Simulating Inclusive Dialogues: Encouraging Faculty-led Conversations Surrounding Bias and Microaggression
Lead Author: Vikasni Mohan, et al.
Submitted by: Amanda Fernandez-Acosta, University of Miami

Within the University of Miami, medical students and residents noted a lack of dialogue surrounding bias and microaggressions, and uncertainty on how to handle these types of situations. To assist, the authors designed a course for faculty to better understand the harmful impact of bias/microaggressions and provide them with the proper tools to engage in meaningful dialogue surrounding the subject. The authors adapted the PAAIL framework and added the Bridge-the-Gap component to better support conversations surrounding bias/microaggressions in healthcare education. The course followed self-selected participants who indicated first-hand personal experiences with bias and microaggressions and offered clinical faculty a framework to intervene in such cases. Next steps include evaluating whether practicing these difficult conversations promotes psychological safety among faculty and normalizing these conversations to foster inclusivity and engagement among faculty, staff and learners.

Student empathy in standardized patient experiences: Applying concepts from a critical thinking emulation model
Lead Author: Lance Brendan Young PhD, MBA
Submitted by: Amy Lorion, NBOME

According to Young et al., research has shown that dental students’ empathy for patients declines over the course of their education and this “empathy-reducing influence of training” can have a real and negative impact on the students’ future patients. In order to address this concern, the authors aspired to “(1) Develop a learning guide for observable behaviors communicating emotional and cognitive empathy and (2) determine whether the learning guide can be used as a rubric for assessing empathy in a standardized patient experience.” The authors created a learning guide/evaluation rubric using an emulation model that focused on, “the communication of empathy,” a guide that SPs then used to score student performance in simulated encounters. According to the authors, the study’s results show that their model, “is viable as both a learning guide and evaluation rubric in a standardized patient format.”

Standardized Patients in Medical Education: A Review of the Literature
Authors: Flanagan O L, Cummings K M
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

The research questions posed for this review were as follows: do medical students in their first two years of education who have practiced skills using SPs have more self-confidence in their ability to perform skills on real patients than those students who did not use SPs? Do medical students in their third and fourth years of medical school have higher clinical competency with sensitive patient examinations after using SPs in their first two years of medical education than those students who did not use SPs? And finally, do medical students who have used SPs for discussing sensitive issues have better interpersonal skills when they encounter real patients in the clinical setting than those who have not used SPs? I’m going to take a leap and say yes.

Using Simulation-Based Learning with Standardized Patients (SP) in an Implicit Bias Mitigation Clinician Training Program
By: Jennifer Tjia et al
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

This article describes the design, implementation, and response to a simulation-based training program on implicit bias awareness and mitigation skills. Two aspects of this undertaking really stood out to me. First, the SPs were recruited from the local community and were involved in case development to ensure that the scenarios were realistic and relevant to the community's needs.  Second, the program creators revised the structure of the program based on participant responses to create a more safe environment and a more robust learning experience.

An Interactive Online Interprofessional Opioid Education Training Using Standardized Patients
By: Connie M. Remsberg et al
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

Opioid pain management is complex and requires a collaborative approach. To prepare health professions students to care for patients who have chronic pain, the authors developed an interprofessional education (IPE) session for delivery using a virtual platform that featured a standardized patient (SP) interaction. The low-stakes, formative training has been developed to enable health profession students to learn from each other about how to provide collaborative care to a patient taking opioids for chronic pain. Since the widespread adoption of videoconferencing technology for teaching and learning is relatively new, this format provides a unique opportunity for IPE. This online IPE opioid education training session, which targets learners from nursing, pharmacy, medicine, physician assistant, and social work, dedicates specific time to the following elements: IP team collaboration to assess and interview an SP with chronic pain who takes opioids, IP team care planning and discussion, and development of a written IP treatment plan submitted as a formative assignment. Other programs may find this IPE training useful specifically because it addresses one of the biggest hurdles in IPE by providing a model for connecting geographically separated students through videoconferencing technology.

