Lead Author: Sarah E. Stumbar, MD, MPH
Submitted by: Catherine Hagele, Perelman School of Medicine at the University of Pennsylvania

Why is it that most health care practitioners do not routinely screen patients for intimate partner violence (IPV)? This third-year family medicine clerkship included a pregnancy options counseling OSCE aiming to explore students’ internal barriers to screening patients for IPV. Even though the educational module included scripted screening questions, students reported a major barrier to screening was difficulty finding the words with which to ask the questions, thereby suggesting that these kinds of practice encounters may be more effective, offering a performance model that can support skills acquisition.

By: George Gillett, Fourth Year Medical Student
Submitted by Kathy Herzberger, Loma Linda School of Medicine

George Gillett, who was a fourth year medical student when he wrote this article, expressed an interesting perspective regarding empathy and standardized “fake” patients. Included in this discussion is a suggestion from Anu Atluru, MD that “improv’s fundamental principles of honesty and spontaneity” might be helpful in teaching students how to acknowledge feelings without the rote “I’m sorry to hear that…” The opinions expressed are certainly issues to ponder as we develop future communication curriculum and assessment.

Lead Author: Hasan Mohiaddin
Submitted by: Marsha Harman, Rush University

How does contact with actual patients affect how medical students develop communication skills, and how does it impact their performance in an SP encounter? First year medical students at Imperial College London learn communication skills through lectures, small group teaching, and SP encounters. This study compared two groups of first-year students; the study group experienced repeated contact with real patients as part of a volunteer organization aiming to reduce isolation in elderly inpatients, while the control group received only the formal curriculum on communication.

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

In an era of increasingly complex advances in oncology, how can health professionals help cancer patients with low health literacy better understand their diagnoses and treatment options? In an effort to improve cancer communication strategies with patients, the National Cancer Policy Forum (NCPF) convened a meeting of invited speakers in Washington, D.C. At the meeting, the point was repeatedly made that skills in cancer communication can be taught and learned, and it is the responsibility of health professionals to make sure all their patients (including those with low health literacy) truly comprehend the information they are being given. We as SP Educators know that SP methodology is an excellent tool for practicing these communication skills.

By: Shahid H. Mirani, Noor A. Shaikh, and Amber Tahir
Submitted by: Dan Brown, Emory University

This study was conducted among medical students of Ghulam Muhammad Mahar Medical College, using a self-administered and self-perceived inventory called the Jefferson Scale of Empathy-Student Version. It compared the empathy scores by gender, by year of medical school, and by career preference. Its findings were comparable to similar studies, in that empathy scores decline over the course of medical school. The study concludes that it is “very important that we pay attention to nurture our medical students to have empathy rather than lose it under the stress of academic performance.”

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

At the American Academy of Physician Assistants (AAPA) annual meeting, held May 18 to 22, 2019 in Denver, Colorado, research was presented about physician assistant (PA) students and training on opioid-use disorder (OUD). Students in the didactic Behavioral Medicine course at Mercer College of Health Professions in Atlanta, Georgia, participated in a lecture series on OUD that included standardized patients to simulate a realistic presentation of patients with clinical pain complaints and provided screening, diagnosis, and counseling techniques. Students in the clinical course received the same instruction following completion of their core clinical rotation. Faculty observers provided students with feedback on patient interaction, empathy, use of professional medical terminology, opioid risk and benefit assessment, universal monitoring strategies, and including patients in the treatment decision-making process. These students reported improved confidence following the OUD instruction.

Lead author: Gillian A. Beauchamp
Submitted by Dan Brown, Emory University

Recognizing through a thorough search of existing sex- and gender-based medical simulation education literature that there is a lack of literature addressing the incorporation of sex and gender aspects of medicine into simulation-based training, the authors discuss the need for further sex- and gender-competent simulation, and outline strategies, considerations, and guidelines for including these topics into medical curriculums.

