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Structural Inequities in the Treatment of Standardized Patients and What That Means for Patient Care

By: Temple D. West, MMHPE
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

Standardized patients (SPs) play a pivotal role in medical education. They are proxies for real patients, preparing students to meet the challenges of excellent patient care. Human simulation, with SPs, is used for teaching and assessing communication and clinical skills in medical education around the world. Standardized patients work individually with other faculty, students, or in conjunction with medical faculty to facilitate learning with feedback. In most simulation centers, SPs receive extensive training in communication and clinical skills, yet they inhabit territory often unrecognized as professional in medical education. The manner in which SPs are seen and treated by faculty and students may be a reflection of how real patients are seen and treated—not always heard, not always respected—and this tension detracts from both simulated and real patient encounters. Exploring how SPs, as proxies for real patients, are treated in medical education is a key to what we might learn and how we might close gaps in cultural respect and, ultimately, in patient care.

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An Interview with Five Conference Attendees

At the Communications and Connections Committee’s invited presentation, How Do I Communicate and Connect with ASPE? The CommConn Committee Tells You How, committee member Dan Brown sat down with five volunteers to interview them about their conference experience. Here are their answers!

When was your first ASPE conference?

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Gender-Affirming Care with Transgender and Genderqueer Patients: A Standardized Patient Case


Lead author: Laura Weingartner, PhD, MS
Submitted by: Renee Wadsworth, SP-ed

Transgender and gender-diverse (TGD) people experience extreme health disparities and prejudice in health care settings. The lack of provider training around gender-affirming care for TGD patients has historically contributed to this inadequate care. Patient simulation is a crucial component of teaching medical students about gender-affirming care because it allows students to practice and become more comfortable with these skills in a low-stakes setting.

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It Is Not Just the Script that Matters: Overlooked Elements in Standardized Patient Methodology


By: Sandra Jaramillo-Rincón, MD, MHPE, Juan Manuel Potes, MD
Submitted by: Nicholas Gonzalez, The Gordon Center at University of Miami Miller School of Medicine

Standardized patients (SPs) range from individuals looking for additional work to full blown actors and actresses, to somewhere in the middle. This article entails what advantages SPs have and what skills they bring to the table regarding the teaching/learning process. The authors go into detail discussing the training and further development of acting, thematic, pedagogic, and planning and leadership skills among their SPs.

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Aportes de la Simulación al Desarrollo del Razonamiento Clínico en Estudiantes de Pregrado de Medicina


Lead Author: Soledad Armijo, MD
Submitted by: Leonardo Pérez, Claudia Arancibia & Iván Silva, Clinical Skills Center, University of Chile

La simulación clínica en Latinoamérica ha ganado relevancia como herramienta formativa en las últimas décadas. En la formación de pregrado en Medicina, el cómo enseñar razonamiento clínico de la mejor manera aún requiere de consenso. Armijo-Rivera y equipo comparte en la revista de la Federación Latinoamericana de Simulación Clínica (FLASIC) una revisión del uso de simulación clínica con pacientes simulados como una excelente alternativa para “promover el desarrollo de aptitudes procesales, la comunicación con los pacientes, la entrega de los pacientes, el razonamiento ético y el trabajo en equipo” además de integrar información y ayudar a la toma de decisiones. También advierte que se requiere de estudios longitudinales que consoliden esta base de conocimiento, dado que el razonamiento clínico en medicina es un constructo complejo de enseñar y de evaluar. Así, queda abierta la invitación a investigar y socializar nuestras experiencias en simulación clínica con pacientes simulados en el mundo hispano hablante.

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Use of Standardized Patient Encounters as Predictors of Fieldwork Performance: A Pilot Study

Lead Author: Linda Frasier
Submitted by Karen Lewis, The George Washington University SMHS

Although standardized patient encounters (SPEs) are being used in occupational therapy (OT) education, limited literature exists on the value these experiences have on OT student learning outcomes and preparation for fieldwork. This study sought to examine if SPEs had the potential to predict Level II A fieldwork performance

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Pursuing a Medical Career While Black: What it Takes and Why it Matters

Authors: Saul Weiner and Stefan Kertesz
Submitted by: Kerensa Peterson, University of California Riverside

“Making it into and through medical school is tough even for those who have all the advantages: excellent schools starting at a young age, well-educated parents who may be doctors themselves, lots of role models and…white skin. In this episode we hear from two pre-meds and one newly minted physician, all Black, about their journeys with few of these advantages. Despite their remarkable optimism, their burdens are evident, and many do seem tied to race, as it is understood in the US. The extreme underrepresentation of Blacks in medicine should be a source of deep concern for the profession and for society, as a matter of social justice as well as patient care. The passion of these young men and woman is inspiring, and the mentorship opportunities provided by pipeline programs like the I Am Abel Foundation, which has been central to their lives, offers hope.”  