Which Teaching Method Is More Effective in a Communication Course – Role-Playing Versus Simulated Patients, Taught by Tutors or Faculty Staff? A Randomized Trial
Lead Author: Julia Herchenröther
Submitted by: Amy Lorion, National Board of Osteopathic Medical Examiners

The article details the results of a study created “as part of the medical history-taking course … that aimed to establish if lecturers or tutors led to better results in student performance. The study also aimed to investigate if the use of simulated patients or role-playing with fellow students led to better communication skills in the students.” The authors find that “in history-taking courses students who trained an increased number of times with SP benefited more from instruction by a university lecturer and that groups led by peer tutors benefited more from the use of RP,” with “RP” referring to the role-playing with fellow students.

An Effective Gender-Affirming Care and Hormone Prescribing Standardized Patient Case for Residents
Lead Author: Ben J. Hersh, MD
Submitted by: Amy Lorion, National Board of Osteopathic Medical Examiners

Recognizing the impact of physician inadequate training in gender-affirming care, the authors piloted a formative SP case for gender-affirming care with 20 family medicine residents. As the authors describe their results: “Self-reported knowledge and awareness increased after standardized patient case participation in multiple skill areas related to providing gender-affirming care. Faculty observers informally reported that the session increased their knowledge and comfort as well.” They recommend the use of such training to improve health care equity for transgender and gender-expansive individuals, although they caution those designing such training to “be certain to review terminology to reflect the ongoing changes specific to the LGBTQIA+ community,” noting that they had “needed to alter the language we used to reflect the changing climate” through their case development process.

Conscious Engagement within Patients’ and Simulated Participants’ Personal Space: Medical Students’ Perspective
Lead Author: Chara Banks‑McGovern
Submitted by: Amy Lorion, National Board of Osteopathic Medical Examiners

Banks-McGovern et al. capture the significance of their study in the first sentences of their abstract: “#MeToo prompted a shift in acceptable societal norms, sparking global recognition of the complexities of entering another’s personal space. Physical examinations are an integral part of medicine yet have the capacity to encroach upon patient’s personal space, whether in simulated or clinical environments. Examinations may be misconstrued as inappropriate advances, with negative effects for both patient and doctor.” As they note in the article, simulation and SPs can play a role in providing medical students with necessary “experience of and teaching on the crucial expertise behind a safe and mutually respectful physical examination.”

Social Determinants of Health: A Multilingual Standardized Patient Case to Practice Interpreter Use in a Telehealth Visit
Lead Author: Gigi Guizado de Nathan
Submitted by: Amy Lorion, National Board of Osteopathic Medical Examiners

Guizado de Nathan et al. describe a piloted simulation for teaching students the use of medical interpreters, a pilot created in recognition that the “growing diversity of the United States population and strong evidence of disparities in health care make it critically important to educate health care professionals to effectively address issues of culture.” They designed a telehealth case that includes an SP and a simulated medical interpreter, both bilingual, in a scenario that requires the student to both identify the need for an interpreter and to communicate with the patient through that interpreter.

An Objective Structured Clinical Exam on Breaking Bad News for Clerkship Students: In-Person Versus Remote Standardized Patient Approach
Lead Author: Lona Prasad, MD
Submitted by: Amy Lorion, National Board of Osteopathic Medical Examiners

This article describes what happened when a breaking-bad-news OSCE was moved from in-person to virtual delivery due to COVID restrictions. The OSCE involves a miscarriage case, a distressing situation that, as the authors note, “calls for communication that incorporates patience and empathy.” The authors understandably wondered what would happen when moving such a scenario to what can be an impersonal technological tool.

Lead Author: Marco Antonio de Carvalho Filho
Submitted by: Sharon Baker, Grand Valley State University

The authors of this study examined how to use an educational method called Co-Constructive Patient Simulation (CCPS) to improve professional development in healthcare. They participated in simulated scenarios aligned with their developmental stages and needs. This method integrates learning opportunities in clinical practice, amplifies learners’ critical reflection and autonomy and harnesses real-life challenges.
Read more about the study here.

