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.

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.

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.

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.

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.

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. 

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. 

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?

Lead Author: Eman A. Hammad
Submitted by: Kerensa Peterson, University of California Riverside

“Simulated patient (SP) visits followed with structured feedback is useful to outline training needs as well

Lead author: Derya Uzelli Yılmaz, R.N., Ph.D.
Submitted by: Erin Walsh, Rosalind Franklin University of Medicine and Science

This study analyzed trainer and instructor feedback given to SPs on performance and issues related to quality assurance and improvement. Six years (2014-2020) of feedback forms were reviewed and analyzed for this study. A logic-based model aiming at developing quality management culture in SP programs is proposed. The study suggests an important part of feedback is that it is analyzed and incorporated into portrayal as soon as possible. The changes that are being made should be communicated to stakeholders to ensure consistency.

Lead Author: Kamil Torres
Submitted by: Mekail Ebbert, NYIT-COM @ Arkansas State University

“Medical simulation has turned out to be a well-developed educational technique at a postgraduate level, including residency programs and continuing vocational training. However, its applicability has still not been clearly defined when providing education to undergraduate medical students.” See how one study sought the opinion of undergraduate medical students about the “effectiveness of manikin-based and SP-based high fidelity scenarios for clinical objectives.”

Lead Author: Sylk Sotto-Santiago
Submitted by: Kerensa Peterson

“With an increasing awareness of the disparate impact of COVID-19 on historically marginalized populations and acts of violence on Black communities in 2020, academic health centers across the United States have been prioritizing antiracism strategies. Often, medical students and residents have been educated in the concepts of equity and antiracism and are ready to tackle these issues in practice. However, faculty are not prepared to respond to or integrate antiracism topics into the curriculum. Leaders in faculty affairs, education, diversity, and other departments are seeking tools, frameworks, expertise, and programs that are best suited to meet this imminent faculty development need.”

Lead Author: Caroline R. Paul, MD
Submitted by: Kerensa Peterson, University of California, Riverside

“Health disparities for the lesbian, gay, bisexual, transgender, queer, intersex, asexual, all other genders, sexes, and sexualities (LGBTQIA+) population are striking. Yet, deliberate efforts to integrate sexual orientation and gender identity in pediatric education settings remain lacking. The type of formal training that pediatric educators currently have for the teaching of sexual orientation and gender identity is unclear and limited, which led to the development and implementation of this curriculum.”

Lead Author: April R. Christensen, MD, MS
Submitted by: Mekail Ebbert, NYIT-COM @ Arkansas State University

With patient communication being a crucial skill for medical professionals, ongoing focus on the design and implementation of meaningful and well-written SP communication cases is imperative to healthcare education. Surveyed educators in this study reported a struggle to write communication cases with a lack of clear guidelines, yet a reported 90% interested in learning more. See how the creation and piloting of a “...workbook that guides SP case development, paired with an in-person case-writing session to teach medical educators a skill vital to conducting effective communication skills education... significantly increased the quality of SP cases, with high reported educator confidence and satisfaction.”

Authors: Shanna Barton, Aaron Calhoun, Carrie Bohnert, et al.
Submitted by: Janice Radway, The Perelman School of Medicine at the University of Pennsylvania

Despite the well-known individual and societal benefits of childhood immunization programs and the demonstrated safety of vaccines, many parents are hesitant to have their children vaccinated. Vaccine hesitancy is more than a simple delay or refusal of vaccination. Rather, it can be characterized as a state of mind regarding immunization marked by uncertainty, indecision, conflict, or opposition, and it is best understood as a complex phenomenon with deep sociocultural and psychological roots. The authors developed a laboratory in which communication could be studied in a codified and controlled environment, using standardized patients portraying vaccine-hesitant parents, video-recording, assessment by blinded raters, and a pseudorandomized assignment of pediatric residents to AIMS or standard of care training.

