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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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Sir Ken Robinson at IMSH 2019

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.

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Blurred Boundaries: Sexuality and Power in Standardised Patients’ Negotiations of the Physical Examination

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.

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Clinical Skills and Professionalism: Assessing Orthopaedic Residents with Unannounced Standardized Patients

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.

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The Case for Medical Improv: Using Theatre Techniques to Improve Patient Care

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.

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Verbal Communication of Students with High Patient-physician Interaction Scores in a Clinical Performance Examination Assessed by Standardized Patients

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.

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Assessing the Performance and Satisfaction of Medical Residents Utilizing Standardized Patient Versus Mannequin-simulation Training

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.

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When Inmates Need A Specialist, They Often See The Doctor By Video

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.

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How to Die Well, According to a Palliative Care Doctor: Preparing for Death by Making Peace With It

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.












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Simulation Training in Palliative Care: State of the Art and Future Directions

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.

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A Program to Train Medical Physicists for Direct Patient Care Responsibilities

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.”

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TEDWomen 2017: Why I Train Grandmothers to Treat Depression

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.

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