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.”

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.”