Standardized Patient Research Articles

Investigating the Relationship Between Patient-Centered Communication and Quality of E-Consult in China: A Cross-Sectional Standardized Patient Study

ABSTRACT Patient-centered communication is widely acknowledged as an essential element of high-quality healthcare. Our study attempted to explore the weaknesses in the actual doctor-patient communication process and the most critical elements in patient-centered communication to improve the service quality of e-consult. We recruited ten standardized patients presenting fixed cases (urticaria and childhood diarrhea) for 321 valid interactions to measure patient-centered communication and e-consult service quality. The scores of patient-centered communication included exploring the patient’s disease experience, understanding the patient’s social situation, and reaching a consensus between doctors and patients. We measured the quality of e-consult services by the total words of doctor’s responses, accurate diagnosis, appropriate prescription, lifestyle modification advice, patient satisfaction, continuance intention, and cost. Ordinary least-squares and logistic regression were performed to investigate the association between patient-centered communication and e-consult service quality. The total mean score of patient-centered communication was 17.67. The mean words of responses and cost were 178.55 words and 39.46 yuan, respectively. 82.87% of doctors diagnosed accurately, with 21.81% prescribing appropriate prescriptions and 81.93% providing lifestyle modification advice. 254 interactions obtained high satisfaction, and 218 had continuance intention after the interactions. Doctors with higher patient-centered communication levels would provide more words of responses. They were more likely to provide accurate diagnoses, appropriate prescriptions, and lifestyle modification advice, resulting in better patient satisfaction, continuance intention, and higher costs. Therefore, it is necessary to standardize and improve the doctor-patient communication process of e-consult and develop training for different doctors.

Preparing for Patient Care: A Pre-clerkship Curricular Thread to Improve Learners’ Knowledge, Attitudes, and Confidence Treating Patients at Risk for Suicide

AbstractSuicide is a leading cause of death. Unfortunately, stigma still surrounds depression and mental health treatment. Many health care providers are uncomfortable broaching the topic with patients. There is an urgent need to better equip future physicians to compassionately identify and treat patients at risk for suicide. To address this problem, we created a novel suicide prevention spiral curricular thread for advanced pre-clerkship medical students. Mixed methods surveys were administered before and after the curriculum. Following completion of the curriculum, learners’ confidence identifying and treating patients at risk of suicide significantly increased. Attitudes including professional confidence, therapeutic optimism, and generalist perspective measured by the Revised Depression Attitudes Questionnaire also increased, indicating reduced stigmatizing attitudes and increased knowledge and confidence. Participants reported that engaging in the standardized patient encounter was the most impactful event, although the prior events provided necessary foundational training. This study demonstrates the feasibility and effectiveness of a curricular thread approach during the pre-clerkship phase for training medical students in suicide prevention to prepare them for patient care. Other medical schools can use this framework to design and integrate suicide prevention training into their own curricula.

Evaluation of an Innovative Postgraduate Medical Education Model Incorporating Social Determinants of Health

Purpose Incorporating social determinants of health (SDH) into medical education is crucial. However, there are limited data on standard education models and comprehensive SDH curricula in Taiwan are insufficient. This study presents a systematic SDH curriculum instructed primarily by social workers for postgraduate doctors and aims to examine the training outcomes of the innovative curriculum. Method This study assessed training outcomes using Kirkpatrick model levels 1 and 2 regarding trainees’ satisfaction and improvement of their knowledge and skills in written and standardized patient (SP) pre- and posttests conducted between 1 August 2021 and 31 July 2022. Results A total of 28 trainees completed the training. The trainees’ overall satisfaction score regarding the curriculum was high (4.6 out of 5). The median pretest scores for the written and SP tests were 66.25 ± 14.38 and 14.50 ± 5.13, respectively, whereas the median posttest scores were 80.00 ± 7.50 and 20.50 ± 6.13, respectively. Both written and SP posttest scores were significantly improved compared to the pretest scores (p < .001). Conclusions The presented education model significantly improved postgraduate doctors’ SDH knowledge and biopsychosocial assessment skills, and received high satisfaction scores from the trainees. Adopting social workers as primary teachers may enhance interdisciplinary collaboration between social workers and trainee doctors.

