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Standardized Patients’ Perspectives on Bias in Student Encounters

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. 

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Standardized Patient Actor Training to Improve Adolescent Engagement in HIV Care

“I Have Actually not Lost any Adolescent Since I Started Engaging Them one on one:” Training Satisfaction and Subsequent Practice among Health Providers Participating in a Standardized Patient Actor Training to Improve Adolescent Engagement in HIV Care

Lead Author: Hellen M. Okinyi, BSN
Submitted by: Amy E. Lorion, National Board of Osteopathic Medical Examiners

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Self-Reported Emotions in Simulation-Based Learning: Active Participants v. Observers

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.

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Reflection: My Simulation Journey: Making the Impossible, Possible 

By: Ignacio del Moral, PhD, MD
Submitted by: Darrell Brock, University of Pittsburgh

Dr. Ignacio’s reflections on how a life-death encounter with a patient and a chance pamphlet lead him on a journey to the heart of simulation education. In a very relatable way, the doctor stumbles upon simulation education and comes to love it. Over time, Dr.Ignacio would become one of Spain’s most notable figures in simulation education. 

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Structural Inequities in the Treatment of Standardized Patients and What That Means for Patient Care

By: Temple D. West, MMHPE
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

Standardized patients (SPs) play a pivotal role in medical education. They are proxies for real patients, preparing students to meet the challenges of excellent patient care. Human simulation, with SPs, is used for teaching and assessing communication and clinical skills in medical education around the world. Standardized patients work individually with other faculty, students, or in conjunction with medical faculty to facilitate learning with feedback. In most simulation centers, SPs receive extensive training in communication and clinical skills, yet they inhabit territory often unrecognized as professional in medical education. The manner in which SPs are seen and treated by faculty and students may be a reflection of how real patients are seen and treated—not always heard, not always respected—and this tension detracts from both simulated and real patient encounters. Exploring how SPs, as proxies for real patients, are treated in medical education is a key to what we might learn and how we might close gaps in cultural respect and, ultimately, in patient care.

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Use of Standardized Patient Encounters as Predictors of Fieldwork Performance: A Pilot Study

Lead Author: Linda Frasier
Submitted by Karen Lewis, The George Washington University SMHS

Although standardized patient encounters (SPEs) are being used in occupational therapy (OT) education, limited literature exists on the value these experiences have on OT student learning outcomes and preparation for fieldwork. This study sought to examine if SPEs had the potential to predict Level II A fieldwork performance

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Aportes de la Simulación al Desarrollo del Razonamiento Clínico en Estudiantes de Pregrado de Medicina

Lead Author: Soledad Armijo, MD
Submitted by: Leonardo Pérez, Claudia Arancibia & Iván Silva, Clinical Skills Center, University of Chile

La simulación clínica en Latinoamérica ha ganado relevancia como herramienta formativa en las últimas décadas. En la formación de pregrado en Medicina, el cómo enseñar razonamiento clínico de la mejor manera aún requiere de consenso. Armijo-Rivera y equipo comparte en la revista de la Federación Latinoamericana de Simulación Clínica (FLASIC) una revisión del uso de simulación clínica con pacientes simulados como una excelente alternativa para “promover el desarrollo de aptitudes procesales, la comunicación con los pacientes, la entrega de los pacientes, el razonamiento ético y el trabajo en equipo” además de integrar información y ayudar a la toma de decisiones. También advierte que se requiere de estudios longitudinales que consoliden esta base de conocimiento, dado que el razonamiento clínico en medicina es un constructo complejo de enseñar y de evaluar. Así, queda abierta la invitación a investigar y socializar nuestras experiencias en simulación clínica con pacientes simulados en el mundo hispano hablante.

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It Is Not Just the Script that Matters: Overlooked Elements in Standardized Patient Methodology

By: Sandra Jaramillo-Rincón, MD, MHPE, Juan Manuel Potes, MD
Submitted by: Nicholas Gonzalez, The Gordon Center at University of Miami Miller School of Medicine

Standardized patients (SPs) range from individuals looking for additional work to full blown actors and actresses, to somewhere in the middle. This article entails what advantages SPs have and what skills they bring to the table regarding the teaching/learning process. The authors go into detail discussing the training and further development of acting, thematic, pedagogic, and planning and leadership skills among their SPs.