Lead author: Jacqueline Ward-Gaines, MD
Submitted by: Erin Walsh, Rosalind Franklin University of Medicine and Science

To address the lack of diversity, equity, and inclusion (DEI) training in residency programs the authors created a simulation exercise for medicine residents with the objective to increase cultural and structural awareness. The simulation included groups of residents rotating through eight scenarios that were each focused on a cultural competency crucial to DEI training. Standardized patients gave feedback to the residents after each case and the residents debriefed with simulation directors. Preliminary data indicates that mass simulation can be an effective teaching method for residents learning about diversity, health equity, inclusivity, and cultural humility.

Authors: Anish K. Agarwal, David A. Asch, Jeffrey Millstein
Submitted by: Janice Radway, The Perelman School of Medicine at the University of Pennsylvania

A passenger is pinged moments after exiting their rideshare vehicle with a request to “rate your driver” using a simple 5-star rating. A few extra typed comments offer detail and context — completed in just moments. The same person, now exiting a doctor's appointment, receives no such alert. Instead, weeks later, they receive a mailed survey consisting of 30, or more, questions spanning a range of content: getting an appointment, interactions with the reception staff, communication by the clinician, and the cleanliness of facilities. It's not just that the survey relies on an ability to recall and report on these long-ago interactions and how they felt—it’s likely the response is the only item that person will physically mail in weeks, if in the end it is mailed at all. In an increasingly digital world where real-time ratings and just-in-time feedback have become routine across a variety of industries, how can healthcare adapt and evolve?

By: Anthony E. Tuggle, NFK National Board Chair
Submitted by: Kerensa Peterson, University of California Riverside

After a recent discussion with faculty about the estimated glomerular filtration rate (eGFR), I received the latest monthly newsletter from the US National Kidney Foundation. In the newsletter, there was a piece highlighting a joint task force that was formed by the NKF and ASN in 2020 to reassess the inclusion of race in the diagnosis of kidney disease. “Both organizations have repeatedly asserted that race, is a social, not a biological, construct.”

Authors: Janae K. Heath, C. Jessica Dine; Denise LaMarra; Serena Cardillo
Submitted by: Janice Radway, The Perelman School of Medicine at the University of Pennsylvania

This retrospective study (2012-2018) examined the impact of gender and race on SP assessments of internal medicine (IM) residents' communication skills during the postgraduate year (PGY) 1. Until now, the impact of SP and resident demographics on the standardized communication ratings in residents had not been evaluated. The data demonstrate an association of resident gender on ratings in standardized communication exercises, across multiple communication skills. Understanding the impact of implicit biases on these assessments is critical.

By: Nick Neel, John-Michael Maury, Karen M. Heskett, Alana Iglewicz & Lina Lander
Submitted by: John-Michael Maury, UC-San Diego – School of Medicine

“Medical students experience rising rates of burnout throughout their training. Efforts have been made to not only mitigate its negative effects but also prevent its development. Medical improv takes the basic ideas of improvisational theatre and applies them to clinical situations. Given improv’s focus on self-awareness and reflection, in addition to its spontaneous nature, we hypothesized it had the potential to serve as a creative outlet, a way to prevent and/or mitigate the negative effects of stress, burnout, and fatigue, and provide a learning environment to develop skills necessary to succeed as a physician. University of California (UC) San Diego School of Medicine developed a medical improv elective for pre-clinical students and assessed its effects on student development and wellbeing. Students enrolled in the elective between Fall 2019 and Fall 2020 at UC San Diego School of Medicine were surveyed pre-and post-course completion using both qualitative and quantitative methods. Students noted significant improvement in domains related to proactivity in their professional career, wellbeing, engagement with their studies, and communication after completion of the medical improv elective. We describe a pilot-study demonstrating the positive effects of improv on medical student wellbeing and professional development, laying the groundwork for both future study of improv on student wellness and its implementation in the pre-clinical curriculum.”