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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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Journal Article: How Do Standardized Patients Form Their Complex Identities? The Impact of Interactions with Medical Students

Lead Author: Samantha A. Starr, BS et al
Submitted by: Claudia Arancibia & Sergio Bozzo, Clinical Skills Center, University of Chile

SPs’ participation in medical education is becoming broader and more powerful in assessments, physical examination instruction and debriefing. Just as their role expands, so does the interest in knowing their perspectives, their thoughts, and their vision of the role they play. If you ask SPs about who they have become since they started working as SPs, you will discover how they have changed, and this could be something big, like a new identity. You may think, this should be expected, as with students and SP educators, but we have not known much about it. This knowledge could be important as you consider its influence on future activities and the development of an SP program.

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Twelve Tips for Running an Effective Session with Standardized Patients

By: J. Talwalkar, K. Cyrus, A. Fortin
Submitted by Kathy Herzberger, Loma Linda School of Medicine

The authors have placed into twelve succinct steps what is required to tackle a new project utilizing standardized patients. This will be a review for some, but for newcomers to the realm of SP work, this is a good outline to utilize to create successful activities.

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Experiencing the Patient Experience

Lead author: Samuel Zverev
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

“She squirmed, sobbing hysterically, grabbing onto the railing of the inpatient hospital bed with IVs still bound to her arm. A grown woman was shouting and crying, not because of physical pain or injury, but out of fear. The sea of medical professionals surrounding her bed only seemed to exacerbate her dismay. She refused to acknowledge any of them, consciously omitting the small army of physicians and nurses crowding her room. She would only speak with one person … me.”

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Managing Medical Curricula During the Pandemic

Published in cooperation with the Federation of American Societies for Experimental Biology (FASEB)
Submitted by: Kerensa Peterson, NBOME

“When the pandemic rapidly developed in the US in mid-spring of this year (2020), it impacted all teaching programs from early childhood to professional schools and many stop-gap changes were introduced to allow virtual instruction to replace face-to-face teacher-student contact across this spectrum. With the time engendered by the summer months in 2020, many teaching programs/curricula have fine-tuned these changes made to accommodate the virtual format. In this Special Collection, the approaches taken by several medical schools, ranging from individual courses to the full curricula, are described. It is our intention to revisit these programs over the next year to evaluate what worked well and what did not.  

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The Modern Physical Exam – A Transatlantic Perspective from the Resident Level

By: A. Jacobsen, Y. Khiew, S. Murphy, C. Lane, & B. Garibaldi
Submitted by Kathy Herzberger, Loma Linda School of Medicine

As someone who teaches clinical skills, I have always advocated that a hypothesis driven physical exam can improve patient/physician relationships and provide better patient outcomes. Ireland relies on high standards of physical exam skills due to their resource-limited health system. Physical exam skills in the U.S., however, have declined due to the “high-tech transformation of health care and a more litigious society”. Medical errors and physician burnout increased as physical exam declined. Reading this article validated my beliefs that teaching and assessing physical exam skills is imperative to quality patient care.

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Interprofessional Communication—A Call for More Education to Ensure Cultural Competency in the Context of Traditional, Complementary, and Integrative Medicine

Lead author: Jennifer Hunter
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

Culturally appropriate communication between healthcare professionals and with patients is widely recognised as a cornerstone of high quality, patient-centred care. The widespread use of traditional, complementary, and integrative medicine (TCIM) necessitates that patient-centre communication and cultural competency in healthcare extends beyond race, ethnicity, and languages spoken to also include an awareness of, and respect for the diverse range of healthcare practices, paradigms, and lexicons that patients and practitioners use. Education can equip practitioners with the necessary communication skills and expand their knowledge about the therapies and practices that patients are accessing.

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Simulated On-Call: Time Well Spent

By: Lauren Misquita, Lucy Millar, Brent Bartholomew
Submitted by Kathy Herzberger, Loma Linda School of Medicine

The authors share an interesting simulation program designed to help fourth year students feel better prepared for their intern year. In two sessions, students participated in several different scenarios that interns typically encounter. One-to-one briefings followed the encounters. Students felt the experience was valuable and felt it should become a mandatory part of the curriculum.

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Diversity and Inclusion in Simulation: Addressing Ethical and Psychological Safety Concerns When Working with Simulated Participants

By: Leanne Picketts, Marika Dawn Warren, Carrie Bohnert
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

Healthcare learners can gain necessary experience working with diverse and priority communities through human simulation. In this context, simulated participants (SPs) may be recruited for specific roles because of their appearance, lived experience or identity. Although one of the benefits of simulation is providing learners with practice where the risk of causing harm to patients is reduced, simulation shifts the potential harm from real patients to SPs. Negative effects may be amplified when SPs are recruited for personal characteristics or lived experience. Educators have an ethical obligation to promote diversity and inclusion; however, we are also obliged to mitigate harm to SPs.

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“It’s Not an Acting Job…Don’t Underestimate What a Simulated Patient Does”: A Qualitative Study Exploring the Perspectives of Simulated Patients in Health Professions Education

Lead Author: Shane A. Pritchard, BPhysio, et al
Submitted by: Kerensa Peterson, NBOME

Using an interpretivist research paradigm and qualitative design, these researchers from Australia considered simulated patients’ self-identified role within healthcare education. The researchers engaged 18 SPs in frank discussion about the SPs’ role in order to explore their experiences, perspectives and practices within their SP programs. The researchers have a rich discussion of themes that emerged from those SP conversations. They offer SP Educators ways to further benefit SPs and engage in quality educational experiences for learners with input from the professionals performing the simulation – the Simulated Patients themselves.

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Assessment of Interruptive Behavior at Residency Teaching Conferences by Gender

Lead author: Amrapali Maitra
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

In anecdotal reports from residency retreats, female residents described a high frequency and negative impact of interruptive behavior by male colleagues. The authors sought to characterize interruptions during residency teaching conferences by gender. The results are eye-opening.

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Non-Heterosexual Medical Students are Critically Vulnerable to Mental Health Risks: The Need to Account for Sexual Diversity in Wellness Initiatives

Lead Author: Daniel Suarez
Submitted by Kathy Herzberger, Loma Linda School of Medicine

This study looks at the association between sexual orientation and the mental health of medical students. One of the more heartbreaking findings was the higher rate of family dysfunction among non-heterosexual students that leads to decreased social and financial support. Once again, our vigilance is essential to help our students find the help that they need to improve their well-being.

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Comparison of Self and Simulated Patient Assessments of First-Year Medical Students’ Interpersonal and Communication Skills (ICS) during OSCEs

Lead Author: Joshua A. Roshal
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

This study identified self and simulated patient (SP)-reported ratings of US first-year medical students’ interpersonal and communication skills (ICS) and the influence of age and gender on performance appraisal during the Objective-Structured Clinical Examination (OSCE). While the majority of students and SPs evaluated the students’ ICS as very good, there was a disparity in the rating of the medical students’ ability to encourage patient question-asking and answer questions; more SPs gave an “inadequate” rating in that category than students. Neither age nor gender influenced the medical students’ self-assessment of ICS. Female SPs assigned lower scores to students in regard to respecting patients and encouraging patient question-asking and answering. Older SPs were more likely to assign lower scores on all survey questions.

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