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Ethical Concerns When Minors Act as Standardized Patients

Lead author: Erwin Jiayuan Khoo
Submitted by: Joe miller, University of Minnesota

Abstract: When minors are asked to assist medical educators by acting as standardized patients (SPs), there is a potential for the minors to be exploited. Minors deserve protection from exploitation. Such protection has been written into regulations governing medical research and into child labor laws. But there are no similar guidelines for minors’ work in medical education. This article addresses the question of whether there should be rules. Should minors be required to give their informed consent or assent? Are there certain practices that could cause harm for the children who become SPs? We present a controversial case and ask a number of experts to consider the ethical issues that arise when minors are asked to act as SPs in medical education.

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A Culture of Safety From Day 1: An Institutional Patient Safety Initiative to Support Incoming Interns

Lead author: Kinga L. Eliasz, PhD
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

On the first day of residency, incoming interns must understand the specific ways their new institution creates a culture of safety. To support transitioning trainees, this group at NYU Langone Health developed an authentic, large-scale immersive patient safety simulation called First Night-on Call (FNOC). This is a 4-hour immersive simulation during which new interns, in groups, were challenged to conduct an ethical informed consent, activate a rapid response team (escalation), document a clinical encounter, conduct an effective patient handoff, and participate in patient safety rounds.

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Specific Feedback Makes Medical Students Better Communicators

Lead Author: Cosima Engerer
Submitted by: Kerensa Peterson, Northwestern University

We are all aware of the important role feedback plays in teaching communication skills. However, there is little research that has systematically investigated specific structures for giving feedback in order to produce evidence on the most effective way to provide feedback. There are several fascinating and challenging methodological insights and limitations in this work. Researchers at the Technical University of Munich, Germany sought out to prove that utilizing structured, and behavior-oriented feedback was the most effective way to provide feedback. While their results confirmed that this feedback is a powerful tool, they agreed that further research would be necessary “to arrive at a firm conclusion.”

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How Does Health Care Simulation Affect Patient Care?

Lead author: Joseph O. Lopreiato, MD, MPH
Submitted by: Dyan Colpo, Cleveland Clinic, Simulation and Advanced Skills Center

Health care simulation programs have spread to many parts of the United States health care system, including hospitals, medical and nursing schools, community college programs, and clinics. Many educational and training units use simulation to help teach new skills, refresh old skills, and promote teamwork in the delivery of health care.

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Blurred Boundaries: Sexuality and Power in Standardised Patients’ Negotiations of the Physical Examination

Blurred Boundaries: Sexuality and Power in Standardised Patients’ Negotiations of the Physical Examination
Lead Author: Grainne P. Kearney
Submitted by: Mary Launder, Rosalind Franklin University of Medicine and Science

Working with standardised or simulated patients (SPs) is now commonplace in Simulated Learning Environments. Embracing the fact that they are not a homogenous group, some literature suggests expansion of learning with SPs in health professional education by foregrounding their personal experiences. Intimate examination teaching, whether with or without the help of SPs, is protected by a particular degree of ceremony given the degree of potential vulnerability. However, other examinations may be equally intrusive for example the close proximity of an eye examination or a chest examination in a female patient. In this study, we looked at SPs’ experiences of boundary crossing in any examinations, sensitised by Foucault’s concept of the clinical gaze. We wished to problematise power relations that construct and subject SPs as clinical tools within simulation-based education.

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Clinical Skills and Professionalism: Assessing Orthopaedic Residents with Unannounced Standardized Patients

Lead Author: David P. Taormina, MD
Submitted by: Kerensa Peterson, Northwestern University

Researchers at NYU-Langone Multi-center Academic University Hospital system embarked on a study that took place over a 2-year period. Forty-eight Unannounced Standardized Patient (USP) encounters were completed by residents in orthopaedics. Since the ACGME requires residency training programs to assess core competencies and track resident longitudinal development, they needed to be able to systematically and reliably assess residents using objective assessment tools.

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Verbal Communication of Students with High Patient-physician Interaction Scores in a Clinical Performance Examination Assessed by Standardized Patients

Lead Author: HyeRin Roh
Submitted by: Kerensa Peterson

There are many evaluation tools that SPs have used to rate medical students’ communication skills.  At times SP ratings differ from the ratings of medical faculty because SPs experience an interaction differently than an observing faculty member.  This study used the frequency of students’ communication behaviors as an objective measure.

