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.”

Lead Author: Samantha A. Starr, BS et al
Submitted by: Claudia Arancibia & Sergio Bozzo, Clinical Skills Center, University of Chile

SPs’ participation in medical education is becoming broader and more powerful in assessments, physical examination instruction and debriefing. Just as their role expands, so does the interest in knowing their perspectives, their thoughts, and their vision of the role they play. If you ask SPs about who they have become since they started working as SPs, you will discover how they have changed, and this could be something big, like a new identity. You may think, this should be expected, as with students and SP educators, but we have not known much about it. This knowledge could be important as you consider its influence on future activities and the development of an SP program.

By: Lauren Misquita, Lucy Millar, Brent Bartholomew
Submitted by Kathy Herzberger, Loma Linda School of Medicine

The authors share an interesting simulation program designed to help fourth year students feel better prepared for their intern year. In two sessions, students participated in several different scenarios that interns typically encounter. One-to-one briefings followed the encounters. Students felt the experience was valuable and felt it should become a mandatory part of the curriculum.

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

Culturally appropriate communication between healthcare professionals and with patients is widely recognised as a cornerstone of high quality, patient-centred care. The widespread use of traditional, complementary, and integrative medicine (TCIM) necessitates that patient-centre communication and cultural competency in healthcare extends beyond race, ethnicity, and languages spoken to also include an awareness of, and respect for the diverse range of healthcare practices, paradigms, and lexicons that patients and practitioners use. Education can equip practitioners with the necessary communication skills and expand their knowledge about the therapies and practices that patients are accessing.

By: A. Jacobsen, Y. Khiew, S. Murphy, C. Lane, & B. Garibaldi
Submitted by Kathy Herzberger, Loma Linda School of Medicine

As someone who teaches clinical skills, I have always advocated that a hypothesis driven physical exam can improve patient/physician relationships and provide better patient outcomes. Ireland relies on high standards of physical exam skills due to their resource-limited health system. Physical exam skills in the U.S., however, have declined due to the “high-tech transformation of health care and a more litigious society”. Medical errors and physician burnout increased as physical exam declined. Reading this article validated my beliefs that teaching and assessing physical exam skills is imperative to quality patient care.

Published in cooperation with the Federation of American Societies for Experimental Biology (FASEB)
Submitted by: Kerensa Peterson, NBOME

“When the pandemic rapidly developed in the US in mid-spring of this year (2020), it impacted all teaching programs from early childhood to professional schools and many stop-gap changes were introduced to allow virtual instruction to replace face-to-face teacher-student contact across this spectrum. With the time engendered by the summer months in 2020, many teaching programs/curricula have fine-tuned these changes made to accommodate the virtual format. In this Special Collection, the approaches taken by several medical schools, ranging from individual courses to the full curricula, are described. It is our intention to revisit these programs over the next year to evaluate what worked well and what did not.  

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

“She squirmed, sobbing hysterically, grabbing onto the railing of the inpatient hospital bed with IVs still bound to her arm. A grown woman was shouting and crying, not because of physical pain or injury, but out of fear. The sea of medical professionals surrounding her bed only seemed to exacerbate her dismay. She refused to acknowledge any of them, consciously omitting the small army of physicians and nurses crowding her room. She would only speak with one person … me.”

By: J. Talwalkar, K. Cyrus, A. Fortin
Submitted by Kathy Herzberger, Loma Linda School of Medicine

The authors have placed into twelve succinct steps what is required to tackle a new project utilizing standardized patients. This will be a review for some, but for newcomers to the realm of SP work, this is a good outline to utilize to create successful activities.

Lead Author: Shane A. Pritchard, BPhysio, et al
Submitted by: Kerensa Peterson, NBOME

Using an interpretivist research paradigm and qualitative design, these researchers from Australia considered simulated patients’ self-identified role within healthcare education. The researchers engaged 18 SPs in frank discussion about the SPs’ role in order to explore their experiences, perspectives and practices within their SP programs. The researchers have a rich discussion of themes that emerged from those SP conversations. They offer SP Educators ways to further benefit SPs and engage in quality educational experiences for learners with input from the professionals performing the simulation – the Simulated Patients themselves.

By: Leanne Picketts, Marika Dawn Warren, Carrie Bohnert
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

Healthcare learners can gain necessary experience working with diverse and priority communities through human simulation. In this context, simulated participants (SPs) may be recruited for specific roles because of their appearance, lived experience or identity. Although one of the benefits of simulation is providing learners with practice where the risk of causing harm to patients is reduced, simulation shifts the potential harm from real patients to SPs. Negative effects may be amplified when SPs are recruited for personal characteristics or lived experience. Educators have an ethical obligation to promote diversity and inclusion; however, we are also obliged to mitigate harm to SPs.