By: Lester Liao
Submitted by: Kathy Herzberger, Loma Linda School of Medicine

Entitlement is a problem in medical education that has received relatively little attention. First, it is felt by educators, who often feel pressured to conform curricula and evaluations to satisfy learner demands and administrative pressures lest their careers are penalized. Second, entitlement affects the medical system, as entitled physicians are less empathetic and focus more on personal goods rather than patient needs. This shifts the humanistic basis for medicine. Thirdly, entitlement is problematic for learners, as constant accommodations ironically undermine self-reliance and adaptability. Constantly meeting these demands can diminish gratitude and overall happiness. To address this issue, learners must acknowledge the problem and seek remedies to it themselves, as top-down interventions will likely be rebuffed. Rather than focusing solely on the learning environment, solutions should also empower learners to engage their environment in effective and productive ways. This should include correcting cognitive distortions that lead learners to expect administrative interventions in all circumstances perceived as harmful. Other solutions include practicing gratitude and developing work friendships. While certainly not all learners are entitled and some environmental amendments should be made, learners and educators must realize that entitlement is shaping medical culture and collectively take steps to mitigate its negative effects.

Lead author: Aaron W. Bernard
Submitted by Kathy Herzberger, Loma Linda School of Medicine

The Frank H. Netter MD School of Medicine established 2-station OSCEs at the end of each clerkship to determine if these could replace the 5-7 station end-of-third-year examinations that are more common among medical schools. The goal was to assess reliability of these OSCEs in isolation, as well as in aggregate. They concluded that 2-station clerkship OSCEs have poor-to-fair reliability, but the aggregating data from all six of the clerkship OSCEs resulted in good reliability. Their article provides a nice discussion of their methods, experience, and findings. As a school that runs an OSCE after every clerkship I found their article interesting and applicable.

Lead Author: Lapkin S

Submitted by: Mary Launder, Rosalind Franklin University of Medicine and Science

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

The aim of this study was to examine student ability, perceptions of competency and effectiveness of simulation methodology for conducting language screenings on individuals with aphasia. Graduate students enrolled in a mandatory course on acquired language disorders completed a variety of simulated learning experiences using videos, high-fidelity manikins, and standardized patients, in preparing them for clinical practice with persons with aphasia. 5-point Likert scales and open-ended survey questions relating to student and standardized patients’ perceptions were administered. Results demonstrated a strong positive perception that simulation promotes student understanding of assessment procedures and aids in the development of clinical judgment.

Lead Author:  Annie J. Keeney
Submitted By: Amber Snyder, M.S., University of Pittsburgh

Poverty is demonstrably a determinant of heath. Approximately 43.1 million people in 2017 lived in poverty in the United States. Social workers consistently interface with individuals living in poverty, which requires a level of empathy and compassion. Learning strategies for adult learners can provide opportunity for skills-based learning to occur prior to interaction with clients in the field. Simulation training has been identified as an effective method for building empathy, knowledge, and skill.

By: Jeannette Guerrasio, MD, and Eva M. Aagaard, MD
Submitted by: Marsha Harman, Rush University

Remedial training methods for physicians who struggle with unprofessional behavior are often ad hoc, are poorly described, and have unknown long-term results. In 2012, a think tank of experts on professional behavior identified a need for the academic community to develop evidence-based interventions to remediate lapses in professional behavior. In this article, we describe the simulation-based remediation methodology used to address individual skill deficiencies in struggling residents and practicing physicians at the University of Colorado School of Medicine. The study assessed the long-term effect of simulation used for specific unprofessional behaviors in residents and faculty referred for remediation.

Lead author: Fiona Roberts, Kay Cooper

Submitted by: Mary Launder, Rosalind Franklin University of Medicine and Science

To evaluate the effectiveness of high fidelity simulation (HFS) versus low fidelity simulation (LFS) on practical/clinical skill development in pre-registration physiotherapy students the authors employed a three-step search strategy.

Evidence suggests that improved skill development in university can reduce anxiety in practice, improving performance of skills and overall learning at clinical placement for health professions students. However, evidence indicates that the clinical environment is most effective for learning. As a result, there has been increased interest in the use of HFS where students can test knowledge and skills in an increasingly self-directed way. No previous reviews on the effectiveness of HFS on skill development in physiotherapy students were identified.