By: Lisa Altshuler
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

In my own conversations with SPs and other SP educators, we have often discussed how SP work alters our perceptions of our real-life patient experience and makes us better advocates for ourselves and our family members when navigating the healthcare system. This article takes a more concrete look at the difference between SPs’ and real patients’ perceptions of care. 

Author: Jeremy J. Webb, M.D.
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

The author suggests that ChatGPT can be used to teach physicians how to break bad news. This is a skill that has been taught effectively through a combination of didactics and practice with simulated patients. The author has ChatGPT create a scenario, have a written dialogue with the physician and then offer feedback based on how his words aligned with the SPIKES framework for breaking bad news. Does this come close to the impact of human interaction and SP methodology? Read for yourself here. 

Lead Author: Océane Richard
Submitted by: Michelle Fernandez, University of Miami

“The present study suggests that simulation-based training may be effective to change attitudes and skills for suicide risk assessment and crisis intervention, with promising preliminary results regarding changes in behaviors and patients’ outcomes. However, numerous limitations must be acknowledged, and many challenges remain. More research of higher methodological quality must be developed.”

Lead Author: Sarah Prediger
Submitted by: Nicholas Gonzalez, Gordon Center for Simulation and Innovation in Medical Education, University of Miami Miller School of Medicine

In the realm of SP work, there may come variation in perspective. What one might determine is an effective patient encounter, another may interpret as one that was less effective or poor in nature. Sarah Prediger and Sigrid Harendza, of the University Hospital of Hamburg-Eppendorf, sought to shine a light on this and many other possible discretions in SP evaluation of communication and interpersonal skills. They had SPs assess medical learners from an internal- and external-patient perspective and discuss their findings of interest.

Lead Author: Easton N. Wollney
Submitted by: Amy Lorion, NBOME

This article purports to be a comparison between two types of raters, SPs and “outside observers with training in healthcare communication,” with the evidence demonstrating that the SPs were more lenient in their scoring on both subjective items (e.g., “used effective body language”) and objective items (e.g., “The resident told the patient she should not start smoking again”). However, as the authors acknowledge partway through the article, there was another glaring factor: the SPs only scored the encounters live, based on memory, and the non-SP observers only scored the encounters via recorded videos; hence, “evaluator type was tied to evaluator method in this study.” This article is worth reading—the differences between the groups’ scores are telling and support several of the discussion points (e.g., cognitive load)—despite the mixed approach which undercuts the assertion that it’s a comparison of rater types per se.

Lead Author: Igal Iancu
Submitted by: Laura Harris and Carys Fritz, OHSU

This article describes how the authors utilized an innovative virtual patient simulation platform to develop successful impact measurement of the educational activities that can be applied to Continuing Medical Education (CME). The new platform is designed to assess learners’ knowledge and competency in the management of type 2 diabetes, high cholesterol, and high blood pressure.

ASPE Scholar Certificate

The awards ceremony started with the ASPE Scholars Certificate presented by Jacqueline R. Klevan
ASPE Scholars complete the required Basic of Scholarship session, as well as requirements in qualitative and/or quantitative measurement and electives, either from the ASPE conference itself or relevant, comparable content from other conferences.

Lead author: Angelina Fluet | Submitted by: Erin Walsh, Rosalind Franklin University of Medicine and Science 

To gather Standardized Patients perspectives on bias the authors designed a qualitative interview study and conducted semi-structured interviews with 16 SPs. The interviews were conducted from July to September of 2020. It was concluded that bias occurs in multiple directions including SP-to student. student-to SP, student-to character, and SP- to -character. Additionally, SPs shared they feel there is bias during scenario development and SP recruitment and training. The authors determined that identifying areas where bias occurs can help simulationists alleviate bias. 

By: Timothy Rogers, MD et al | Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

Experiential learning through active participation is thought to be a key benefit of simulation-based education. Recent research has challenged this assumption, suggesting that active participants learn just as well as observers. Studies report that active participants experience stress and anxiety during simulation, which may hamper learning by active participants. We undertook the current study to examine whether active participation results in different emotional arousal than observing during simulation.