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.

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.

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.

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.”

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.

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.

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.

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.

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.

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.

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.”

Journal Article: Standardized patients in psychiatry – the best way to learn clinical skills?
By: Monika Himmelbauer, Tamara Seitz, Charles 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.

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.