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Assessing the Performance and Satisfaction of Medical Residents Utilizing Standardized Patient Versus Mannequin-simulation Training

Lead Author:  Ali A. Alsaad
Submitted by: Mary Launder, Rosalind Franklin University of Medicine and Science

At our institution, the traditional IM curriculum in clinical reasoning and critical thinking skills focused on the learner interacting with a simulation mannequin. Feedback from this experience was mixed, with the learners often pointing out that the interaction with the mannequin was unrealistic. We hypothesized that using an SP instead of a mannequin would not only give a more realistic experience but would also improve medical knowledge acquisition. Therefore, the aim of this study was to compare residents’ performance in management of four scenarios depicting patient clinical deterioration utilizing either a high-fidelity simulation mannequin or SP.

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Simulation Training in Palliative Care: State of the Art and Future Directions

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

The growing need for palliative care (PC) among patients with serious illness is outstripped by the short supply of PC specialists. This mismatch calls for competency of all health care providers in primary PC, including patient-centered communication, management of pain and other symptoms, and interprofessional teamwork. Simulation-based medical education (SBME) has emerged as a promising modality to teach key skills and close the educational gap.

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A Program to Train Medical Physicists for Direct Patient Care Responsibilities

Authors: Derek W. Brown, Todd F. Atwood, Kevin L. Moore, Robert MacAulay, James D. Murphy, Arno J. Mundt and Todd Pawlicki
Submitted by: Michael Maury, UC-San Diego

Most of the time in the medical profession, the responsibility of patient care and empathic interaction falls mainly on the doctors and nurses. Yet, a responsibility like this must be shared by all individuals on the team. In this research study, the authors sought to “develop a training program designed to meet the specific needs of medical physicists as they transition into a clinical role with direct patient care responsibilities.” Please read on for information about the developed program that “incorporates an array of established education techniques and provides a comprehensive, accessible, means of improving medical physicists’ patient communication skills.”

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Journal Article: Standardized patients in psychiatry – the best way to learn clinical skills?

Journal Article: Standardized patients in psychiatry – the best way to learn clinical skills?
By: Monika HimmelbauerTamara SeitzCharles Seidman, and Henriette Löffler-Stastka
Submitted by: Mary Launder, Rosalind Franklin University of Medicine and Science

Standardized patients (SP) have been successfully utilized in medical education to train students’ communication skills. At the Medical University of Vienna communication training with SPs in psychiatry is a mandatory part of the curriculum. In the training, the SP plays the role of four different patients suffering from depression/suicidal tendencies, somatoform disorder, anxiety disorder, or borderline disorder while the student attempts to gather the patient’s medical history. Both the instructor and SP then give the student constructive feedback afterwards.

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Research Article: Exploring patient-centeredness: The relationship between self-reported empathy and patient-centered communication in medical trainees

Research Article: Exploring patient-centeredness: The relationship between self-reported empathy and patient-centered communication in medical trainees
Lead author: Marianna D. LaNoue
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

Patient-centered communication can lead to better clinical outcomes as well as greater patient satisfaction and perceived quality of care. Based on evidence suggesting a relationship between empathy and patient-centered communication, this study explored the relationship between 3rd year medical students’ self-reported empathy and their verbal performance during an OSCE in which communication was coded from audio tapes of the interactions. This study provides evidence that ‘patient-centered’ features of trainee-provider communication are related to the self-reported empathy of those same students.

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Journal Article: Promoting Empathy Among Medical Students: a Two-site Randomized Controlled Study

Journal Article: Promoting Empathy Among Medical Students: a Two-site Randomized Controlled Study
Lead Author: Celine Buffel du Vaure
Submitted by: Kerensa Peterson, Northwestern University

Two universities in Paris took part in this randomized controlled trial. The results? The use of Balint groups may promote empathy among medical students. Self-reported empathy at follow-up was significantly higher among the fourth-year medical students who participated in Balint groups. There are interesting results in this study when looking at student characteristics, such as education level of parents, gender, anticipated specialty choice and living status.