Lead Author: Scott Haperin
Submitted by Kathy Herzberger, Loma Linda School of Medicine

Medical students suffer from increased anxiety and depression. Add Covid isolation to an already difficult situation and these problems are exacerbated. This study assessed the mental health situation of 1,428 students from 40 U.S. medical schools. The results suggest that we should be especially vigilant in recognizing and offering help to students that require extra emotional support.

Lead Author: Martina Ann Kelly
Submitted by Kathy Herzberger, Loma Linda School of Medicine

We have all realized how much touch is essential to our lives during this past year. Touch, according to the authors, expresses healing, caring, and connection. They discuss how virtual life has transformed interactions with their patients and colleagues. If telemedicine continues beyond our current pandemic, then physicians will need to find a way, other than touch, to connect with their patients to develop therapeutic relationships. 

Lead Author: Joshua A. Roshal
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

This study identified self and simulated patient (SP)-reported ratings of US first-year medical students’ interpersonal and communication skills (ICS) and the influence of age and gender on performance appraisal during the Objective-Structured Clinical Examination (OSCE). While the majority of students and SPs evaluated the students’ ICS as very good, there was a disparity in the rating of the medical students’ ability to encourage patient question-asking and answer questions; more SPs gave an “inadequate” rating in that category than students. Neither age nor gender influenced the medical students’ self-assessment of ICS. Female SPs assigned lower scores to students in regard to respecting patients and encouraging patient question-asking and answering. Older SPs were more likely to assign lower scores on all survey questions.

Lead Author: Daniel Suarez
Submitted by Kathy Herzberger, Loma Linda School of Medicine

This study looks at the association between sexual orientation and the mental health of medical students. One of the more heartbreaking findings was the higher rate of family dysfunction among non-heterosexual students that leads to decreased social and financial support. Once again, our vigilance is essential to help our students find the help that they need to improve their well-being.

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

In anecdotal reports from residency retreats, female residents described a high frequency and negative impact of interruptive behavior by male colleagues. The authors sought to characterize interruptions during residency teaching conferences by gender. The results are eye-opening.

Lead author: Andrew M. Luks
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

The authors make a compelling argument as to why clinicians should avoid using jargon: “Despite our best efforts to ensure appropriate care for patients, we often find ourselves distracted on rounds by the sometimes bewildering array of jargon during bedside presentations. Why does our team want to “sprinkle” or “hit” the patient with diuretics? Do our patients have the capacity to “fly” off the ventilator or “throw” PVCs (premature ventricular contractions)? …Perhaps the biggest challenges arise when we consider how our words sound to patients and their families. Many of our word choices run the risk of confusing them rather than clarifying the patient’s condition, diagnosis, or treatment. They may nod, but do they clearly understand what we have said? Even worse, are they offended by what they hear?”

Lead author: Doreen M. Olvet
Submitted by: Kathy Herzberger, Loma Linda University

This is an interesting article discussing near peer 4^th year tutors to give feedback to 1^st and 2^nd year students on note writing skills. The authors found that near peers can be an asset to medical education. I too, have found near peer tutoring effective. I have used 4^th year students that are remediating to help grade our 2^nd year OSCE. This exercise enhances the 4^th year’s skills and the 2^nd years appreciate the feedback from their upper classmen.

By: Mario Veen & Anna T. Cianciolo
Submitted by: Kerensa Peterson, NBOME

Philosophy is not just “the talk on a cereal box” that Edie Brickell first sang about in 1986. But it is the topic of this first in a series of thought-provoking pieces by Veen and Ciancolo. The authors write, “ Slowing down to consider context and reflect on practice are now seen as essential to medical education as we are called upon to examine carefully what we are doing to care for learners and improve their performance, professionalism, and well-being.” During this time of COVID-19, their piece seems especially relevant as we take on questions that don’t have clear answers. We are asked to approach problems in medical education with “wonder and intense, childlike curiosity, human qualities we all share.”

Teaching Students the Art of Working with Patients with Cognitive Impairments: A Comparison between the Use of Standardized Patients vs a One-time Clinical Experience
By: Shaun Varrecchia and Carol A. Maritz
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

Working with individuals with cognitive impairment can be an uncomfortable experience for students in the health professions. One-time clinical experiences are a common strategy in Physical Therapy programs, but the authors note that the variability among different clinical sites in terms of the patients seen and the assessments the students are allowed to perform means that educational outcomes vary widely. This article describes a study comparing the outcomes associated with a Standardized Patient encounter versus one-time clinical experience. Overall, when comparing the SP encounter to the one-time clinical experience, faculty found that the SP experience was more pedagogically sound.