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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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Simulated Patient-Based Communication Skills Training for Undergraduate Medical Students at a University in Ethiopia

Simulated Patient-Based Communication Skills Training for Undergraduate Medical Students at a University in Ethiopia
Lead Author: Tesfamichael Alaro Agago
Submitted by: Mekail Ebbert, NYIT-COM @ Arkansas State University

“The verbal and non-verbal messages we utilize to interact with others could result in common understanding and are the cornerstone in the training of communication skills (CSs).” A study implemented at an Ethiopian University searches for answers to which interactive methods of teaching communication skills proves to be the most successful when working with medical students. Which do you think offered better results for students learning communications skills-simulated patients or case-based role-play?

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Feasibility of Using Simulated Patients for Onsite Structured Practice Feedback in Jordanian Community Pharmacy Settings

Lead Author: Eman A. Hammad
Submitted by: Kerensa Peterson, University of California Riverside

Simulated patient (SP) visits followed with structured feedback is useful to outline training needs as well

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In The Spotlight: NYIT-COM @ ARKANSAS STATE UNIVERSITY

Submitted By: Mekail Ebbert
Full Center Name: Institute for Clinical Competence


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In The Spotlight: Northeast Georgia Health System (NGHS)

Submitted By: Nicole Beringson
Full Center Name: NGHS Center for Simulations and Innovation
Center Location: Gainesville, GA USA
Year Opened: 2006

Center Mission Statement: Our mission is to promote high quality and safe patient care, enhance education, and develop research through excellence in multimodal simulation-based training and experiential learning.


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IMSH 2022 Plenary Speaker: Erica Dhawan, Get Big Things Done: The Power of Connectional Intelligence

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

I had the privilege to attend the 2022 International Meeting on Simulation in Healthcare (IMSH), held in Los Angeles from January 15-19. I felt grateful to attend a conference in-person, and I felt fairly comfortable with the many protections taken to keep conference attendees safe. One of the most inspiring aspects of the conference is The Lou Oberdorff Lecture on Innovation and Healthcare Simulation. This year’s speaker was no exception. Erica Dhawan is the author of Get Big Things Done: The Power of Connectional Intelligence and Digital Body Language: How to Build Trust and Connection, No Matter the Distance.She asks the question: how do we create a better normal than pre-pandemic times? How do we connect more intelligently when 75% of face-to-face collaboration is non-verbal and currently, collaboration in teams is 70% virtual? When non-verbal cues are missed, we misunderstand quickly, argue more and walk away faster. She highlighted her idea of Connectional Intelligence, which is the capability to unlock new and unrealized value by fully maximizing the power of networks and relationships. She cited projects such as The Granny Project and Task Rabbit as ways that people have collaborated in new ways, across previously untapped communities, to solve a problem.

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IMSH 2022 Keynote Presentation - Yassmin Abdel-Magied, “Transformative Leadership”

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

I had the pleasure of attending the IMSH 2022 Keynote Presentation from Yassmin Abdel-Magied, speaking about “Transformative Leadership.” Yassmin is a Sudanese-Australian writer, broadcaster, and award-winning social advocate with a background in mechanical engineering. Yassmin is a globally sought-after advisor on issues of social justice, focused on the intersections of race, gender and faith. What struck me most about her was her sense of humor, her completely approachable style and her clever use of “costume changes” as a way to challenge assumptions based on appearance. She characterized confirmation bias and group think as “sneaky little buggers,” sharing her experience of being the only woman working on an oil rig. She outlined methods of marginalization; when difference is amplified, we impose stereotypical expectations, and the individual is tuned out. She advocates for the use of standardized decision-making tools to overcome unconscious bias and a focus on patient-centered communication to see people as individuals and not a member of a group. She encourages us to lean into our discomfort to make real, structural change.

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Quality in standardized patient training and delivery: retrospective documentary analysis of trainer and instructor feedback

Lead author: Derya Uzelli Yılmaz, R.N., Ph.D.
Submitted by: Erin Walsh, Rosalind Franklin University of Medicine and Science

This study analyzed trainer and instructor feedback given to SPs on performance and issues related to quality assurance and improvement. Six years (2014-2020) of feedback forms were reviewed and analyzed for this study. A logic-based model aiming at developing quality management culture in SP programs is proposed. The study suggests an important part of feedback is that it is analyzed and incorporated into portrayal as soon as possible. The changes that are being made should be communicated to stakeholders to ensure consistency.

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Healing a Broken Clerkship Grading System

By: Justin Bullock, MD, MPH and Karen E. Hauer, MD, PhD
Submitted by: Dan Brown, Emory University

This article by a first-year resident and associate dean at University of California San Francisco highlights the problems in how many medical schools assess clerkship students. It’s a valuable read for any SP Educators who manage simulations for clerkships, arguing for pass/fail grading, more evaluation training for assessors, quality feedback, and an honest examination of bias in grading.

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What is the Students’ Opinion about Using Scenarios with Manikins and Simulated Patients in Undergraduate Medical Education?

Lead Author: Kamil Torres
Submitted by: Mekail Ebbert, NYIT-COM @ Arkansas State University

“Medical simulation has turned out to be a well-developed educational technique at a postgraduate level, including residency programs and continuing vocational training. However, its applicability has still not been clearly defined when providing education to undergraduate medical students.” See how one study sought the opinion of undergraduate medical students about the “effectiveness of manikin-based and SP-based high fidelity scenarios for clinical objectives.”

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