Lead Author: Heather Leggett
Submitted by: Kathy Herzberger, Loma Linda School of Medicine

As someone who is always open to new ideas that enhance my feedback skills, I found this article on providing feedback utilizing a 12-step process that encourages self-regulated learning thought-provoking. The comparisons between types of learners is particularly interesting. As the authors state, the provision of self-regulated learning (SRL) enhanced feedback on performing clinical skills and making a clinical diagnosis recognizes the importance of feedback. In contrast to the broader concept of self-directed learning, SRL has a specific focus on the individual learner’s approach to achieve a task, including their planning, self-monitoring, and future adaptations. The key SRL processes can be identified using structured microanalysis during the clinical task and feedback using the tips outlined in this article. It is essential that SRL enhanced feedback is integrated with best practices on providing feedback to ensure that its potential is achieved.

By: Holly Gerzina
Submitted by: Valerie Fulmer, President, ASPE

Performance-based assessment is consistent with outcomes-based education, whereby learners can demonstrate the performance of tasks, approach to tasks, and professionalism. Specifically, standardized patient-based performance assessment has advanced to include undergraduate and graduate medical education and is commonly used to evaluate both the technical and nontechnical skills necessary for the safe and effective practice of medicine. A standardized, objective, and structured method of assessment is critical for quality and accountability in medical education and transition to clinical practice. Miller’s prism of clinical competence provides a framework for simulation-based performance assessment of cognition and behaviors that demonstrate knowledge, skills, and attitudes on the continuum from novice to expert medical professional. Similarly, the Kirkpatrick model provides an adaptable framework to evaluate learners acquisition of knowledge, skills, and attitudes in the simulation lab and the subsequent transfer to clinical practice and actual patient outcomes. Thus, medical learners are commonly required to demonstrate acquisition of skills and competence via simulation before integration into clinical practice. Specifically, standardized patient methodology applied to performance-based assessment has been shown to provide a means of valid standardized objective assessment of learning and clinical skills before clinical practice.

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

In 2013 the AAP Committee on Adolescence published “Office-Based Care for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth”. This policy highlighted the importance of creating an inclusive environment for LGBTQ youth in the pediatrician's office, emphasizing patient confidentiality and the use of inclusive language. To help improve pediatric resident competency in these areas, this group from Riley Hospital for Children and Indiana University School of Medicine created a clinical simulation where residents had to discuss sexuality with a teenage standardized patient. The purpose of this project was to assess the usefulness of simulation to teach these skills, and then identify resident educational gaps for further curriculum development.

Author: Irene Perini
Submitted By: Amber Snyder, M.S., University of Pittsburgh

Adolescent girls who self-injure feel that they receive more negative feedback than they actually receive, and are more sensitive to "thumbs down" responses, compared to other adolescent girls. These are the findings presented by Irene Perini, researcher at Center for Social and Affective Neuroscience (CSAN) at Linköping University, in a recently published article.

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

Registered nurses (RNs) receive didactic training regarding caring for patients receiving epidural analgesia. Although RNs are tested on their knowledge after this training, their ability to critically think through adverse events has not been assessed at this institution. The aim of this study was to examine the feasibility and effectiveness of simulation education for RNs regarding the assessment and management of patients receiving epidural analgesia. The study included an education intervention, which consisted of a 4-hour workshop. After obtaining informed consent, RNs completed a pre-workshop evaluation of skill performance where they completed an OSCE in which they demonstrated an epidural assessment of a standardized patient. RNs then completed a demographic and knowledge questionnaire followed by a lecture. The results of this study indicate that the use of an instructional module using SPs is a feasible approach for RNs to learn the safe care of individuals receiving epidural analgesia.

Lead Author: Dr. L. Gao
Submitted by: Michael Maury, UC-San Diego 

In this research article the authors sought “to synthesize evidence on learning outcomes and curricular design elements of improvizational theater training in health professions education.” They conducted a literature search using the keywords of “improv” and “improvisational theatre” starting in January of 2016 which originally identified 95 abstracts. As it is noted in the article, “51 met criteria for abstract review. Of these, 23 publications were excluded for interventions not involving health professional learners, 15 did not employ improv techniques (no unscripted, unplanned component), and 6 did not include some measure or description of a learning outcome. As a result, a total of seven articles were selected for inclusion in our analysis.” While there is still much data to be gathered on the positive outcome of improv as an applied art, we are beginning to see the importance of this art craft within medical education.