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Journal Article: Smoking Cessation Counseling: A Simulation Enhanced Curriculum to Improve Motivational Interviewing in Pediatric Residents

Journal Article: Smoking Cessation Counseling: A Simulation Enhanced Curriculum to Improve Motivational Interviewing in Pediatric Residents
Lead author: Sarah Schaefer, MD
Submitted by: Dan Brown, Emory University School of Medicine

Recognizing the lack of education and experience in smoking cessation counseling among pediatric residents, a team of doctors and educators at University of Alabama at Birmingham developed a curriculum using standardized patients to teach evidence-based counseling techniques and resources such as “The 5 A’s,” nicotine replacement therapy, telephone hotlines, and motivational interviewing.

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Journal Article: Recruiting Participants into Pilot Trials: Techniques for Researchers with Shoestring Budgets

Journal Article: Recruiting Participants into Pilot Trials: Techniques for Researchers with Shoestring Budgets
Lead authors: Rodney P. Joseph, Colleen Keller and Barbara E. Ainsworth
Submitted by: Michael Maury, UCSD

As pointed out in the abstract, “Limited research has focused on recruitment strategies for health promotion researchers conducting small-scale pilot studies.” The authors lay out five key recruitment techniques that can be utilized to succeed in recruitment efforts when working on a budget. These techniques are: 1) leverage existing social networks and personal contacts, 2) identify and foster collaborations with community gatekeepers, 3) develop a comprehensive list of potential recruitment platforms and venues, 4) create recruitment materials that succinctly describe the purpose of the study, and 5) build respectful and trusting relationships with potential participants. As Standardized Patient Educators, we often find ourselves in a similar situation in which time and fiscal support are minimal. These five key techniques may be utilized to assist each of us in our own programs at our various institutions.

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Media Article: Could Undertaking Qualitative Research Serve to Develop Clinical Empathy at Undergraduate Level?

Lead author: Karen Mulligan
Submitted by: Dyan Colpo, Cleveland Clinic, Simulation and Advanced Skills Center

Clinical empathy is essential to the practice of medicine and is linked inextricably to the competence of a physician. It benefits both patient care and physician satisfaction yet the concept is often ill-defined. Recent studies have also shown that it is taught ineffectually at the undergraduate level and suggest that new methods be sought. Conducting interviews for qualitative research could provide the opportunity for medical students to explore patient experience, develop clinical empathy and compassion as well as gain research experience. Even the exercise of designing questionnaires for qualitative research could encourage students to engage with clinical empathy. 

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Journal Article: Beyond Knowles – What Those Conducting Simulation Need to Know About Adult Learning Theory

Lead Author: Timothy C. Clapper, MA
Submitted by: Amber Snyder, University of Pittsburgh

Understanding adult learning theory is essential for all educators who are working with adult learners. Those working in simulation often access Malcolm Knowles theory of andragogy to ensure that curriculum addresses the needs of adult learners.

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Media Article: Oakland University William Beaumont School of Medicine Collaborates with University of Detroit Mercy on Interprofessional Curriculum

Submitted by: Todd Lash, Publications Committee Chair

Oakland University William Beaumont School of Medicine (OUWB) and University of Detroit Mercy School of Dentistry (Detroit Mercy) will launch a new interprofessional course to educate medical and dental students on how health care professionals collaborate for the benefit of their patients.

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Journal Article: Quality Assurance Processes for Standardized Patient Programs

Lead Author: Shelley Zhang
Submitted by: Kerensa Peterson, Northwestern University

As other clinical professions enter the world of simulation, their questions and development are catalogued in research. The pharmacy profession is an example of a clinical profession that is evolving to include a larger emphasis on communication skills and collaborative care. New simulation practitioners are asking how to assure quality in their newly developed standardized patient (SP) programs. This article focuses on the authors’ recommendations and applications for quality assurance in SP programs through a thematic analysis of the current scholarly literature.

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Journal Article: Cultural Competency and Cultural Humility in Simulation-Based Education: An Integrative Review

Lead author: Cynthia L. Foronda
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

There has been increased focus on the need to combat inequities in healthcare by teaching cultural humility. As SPEs, we know SPs are a fantastic tool to teach this skill. However, this review of literature shows there is a lack of studies published involving the use of simulation to teach cultural humility. The authors point out that “current international simulation standards lack an emphasis on diversity and cultural humility; thus, simulation curricula may be missing this essential component.” The study identified the need for more robust research on the subject. Let’s get cracking.

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