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Gender-Affirming Care with Transgender and Genderqueer Patients: A Standardized Patient Case

Lead author: Laura Weingartner, PhD, MS
Submitted by: Renee Wadsworth, SP-ed

Transgender and gender-diverse (TGD) people experience extreme health disparities and prejudice in health care settings. The lack of provider training around gender-affirming care for TGD patients has historically contributed to this inadequate care. Patient simulation is a crucial component of teaching medical students about gender-affirming care because it allows students to practice and become more comfortable with these skills in a low-stakes setting.

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The Use of Clinical Simulation to Address Disability Content Inclusion in Nursing Education: A Review of The Literature

Lead Author: Eda Ozkara San
Submitted By: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

Nursing students receive limited education to prepare them for providing quality nursing care to people with disabilities. The aim of this article is to provide the state of the science, or what is known, about nursing simulation with disability content to provide direction for nursing education and research in the future. Thirteen studies were reviewed and appraised in this integrative review. This review revealed three major student-related study outcomes for simulation activities: (a) empathy, (b) understanding and awareness, and (c) communication and disability. Only a few studies integrated a definition of a disability and specified the disability model to guide the development of the simulation activity. This review revealed limited research on the use of simulation with disability content in nursing education. The findings indicate there is a need for nurse educators and researchers to use best practices, such as a competency-based approach, when integrating simulation activities with disability content into the nursing curriculum.
Read the full study here.

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Co-constructive Patient Simulation: a Learner-centered Method to Enhance Communication and Reflection Skills

Lead Author: Andres Martin, MD
Submitted by: Claudia Arancibia, Leonardo Pérez & Iván Silva, Clinical Skills Center, University of Chile

Co-construction of clinical scenarios could drive one to achieve best practices in simulation. Here, Martin et. al. presents a "co-constructive patient simulation model" highlighting the active collaboration of clinical instructors, standardized patients, and students. In summary, co-constructive patient simulation offers a novel strategy to engage learners and promote significant learning and relevant experiences that balance the cultivation of their professional competencies with the specific needs of the learners themselves enhancing communication and reflecting skills.

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Experiences of Simulated Patients in Providing Feedback in Communication Skills Teaching for Undergraduate Medical Students

Lead Author: Riya Elizabeth George
Submitted By: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

The experiences of SPs and their perspective on providing feedback is an under-studied area. This study aims to explore SP experiences and views on feedback, factors influencing their feedback and implications for training. The authors conducted six focus groups with 30 SPs. Five over-arching themes were identified: feedback processes, challenges in providing feedback, cumulative experiences, web of interpersonal relationships and dynamics, and portraying the character and patient representations.
Read the full study here.

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Enhancing the Structural Competency of Nurses Through Standardized Patient Simulation

Lead Author: Zvika Orr, PhD
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

Structural competency is a new conceptual and educational framework for training health professionals to discern and respond to the impact of social, political, and economic structures on health. This article discusses a new online standardized patient simulation method that enhances the structural competency of nurses and nursing students. This method has been used to train nurse practitioner students. The article suggests that simulation-based learning can help nurses translate the theoretical comprehension of macro-level forces into clinical practices. This method expands the nurses' perspective, develops their social-political awareness, and encourages them to lead interventions. This simulation can contribute to dismantle structural racism and reduce health inequities.
The article includes a description of one of the scenarios used and a selection of the nursing students’ responses to experience.

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Barriers, Challenges, and Supports to the Implementation of Standardized Patients and Simulated Environments by Occupational Therapy Education Programs

Lead Author: Amanda Mack, OT, OTD, MS, OTR, CLC
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

A national survey examined the implementation rates, barriers, challenges, and supports to implementation of two types of simulation (standardized patients and simulated environments) by entry-level occupational therapy education programs in the United States. An online survey inquiring about academic program characteristics and use of simulation was sent to all occupational therapy and occupational therapy assistant programs in the United States in 2017 prior to the implementation of the 2018 Accreditation Council for Occupational Therapy Education Standards and the onset of the COVID-19 Pandemic. Data were analyzed using both statistical and content analysis. Thirty-eight percent of responses used standardized patients and 70% used simulated environments in their didactic coursework.
Funding was the most cited support, challenge, and barrier to the use of standardized patients. Physical space was the most cited support and challenge for the use of simulated environments, with funding as the most cited barrier. This study highlights the need for additional research in the use of simulation in OT education, specifically into feasibility and outcomes of lower-cost methods of simulation. Also, the outcomes of the study indicate that OT education programs would benefit from widely available, easy to access, and low-cost or free resources to help with the development and implementation of simulation within their own curricula. Access to these resources may allow academic programs to overcome some of the institutional barriers to implementation of simulation. For simulation to become more widely implemented and to truly reduce the burden of fieldwork education on fieldwork sites and partners, academic institutions may need to provide resources to help occupational therapy education programs overcome the common barriers and challenges and strengthen existing supports.