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ASPE Plenary: Celebrating Our Past, Imagining Our Future: 3 Presidents Reflect


By Daniel C. Brown, Emory University

Monday morning in New Orleans, the first full day of ASPE’s 2022 conference included a plenary address from three prior ASPE Presidents: Tamara Owens, Grace Gephardt, and Rob MacAulay. The trio regaled the audience with stories from ASPE’s history, reminded the crowd of recent and current accomplishments, shared a vision for the future, and issued calls to action for ASPE members.

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Annual Literature Review from the ASPE 2022 Conference

Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

It was a pleasure to be back in-person for our 2022 annual conference! One of the highlights every year is the review of published literature in SP methodology, usually run by Dr. Karen Szauter. This year, the job was handed into the capable hands of the Grants and Research Committee. Before they got into the literature, they gave a heartfelt thank you to Dr. Szauter, which culminated in a standing ovation for our esteemed colleague. The committee hailed this literature review as a “celebration of our work”. For 2021, there were 200 papers reviewed, narrowed down to 12 they presented in this session. 6 themes emerged from the work: SP Voices in Social Justice, Addressing the Gap Between Education and Clinical Practice, SP Professional Identity, Advancing SP Educators as Authors, SPs as Assessors, and Interprofessional Education/Program Improvement. A full list will be posted on the ASPE website and added to the existing bibliography here.

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Quality in Standardized Patient Training and Delivery: Retrospective Documentary Analysis of Trainer and Instructor Feedback

Lead Author: Derya Uzelli Yilmaz, RN
Submitted by: Mekail Ebbert, NYIT-COM at Arkansas State University

Creating and maintaining a consistent and meaningful SP quality assurance program has always been a priority of mine, and one that I’ve learned requires a continuous approach of evaluation and monitoring. This article documents a study using the collection of 6 years worth of feedback to “determine programmatic and systematic issues in the scope of quality assurance and improvement...” With this large collection of data they were able to review the outcomes of both trainer and instructor feedback on SP performances, resulting in the emergence of four key themes.

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Barriers, Challenges, and Supports to the Implementation of Standardized Patients and Simulated Environments by Occupational Therapy Education Programs

Lead Author: Amanda Mack, OT, OTD, MS, OTR, CLC
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

A national survey examined the implementation rates, barriers, challenges, and supports to implementation of two types of simulation (standardized patients and simulated environments) by entry-level occupational therapy education programs in the United States. An online survey inquiring about academic program characteristics and use of simulation was sent to all occupational therapy and occupational therapy assistant programs in the United States in 2017 prior to the implementation of the 2018 Accreditation Council for Occupational Therapy Education Standards and the onset of the COVID-19 Pandemic. Data were analyzed using both statistical and content analysis. Thirty-eight percent of responses used standardized patients and 70% used simulated environments in their didactic coursework.
Funding was the most cited support, challenge, and barrier to the use of standardized patients. Physical space was the most cited support and challenge for the use of simulated environments, with funding as the most cited barrier. This study highlights the need for additional research in the use of simulation in OT education, specifically into feasibility and outcomes of lower-cost methods of simulation. Also, the outcomes of the study indicate that OT education programs would benefit from widely available, easy to access, and low-cost or free resources to help with the development and implementation of simulation within their own curricula. Access to these resources may allow academic programs to overcome some of the institutional barriers to implementation of simulation. For simulation to become more widely implemented and to truly reduce the burden of fieldwork education on fieldwork sites and partners, academic institutions may need to provide resources to help occupational therapy education programs overcome the common barriers and challenges and strengthen existing supports.

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Enhancing the Structural Competency of Nurses Through Standardized Patient Simulation

Lead Author: Zvika Orr, PhD
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

Structural competency is a new conceptual and educational framework for training health professionals to discern and respond to the impact of social, political, and economic structures on health. This article discusses a new online standardized patient simulation method that enhances the structural competency of nurses and nursing students. This method has been used to train nurse practitioner students. The article suggests that simulation-based learning can help nurses translate the theoretical comprehension of macro-level forces into clinical practices. This method expands the nurses' perspective, develops their social-political awareness, and encourages them to lead interventions. This simulation can contribute to dismantle structural racism and reduce health inequities.
The article includes a description of one of the scenarios used and a selection of the nursing students’ responses to experience.

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Experiences of Simulated Patients in Providing Feedback in Communication Skills Teaching for Undergraduate Medical Students

Lead Author: Riya Elizabeth George
Submitted By: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

The experiences of SPs and their perspective on providing feedback is an under-studied area. This study aims to explore SP experiences and views on feedback, factors influencing their feedback and implications for training. The authors conducted six focus groups with 30 SPs. Five over-arching themes were identified: feedback processes, challenges in providing feedback, cumulative experiences, web of interpersonal relationships and dynamics, and portraying the character and patient representations.
Read the full study here.

