that further research would be necessary “to arrive at a firm conclusion.”

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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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Watching Movies and Learning About Medicine

Author: Amy Jeter Hanson
Submitted by: Michael Maury, UC-San Diego

Stanford Medicine’s course entitled “Medicine in the Movies” explores “medicine through the filmmaker’s lens” as it guides students in “examining questions of preconception and point-of-view, narrative and cinematography.” This innovative seminar “is the brainchild” of second—year student Bronwyn Scott and “leaders of Stanford’s Program in Bioethics and Film: founder and director Maren Monsen, MD; and assistant director Diana Farid, MD”. It covers communication themes such as “empathy, education and advocacy, nonverbal communication and the art of storytelling.” Scott shares with Author Hanson, “Ideally with this class, we’re able to have fun, watch some good movies, and take a little break from the medical school curriculum, while also thinking more deeply about how we communicate as future physicians.”

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Med School Promotes Humanistic Medicine

By: Mia Pattillo
Submitted by: Michael Maury, UC-San Diego

Being in Standardized Patient Education gives us the wonderful opportunity to better the world by helping future doctors navigate medicine empathically through reflective listening with a patient-centered focus. In this article, author Mia Pattillo points out different ways in which the Alpert Medical School at Brown University is working with their students to foster the skills necessary to connect with patients through the care they need. As Steven Rougas, assistant professor of medical science and emergency medicine points out in the article, “Brown has taken a lead in thoughtfully incorporating critical topics that have previously been neglected into curricula, such as LGBTQ+ patient care, racism and transgender medicine.” Many positive ideas are shared in this article including an annual Ceremony of Gratitude which is given each May to thank the families who have donated bodies to help the students understand human anatomy. Pattillo writes, “During the ceremony, students express their gratitude through poetry and speeches, dances and hand-written cards.” Please read further for potentially positive inspiratory ideas that could support our wonderful efforts in medical education.

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