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Quality in Standardized Patient Training and Delivery: Retrospective Documentary Analysis of Trainer and Instructor Feedback

Lead Author: Derya Uzelli Yilmaz, RN
Submitted by: Mekail Ebbert, NYIT-COM at Arkansas State University

Creating and maintaining a consistent and meaningful SP quality assurance program has always been a priority of mine, and one that I’ve learned requires a continuous approach of evaluation and monitoring. This article documents a study using the collection of 6 years worth of feedback to “determine programmatic and systematic issues in the scope of quality assurance and improvement...” With this large collection of data they were able to review the outcomes of both trainer and instructor feedback on SP performances, resulting in the emergence of four key themes.

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Developing standardized patient-based cases for communication training: lessons learned from training residents to communicate diagnostic uncertainty

Lead Author: Dimitrios Papanagnou
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

Effective case design is essential to ensure an SP encounter successfully meets learning objectives that are focused on communication skills. Creative, well-designed case scenarios offer learners the opportunity to engage in complex patient encounters, while challenging them to address the personal and emotional contexts in which their patients are situated. Therefore, prior to considering the practical execution of the patient encounter, educators will first need a clear and structured strategy for writing, organizing, and developing cases. 

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The Role of Standardized Patient Programs in Promoting Equity, Diversity, and Inclusion: A Narrative Review

Lead Author: Derya Uzelli Yilmaz, RN
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

Integrating equity, diversity, and inclusion (EDI) in curricula for training health professionals is a frequent institutional goal. Here the authors present a theoretical model based on a synthesis of the literature for using standardized (or simulated) patient programs (SPPs) in EDI training, along with a narrative review of the available literature between January 2000 and October 2019. Three primary themes emerged: improving cultural competence, effective communication with diverse patients, and highlighting health inequalities.

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Integrating the Electronic Health Record Into Patient Encounters: An Introductory Standardized Patient Exercise for Preclinical Medical Students

Lead Author: Joseph A. Cristiano, MD
Submitted by: Erin Walsh, Rosalind Franklin University of Medicine and Science

This article explores incorporating the electronic health record (EHR) into simulated patient encounters with standardized patients. The authors created a formative exercise where preclinical medical students practiced EHR related communication and data collection while interviewing standardized patients. Two-hundred and eighty- nine second-year students took part in the exercise and most rated the activity as extremely or quite effective. The article suggests the training session was a valuable exercise to introduce preclinical medical students to integrating the EHR in patient encounters. Details of the exercise are included in the article.

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Medical students’ experiences when empathizing with patients’ emotional issues during a medical interview – a qualitative study

Lead Author: Knut Ørnes Brodahl
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

There are few in-depth studies investigating medical students’ own experiences when trying to empathize in concrete clinical encounters. This study explores medical students’ perceptions, experiences, and reflections when empathizing with patients expressing emotional issues. After conducting an interview with a Standardized Patient, participants were asked to reflect on their internal experiences during the encounters. Five themes which may influence student empathy during history-taking were identified through analysis of interview data: (1) Giving priority to medical history taking, (2) Interpreting the patient’s worry as lack of medical information, (3) Conflict between perspectives, (4) Technical communication skill rather than authentic and heart-felt and (5) The distant professional role. 

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Simulated Patient-Based Communication Skills Training for Undergraduate Medical Students at a University in Ethiopia

Simulated Patient-Based Communication Skills Training for Undergraduate Medical Students at a University in Ethiopia
Lead Author: Tesfamichael Alaro Agago
Submitted by: Mekail Ebbert, NYIT-COM @ Arkansas State University

“The verbal and non-verbal messages we utilize to interact with others could result in common understanding and are the cornerstone in the training of communication skills (CSs).” A study implemented at an Ethiopian University searches for answers to which interactive methods of teaching communication skills proves to be the most successful when working with medical students. Which do you think offered better results for students learning communications skills-simulated patients or case-based role-play?

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