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.

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

I am proud to share a journal article written by my manager and mentor Denise LaMarra and our colleagues at The Children’s Hospital of Philadelphia on a novel telesimulation program they began 6 years ago. Some background: the Heart And Lung Failure—Pediatric INsulin Titration study was experiencing poor subject enrollment due to low rates of informed consent. The program investigators collaborated with the Perelman School of Medicine Standardized Patient Program to explore the novel use of telesimulation with standardized parents to train research staff to approach parents of critically ill children for informed consent. We describe the feasibility, learner acceptance, and financial costs of this novel intervention and performed a post hoc analysis to determine if this intervention improved study consent rates.

Lead Author: Dara VF. Albert

Submitted by: Todd Lash, The Ohio State University

We developed nine standardized scenarios that highlighted communication challenges commonly encountered in child neurology. Child neurology trainees participated in three OSCE events with three scenarios each over three academic years. Standardized patients (SPs) portrayed patients and/or their parents. Each trainee-SP encounter was evaluated by an observing faculty member using a modified Gap-Kalamazoo Communication Skills Assessment Form, the SP who provided direct feedback, and by the participating trainee.

Lead author: Daniela Keren

Submitted by: Kathy Herzberger, Loma Linda School of Medicine

Social studying and learning (SSL), according to the authors is any independent, elective, self-directed and self-organized approach to learning. The article explores what kind of SSL second year medical students developed, their viewpoints regarding the pros and cons, and their perceptions on how it affected their overall learning. How Covid has influenced SSL at this school would make for an interesting follow-up study.

Published by: Academic Medicine

Submitted by: Kerensa Peterson, NBOME

Academic Medicine has released a collection of articles that address race and racism in Medical Education.  The collection is geared toward a variety audiences within the Medical Education Community from medical students to simulation educators to faculty physicians to program directors.

Lead author: Young Soon Park

Submitted by: Kathy Herzberger, Loma Linda University

Establishing major competencies and training for clinical performance in medical education has been prevalent in Korea for only the last 15 years. This is due to the clinical skills test that was added to the paper-based Korean Medical Licensing Examination (KMLE) in 2009. This crucial change in the KMLE has strengthened clinical performance in Korean medical schools. This interesting study emphasizes how evaluator factors as well as the type of scale utilized can influence physician-patient interaction scores.

Lead Authors: Christine S. Park, Lou Clark, Grace Gephardt, Jamie M Robertson, Jane Miller, etc.
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

A pandemic has sent the world into chaos. It has not only upended our lives; hundreds of thousands of lives have already been tragically lost. The global crisis has been disruptive, even a threat, to healthcare simulation, affecting all aspects of operations from education to employment. While simulationists around the world have responded to this crisis, it has also provided a stimulus for the continued evolution of simulation. We have crafted a manifesto for action, incorporating a more comprehensive understanding of healthcare simulation, beyond tool, technique or experience, to understanding it now as a professional practice. Healthcare simulation as a practice forms the foundation for the three tenets comprising the manifesto: safety, advocacy and leadership. Using these three tenets, we can powerfully shape the resilience of healthcare simulation practice for now and for the future. Our call to action for all simulationists is to adopt a commitment to comprehensive safety, to advocate collaboratively and to lead ethically.

By: Michael Miller, Dawnelle Schatte, Karen Szauter
Submitted by: Marsha Harman, Rush Center for Clinical Skills and Simulation

The abrupt discontinuation of medical student-patient contact due to the covid-19 pandemic resulted in a rapid change to virtual teaching. Student education was restructured to include online cases, small group discussions, synchronous and asynchronous lectures, and modified problem-based learning and team-based learning sessions. However, the key focus of the clerkship experience, contact with patients, was missing. This article outlines the process and outcomes of one institution’s development of a simulated telepsychiatry visit for third year medical students in the Psychiatry Clerkship.

Lead Authors: Emily J. Noonan, Carrie Bohnert
Submitted by: Janice Radway, Perelman School of Medicine at the University of Pennsylvania

Disparities in health and healthcare for gender minorities (GMs) such as transgender people are significant, and medical educators have a responsibility to ensure trainees master the clinical skills required to provide them with quality care. The authors implemented a standardized patient (SP) scenario designed to measure students’ ability to provide gender-affirming care and sought to understand the experiences and perceptions of the GMs who served as SPs in this case. Their key research question was: how do GM SPs describe the experience of serving as an SP on a gender-affirming care clinical case?

