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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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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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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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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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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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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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