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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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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A Framework for Developing Antiracist Medical Educators and Practitioner–Scholars

Lead Author: Sylk Sotto-Santiago
Submitted by: Kerensa Peterson

“With an increasing awareness of the disparate impact of COVID-19 on historically marginalized populations and acts of violence on Black communities in 2020, academic health centers across the United States have been prioritizing antiracism strategies. Often, medical students and residents have been educated in the concepts of equity and antiracism and are ready to tackle these issues in practice. However, faculty are not prepared to respond to or integrate antiracism topics into the curriculum. Leaders in faculty affairs, education, diversity, and other departments are seeking tools, frameworks, expertise, and programs that are best suited to meet this imminent faculty development need.”

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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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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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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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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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In The Spotlight: Duqesne University School of Nursing

Submitted By: Rosanna Henry

Full Center Name: The Learning and Simulation Center 

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Teaching Sexual Orientation and Gender Identity in Pediatric Clinical Settings: A Training Workshop for Faculty and Residents

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.”

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A Curriculum Innovation on Writing Simulated Patient Cases for Communication Skills Education

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.”

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Standardized Vaccine-Hesitant Patients in the Assessment of the Effectiveness of Vaccine Communication Training

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.

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Teaching Emergency Medicine Residents Health Equity through Simulation Immersion

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.

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Helping the Measurement of Patient Experience Catch Up with the Experience Itself

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?

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Removing Race from Diagnosing Kidney Disease and Addressing Health Inequities

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.”

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The Impact of Trainee and Standardized Patient Race and Gender on Internal Medicine Resident Communication Assessment Scores

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.

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The Impact of a Medical Improv Curriculum on Wellbeing and Professional Development among Pre-clinical Medical Students

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.”

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Plenary Speaker: “We Stop for No Storm” by Karen Szauter, MD

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

One of the highlights at every ASPE Conference is Karen Szauter’s literary review. She presents highlights from research published in the last year in the field of simulation. It’s fast, it’s educational, it’s entertaining – and usually standing room only. At this year’s virtual conference, Ms. Szauter presented “We Stop for No Storm”, a title inspired by a telegram from the year 1900 during a storm at the University of Texas in Galveston. She has been presenting this session since 2011, and this year is scheduled to be her last.

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