Journal Article: Challenges facing standardised patients representing equity-deserving groups: Insights from health care educators

By: Matt Sibbald et al

Article 1: The Contribution of Simulated Patients to Meaningful Student Learning
Article 2: How Simulated Patients Contribute to Student Learning in an Authentic Way, an Interview Study
Lead Author: Annelies Lovink
Submitted by: Amy Lorion, NBOME

Annelies Lovink et al. published two articles looking at the same phenomenon from two perspectives: that of the student and that of the SP. The articles stand on their own but can also be read in conversation with one another.

2024 ASPE Annual Conference Scholarship Inaugural Recipients
By: Amber Snyder, Vice President for Finance

Each year, we get requests for scholarships to attend ASPE and we didn’t have a funding source for these opportunities. At the ASPE conference in Portland in 2023, we stretched our imaginations on how we could bring more member benefits and launched the ASPE Fund. The goal of the ASPE fund was to provide an income stream for grassroot donations to build a fund to allow us to continue to bring existing membership benefits to you all, but also expand our international reach, our SP community, and Equity, Diversity, and Inclusion efforts.

LGBTQ+ Microaggressions in Health Care: Piloting an Observation Framework in a Standardized Patient Assessment
Lead Author: Hallie Decker
Submitted by: Kerensa Peterson, UCR School of Medicine

“Microaggressions are subtle derogatory behaviors that unintentionally communicate hostility toward marginalized social groups. This article describes the preliminary validation of a framework for observing LGBTQ+ microaggressions in healthcare, which can lead to distrust and disengagement from the healthcare system. Coders used the framework to observe microaggressions in video-recorded clinical-skills assessments with medical students who elicited health histories from standardized patients.

Simulating Inclusive Dialogues: Encouraging Faculty-led Conversations Surrounding Bias and Microaggression
Lead Author: Vikasni Mohan, et al.
Submitted by: Amanda Fernandez-Acosta, University of Miami

Within the University of Miami, medical students and residents noted a lack of dialogue surrounding bias and microaggressions, and uncertainty on how to handle these types of situations. To assist, the authors designed a course for faculty to better understand the harmful impact of bias/microaggressions and provide them with the proper tools to engage in meaningful dialogue surrounding the subject. The authors adapted the PAAIL framework and added the Bridge-the-Gap component to better support conversations surrounding bias/microaggressions in healthcare education. The course followed self-selected participants who indicated first-hand personal experiences with bias and microaggressions and offered clinical faculty a framework to intervene in such cases. Next steps include evaluating whether practicing these difficult conversations promotes psychological safety among faculty and normalizing these conversations to foster inclusivity and engagement among faculty, staff and learners.

Student empathy in standardized patient experiences: Applying concepts from a critical thinking emulation model
Lead Author: Lance Brendan Young PhD, MBA
Submitted by: Amy Lorion, NBOME

According to Young et al., research has shown that dental students’ empathy for patients declines over the course of their education and this “empathy-reducing influence of training” can have a real and negative impact on the students’ future patients. In order to address this concern, the authors aspired to “(1) Develop a learning guide for observable behaviors communicating emotional and cognitive empathy and (2) determine whether the learning guide can be used as a rubric for assessing empathy in a standardized patient experience.” The authors created a learning guide/evaluation rubric using an emulation model that focused on, “the communication of empathy,” a guide that SPs then used to score student performance in simulated encounters. According to the authors, the study’s results show that their model, “is viable as both a learning guide and evaluation rubric in a standardized patient format.”

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.

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.

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.

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.

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.

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.”

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. 

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.

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.

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.

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.

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.

Lead Author: Caroline R. Paul, MD
Submitted by: Kerensa Peterson, University of California, Riverside

“Health disparities for the lesbian, gay, bisexual, transgender, queer, intersex, asexual, all other genders, sexes, and sexualities (LGBTQIA+) population are striking. Yet, deliberate efforts to integrate sexual orientation and gender identity in pediatric education settings remain lacking. The type of formal training that pediatric educators currently have for the teaching of sexual orientation and gender identity is unclear and limited, which led to the development and implementation of this curriculum.”

Lead Author: April R. Christensen, MD, MS
Submitted by: Mekail Ebbert, NYIT-COM @ Arkansas State University

With patient communication being a crucial skill for medical professionals, ongoing focus on the design and implementation of meaningful and well-written SP communication cases is imperative to healthcare education. Surveyed educators in this study reported a struggle to write communication cases with a lack of clear guidelines, yet a reported 90% interested in learning more. See how the creation and piloting of a “...workbook that guides SP case development, paired with an in-person case-writing session to teach medical educators a skill vital to conducting effective communication skills education... significantly increased the quality of SP cases, with high reported educator confidence and satisfaction.”