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Co-constructive Patient Simulation: a Learner-centered Method to Enhance Communication and Reflection Skills

Lead Author: Andres Martin, MD
Submitted by: Claudia Arancibia, Leonardo Pérez & Iván Silva, Clinical Skills Center, University of Chile

Co-construction of clinical scenarios could drive one to achieve best practices in simulation. Here, Martin et. al. presents a "co-constructive patient simulation model" highlighting the active collaboration of clinical instructors, standardized patients, and students. In summary, co-constructive patient simulation offers a novel strategy to engage learners and promote significant learning and relevant experiences that balance the cultivation of their professional competencies with the specific needs of the learners themselves enhancing communication and reflecting skills.

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The Use of Clinical Simulation to Address Disability Content Inclusion in Nursing Education: A Review of The Literature

Lead Author: Eda Ozkara San
Submitted By: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

Nursing students receive limited education to prepare them for providing quality nursing care to people with disabilities. The aim of this article is to provide the state of the science, or what is known, about nursing simulation with disability content to provide direction for nursing education and research in the future. Thirteen studies were reviewed and appraised in this integrative review. This review revealed three major student-related study outcomes for simulation activities: (a) empathy, (b) understanding and awareness, and (c) communication and disability. Only a few studies integrated a definition of a disability and specified the disability model to guide the development of the simulation activity. This review revealed limited research on the use of simulation with disability content in nursing education. The findings indicate there is a need for nurse educators and researchers to use best practices, such as a competency-based approach, when integrating simulation activities with disability content into the nursing curriculum.
Read the full study here.

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Teaching Students as a Family

Author: Erika Klein
Submitted by: Kerensa Peterson, University of California Riverside

Many of you are familiar with the joys of Simulated Patient work. But how many of you have had the fortune of working with multiple generations in your SP Program? At UCR, I’ve had the privilege of working with a young woman, her mother and her grandmother. Our Communication team at the School of Medicine heard about our three generations of SPs and wrote a short piece about them. I hope you enjoy this quick read about their love and passion for SP work!

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The Role of Standardized Patient Programs in Promoting Equity, Diversity, and Inclusion: A Narrative Review

Lead Author: Derya Uzelli Yilmaz, RN
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

Integrating equity, diversity, and inclusion (EDI) in curricula for training health professionals is a frequent institutional goal. Here the authors present a theoretical model based on a synthesis of the literature for using standardized (or simulated) patient programs (SPPs) in EDI training, along with a narrative review of the available literature between January 2000 and October 2019. Three primary themes emerged: improving cultural competence, effective communication with diverse patients, and highlighting health inequalities.

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Integrating the Electronic Health Record Into Patient Encounters: An Introductory Standardized Patient Exercise for Preclinical Medical Students

Lead Author: Joseph A. Cristiano, MD
Submitted by: Erin Walsh, Rosalind Franklin University of Medicine and Science

This article explores incorporating the electronic health record (EHR) into simulated patient encounters with standardized patients. The authors created a formative exercise where preclinical medical students practiced EHR related communication and data collection while interviewing standardized patients. Two-hundred and eighty- nine second-year students took part in the exercise and most rated the activity as extremely or quite effective. The article suggests the training session was a valuable exercise to introduce preclinical medical students to integrating the EHR in patient encounters. Details of the exercise are included in the article.

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Medical students’ experiences when empathizing with patients’ emotional issues during a medical interview – a qualitative study

Lead Author: Knut Ørnes Brodahl
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

There are few in-depth studies investigating medical students’ own experiences when trying to empathize in concrete clinical encounters. This study explores medical students’ perceptions, experiences, and reflections when empathizing with patients expressing emotional issues. After conducting an interview with a Standardized Patient, participants were asked to reflect on their internal experiences during the encounters. Five themes which may influence student empathy during history-taking were identified through analysis of interview data: (1) Giving priority to medical history taking, (2) Interpreting the patient’s worry as lack of medical information, (3) Conflict between perspectives, (4) Technical communication skill rather than authentic and heart-felt and (5) The distant professional role. 

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Developing standardized patient-based cases for communication training: lessons learned from training residents to communicate diagnostic uncertainty

Lead Author: Dimitrios Papanagnou
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

Effective case design is essential to ensure an SP encounter successfully meets learning objectives that are focused on communication skills. Creative, well-designed case scenarios offer learners the opportunity to engage in complex patient encounters, while challenging them to address the personal and emotional contexts in which their patients are situated. Therefore, prior to considering the practical execution of the patient encounter, educators will first need a clear and structured strategy for writing, organizing, and developing cases. 

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