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.”

Authors: Shanna Barton, Aaron Calhoun, Carrie Bohnert, et al.
Submitted by: Janice Radway, The Perelman School of Medicine at the University of Pennsylvania

Despite the well-known individual and societal benefits of childhood immunization programs and the demonstrated safety of vaccines, many parents are hesitant to have their children vaccinated. Vaccine hesitancy is more than a simple delay or refusal of vaccination. Rather, it can be characterized as a state of mind regarding immunization marked by uncertainty, indecision, conflict, or opposition, and it is best understood as a complex phenomenon with deep sociocultural and psychological roots. The authors developed a laboratory in which communication could be studied in a codified and controlled environment, using standardized patients portraying vaccine-hesitant parents, video-recording, assessment by blinded raters, and a pseudorandomized assignment of pediatric residents to AIMS or standard of care training.

Lead author: Jacqueline Ward-Gaines, MD
Submitted by: Erin Walsh, Rosalind Franklin University of Medicine and Science

To address the lack of diversity, equity, and inclusion (DEI) training in residency programs the authors created a simulation exercise for medicine residents with the objective to increase cultural and structural awareness. The simulation included groups of residents rotating through eight scenarios that were each focused on a cultural competency crucial to DEI training. Standardized patients gave feedback to the residents after each case and the residents debriefed with simulation directors. Preliminary data indicates that mass simulation can be an effective teaching method for residents learning about diversity, health equity, inclusivity, and cultural humility.

Authors: Anish K. Agarwal, David A. Asch, Jeffrey Millstein
Submitted by: Janice Radway, The Perelman School of Medicine at the University of Pennsylvania

A passenger is pinged moments after exiting their rideshare vehicle with a request to “rate your driver” using a simple 5-star rating. A few extra typed comments offer detail and context — completed in just moments. The same person, now exiting a doctor's appointment, receives no such alert. Instead, weeks later, they receive a mailed survey consisting of 30, or more, questions spanning a range of content: getting an appointment, interactions with the reception staff, communication by the clinician, and the cleanliness of facilities. It's not just that the survey relies on an ability to recall and report on these long-ago interactions and how they felt—it’s likely the response is the only item that person will physically mail in weeks, if in the end it is mailed at all. In an increasingly digital world where real-time ratings and just-in-time feedback have become routine across a variety of industries, how can healthcare adapt and evolve?

By: Anthony E. Tuggle, NFK National Board Chair
Submitted by: Kerensa Peterson, University of California Riverside

After a recent discussion with faculty about the estimated glomerular filtration rate (eGFR), I received the latest monthly newsletter from the US National Kidney Foundation. In the newsletter, there was a piece highlighting a joint task force that was formed by the NKF and ASN in 2020 to reassess the inclusion of race in the diagnosis of kidney disease. “Both organizations have repeatedly asserted that race, is a social, not a biological, construct.”

Authors: Janae K. Heath, C. Jessica Dine; Denise LaMarra; Serena Cardillo
Submitted by: Janice Radway, The Perelman School of Medicine at the University of Pennsylvania

This retrospective study (2012-2018) examined the impact of gender and race on SP assessments of internal medicine (IM) residents' communication skills during the postgraduate year (PGY) 1. Until now, the impact of SP and resident demographics on the standardized communication ratings in residents had not been evaluated. The data demonstrate an association of resident gender on ratings in standardized communication exercises, across multiple communication skills. Understanding the impact of implicit biases on these assessments is critical.

By: Nick Neel, John-Michael Maury, Karen M. Heskett, Alana Iglewicz & Lina Lander
Submitted by: John-Michael Maury, UC-San Diego – School of Medicine

“Medical students experience rising rates of burnout throughout their training. Efforts have been made to not only mitigate its negative effects but also prevent its development. Medical improv takes the basic ideas of improvisational theatre and applies them to clinical situations. Given improv’s focus on self-awareness and reflection, in addition to its spontaneous nature, we hypothesized it had the potential to serve as a creative outlet, a way to prevent and/or mitigate the negative effects of stress, burnout, and fatigue, and provide a learning environment to develop skills necessary to succeed as a physician. University of California (UC) San Diego School of Medicine developed a medical improv elective for pre-clinical students and assessed its effects on student development and wellbeing. Students enrolled in the elective between Fall 2019 and Fall 2020 at UC San Diego School of Medicine were surveyed pre-and post-course completion using both qualitative and quantitative methods. Students noted significant improvement in domains related to proactivity in their professional career, wellbeing, engagement with their studies, and communication after completion of the medical improv elective. We describe a pilot-study demonstrating the positive effects of improv on medical student wellbeing and professional development, laying the groundwork for both future study of improv on student wellness and its implementation in the pre-clinical curriculum.”

By Deborah Davidson, SP for Howard University, Georgetown University and George Washington University

Submitted by: Kerensa Peterson, NBOME

This SP wrote a poem about her SP experience and transition during COVID. It begins, “To be an SP is a challenging role. We show syndromes and symptoms in body and soul. We try to recall every smile, word, and action. So our feedback’s reflective of each interaction…

Lead Author: Dara VF. Albert

Submitted by: Todd Lash, The Ohio State University

We developed nine standardized scenarios that highlighted communication challenges commonly encountered in child neurology. Child neurology trainees participated in three OSCE events with three scenarios each over three academic years. Standardized patients (SPs) portrayed patients and/or their parents. Each trainee-SP encounter was evaluated by an observing faculty member using a modified Gap-Kalamazoo Communication Skills Assessment Form, the SP who provided direct feedback, and by the participating trainee.

By: Timothy M. Smith

Submitted by: Michael Maury, UC-San Diego

Some of the most adverse patient outcomes are caused by poor communication, so medical schools are adopting improv—improvisational theater training—to help students live more in the moment and better empathize with patients. A study published prior to the pandemic found that students used the skills they learned from it, but the gravity of COVID-19 now supplies the ultimate proving ground.

Lead author: Daniela Keren

Submitted by: Kathy Herzberger, Loma Linda School of Medicine

Social studying and learning (SSL), according to the authors is any independent, elective, self-directed and self-organized approach to learning. The article explores what kind of SSL second year medical students developed, their viewpoints regarding the pros and cons, and their perceptions on how it affected their overall learning. How Covid has influenced SSL at this school would make for an interesting follow-up study.

By: David Weiss

Submitted by: Kerensa Peterson, NBOME

David Weiss is a Standardized Patient at Northwestern University and Rush University in Chicago, IL. David created a beautiful (and brief) sound story – listen to Corona Thoughts.