By: C. Roth, K. Eldin, V. Padmanabhan, E. Friedman
Submitted by Kathy Herzberger, Loma Linda School of Medicine

Medical Teacher has articles entitled “Twelve …” that I always find useful. This particular one provides twelve easy steps to help develop and introduce emotional intelligence into our curriculum. Developing emotional intelligence is vital to enhance patient centered care, clinical outcomes, patient safety, as well as team building.

Lead Author: Kelly V. Johnson, EdD, RN
Submitted by: Marsha Harman, Rush University

Utilizing standardized patients (SPs) as a strategy to potentially improve beginning level nursing students’ confidence, satisfaction, and communication after simulated clinical cases is an innovative approach in nursing education. To examine how an SP encounter affects these three things, first semester undergraduate nursing students completed a simulation either an SP or high-fidelity manikin. Students who completed the simulation with an SP reported greater satisfaction and improved communication.

Lead Author: Pierre A. Geoffroy
Submitted by: Kerensa Peterson, NBOME Chicago

A group of researchers at Paris Diderot University conducted a randomized controlled study. They compared the effectiveness of teaching communication skills via standardized patients versus a conventional lecture format. The Standardized Patients helped the medical student perform 5 particular communication skills better than the lecture counterpart.

Lead Author: Kathleen Hanley
Submitted by: Kerensa Peterson, NBOME

A group of medical educators look for patterns in the development of communication skills in a cohort of medical students. The reported results show an overall increase in communication skills but leave a question for further research about whether or not an Introductory Clinical Experience at the beginning of medical school is a good predictor of performance on future communication skills.

Author: Rashmi A. Kusurkar
Submitted by: Kathy Herzberger, Loma Linda University

The author has provided an interesting discussion that describes autonomous motivation and its necessity in the practice of medical education. Autonomous motivation is “motivation that arises out of genuine interest or personal endorsement or valuing of an activity”. This type of personal motivation creates life-long learners, which is a vital goal in medical education.

Lead Author: Melodee Harris, PhD, APRN, FAAN
Submitted by: Marsha Harman, Rush University

Standardized patient (SP) simulation is used to teach geropsychiatry. This project tested feasibility and effectiveness of video-enabled SP simulation to teach interprofessional (IP) late-life depression screening. The study focuses on the potential advantages of remote learning for students in rural areas, including savings on travel and faculty time. (In the light of the COVID-19 pandemic, an additional advantage is the ability to continue simulation-based learning while maintaining social distancing.)

Lead author: Rachel Boykan
Submitted by: Todd Lash, The Ohio State University

Motivational interviewing (MI) is a well-established evidence-based method of working with patients to promote health behavior change. Standardized patient (SP) simulation allows trainees to practice and receive feedback on clinical and communication skills and may be useful in applying MI techniques to address tobacco use and exposure. The authors developed two SP cases for pediatric residents to practice addressing tobacco use with parents of their patients.

Lead author: Wendi F. Cross
Submitted by: Todd Lash, The Ohio State University

Background: Suicide is a national public health crisis and a critical patient safety issue. It is the 10th leading cause of death overall and the second leading cause of death among adolescents and young adults (15–34 years old). Research shows 80% of youth who died by suicide saw their primary care provider within the year of their death. It is imperative that primary care providers develop the knowledge and skills to talk with patients about distress and suicidal thoughts, and to assess and respond in the context of the ongoing patient - primary care provider relationship.

By: George Shand
Submitted by Kathy Herzberger, Loma Linda School of Medicine

This article presents an interesting discussion regarding the development of Open Resource Clinical Assessments (ORCAs). These assessments allow students to utilize internet resources during SP encounters just as physicians do in real practice. Assessing a student’s judgment regarding their choice of resources, interpretation of the information, and their application of this knowledge to the patient’s concern and treatment plan could be valuable in assessing their skill in information management.  

Lead Author: S. O’Rourke
Submitted by Kathy Herzberger, Loma Linda School of Medicine

I am personally not a big fan of virtual patients, but the findings in this study have given me pause to rethink my attitude toward virtual vs real patients. Their findings add credence for the use of virtual SPs even when dealing with difficult scenarios such as delivering bad news.

Lead Author: Janna M. Wisniewski, PhD; Brigham Walker, MS
Submitted by: Dan Brown, Emory University School of Medicine

This study used seven Simulated Patients belonging to three ethnic groups (self-reported as white, black, Hispanic) to call 804 randomized physician offices to attempt to schedule an appointment. All patients, if asked, would report being uninsured and paying out of pocket. The black and Hispanic patients were asked about their insurance significantly more frequently than the white patients. They also had a longer average wait time until their appointment.