12565 Expression Of Sex Hormone Receptors In Levator Ani Muscle Tissue From Patients With Pelvic Organ Prolapse

Abstract Disclosure: T. You: None. A. Halle: None. W. Xu: None. T. Potluri: None. H. Nguyen: None. S.E. Bulun: None. J. Julia Geynisman-Tan: None. H. Zhao: None. Introduction: Women with pelvic floor disorders usually have weakened pelvic floor muscles, which may cause urinary incontinence, fecal incontinence, and pelvic organ prolapse (POP). Histologically, the pelvic floor musculature in POP patients displays increased fibrosis and muscle atrophy. However, the underlying molecular mechanism for POP has not been fully investigated. We and others found that estrogen causes pelvic skeletal muscle fibrosis and inguinal hernias in male animal models. Additionally, clinical trials from the Women's Health Initiative showed women receiving estrogen-only or estrogen plus progestin treatment had statistically significant increases in the risk for urinary incontinence. However, the role of estrogen, progesterone, androgen, and their receptor expression in pelvic floor muscle is not well studied. Methods: TruCut biopsy needles were used to obtain levator ani (LA, the major pelvic floor muscle) biopsies from four groups of patients undergoing surgery: (i) 5 premenopausal women with stage II/III POP (age 38-52 years), (ii) 5 postmenopausal women with stage III POP (59-75 years), (iii) 5 age and parity matched premenopausal controls, and (iv) 5 age and parity matched postmenopausal controls. The control patients did not have any POP (stage 0) or only had sole stress urinary incontinence. H&amp;E staining, Masson’s trichrome staining, and immunohistochemistry (IHC) staining for estrogen receptor α (ERα), progesterone receptor (PGR), and androgen receptor (AR) were performed in LA muscle tissue. Standard patient demographics (age, parity, and diagnosis) were collected. Results: We used H&amp;E staining to morphologically assess stromal cells and myofibers obtained from LA muscle biopsies. Masson’s trichrome staining showed extracellular matrix deposition in the LA muscle from women with or without POP. In addition, we found ERα was present in the stromal cells from nearly every LA biopsy using IHC staining. ERα expression (H-Score) was similar in four groups of patients. ERα IHC staining was absent in LA myofibers. AR was highly expressed in stromal cells in all LA muscles and weakly expressed in myofibers in ∼70% of LA tissues. AR expression (H-Score) was significantly decreased in postmenopausal women with stage III pelvic organ prolapse. PGR was only expressed in a small portion of the LA sample (30%), with PGR exclusively expressed in the stroma of the LA muscle. Conclusion: Our findings indicate that sex hormone receptors (ERα, AR, and PGR) are present in LA muscle stroma, providing the foundation to further define the roles of sex steroid hormones in pelvic organ prolapse. Presentation: 6/3/2024

Comparison of 6 handheld ultrasound devices by point-of-care ultrasound experts: a cross-sectional study

BackgroundPoint-of-care ultrasound (POCUS) has emerged as an essential bedside tool for clinicians, but lack of access to ultrasound equipment has been a top barrier to POCUS use. Recently, several handheld ultrasound devices (“handhelds”) have become available, and clinicians are seeking data to guide purchasing decisions. Few comparative studies of different handhelds have been done. We conducted a cross-sectional study comparing 6 handhelds readily available in the United States (Butterfly iQ + ™ by Butterfly Network Inc.; Clarius™ by Clarius Mobile Health; Kosmos™ by EchoNous; TE Air™ by Mindray; Vscan Air™ SL and CL by General Electric; and Lumify™ by Philips Healthcare). A multi-specialty group of physician POCUS experts (n = 35) acquired three standard ultrasound views (abdominal right upper quadrant, cardiac apical 4-chamber, and superficial neck and lung views) in random order on the same standardized patients and rated the image quality. Afterward, a final survey of the overall ease of use, image quality, and satisfaction of each handheld was completed.ResultsThirty-five POCUS experts specializing in internal medicine/hospital medicine, critical care, emergency medicine, and nephrology acquired and rated right upper quadrant, apical 4-chamber, and superficial neck and lung views with 6 different handhelds. For image quality, the highest-rated handhelds were Vscan Air™ for the right upper quadrant view, Mindray TE Air™ for the cardiac apical 4-chamber view, and Lumify™ for superficial views of the neck and lung. Overall satisfaction with image quality was highest with Vscan Air™, Lumify™, and Mindray, while overall satisfaction with ease of use was highest with Vscan Air™. The 5 most desirable characteristics of handhelds were image quality, ease of use, portability, probe size, and battery life. Ultimately, all 6 handhelds had notable advantages and disadvantages, with no single device having all desired qualities or features.ConclusionsThe overall satisfaction with image quality was rated highest with Vscan Air™, Lumify™, and Mindray TE Air™when acquiring right upper quadrant, apical 4-chamber, and superficial neck and lung views. No single handheld was perceived to be superior in image quality for all views. Vscan Air™ was rated highest for overall ease of use and was the most preferred handheld for purchase by POCUS experts.

Athletic training students’ experiences and perceptions of exertional heat stroke simulated encounters: A qualitative analysis

Introduction: Athletic trainers are trained to recognize exertional heat stroke (EHS), which is critical to implementing lifesaving measures. Rectal thermometry is the best practice for recognizing EHS, and the Commission on Accreditation of Athletic Training Education (CAATE) requires students to learn rectal thermometry. Rooted in transformative learning theory, this study explored the perceptions and experiences of athletic training students following simulated EHS encounters with either high-fidelity (HF) simulators or standardized patients (SPs). Methods: This was a qualitative study using phenomenological theory. Through semi-structured qualitative interviews, we explored participants' personal experiences and perceptions following their simulation interventions. Participants included sixteen first-year Master of Athletic Training students (HF=8, SP=8; 4 males and 4 females in each group) ages 21-38 (23.69±4.48) who were enrolled in a course discussing exertional heat illnesses. Data Analysis: We recorded and transcribed the interviews verbatim. We used qualitative software, Nvivo (Denver, CO), to categorize the data into themes and codes. To ensure trustworthiness, we used member checking and investigator triangulation. Results: Three themes emerged from the data: 1) Simulation environment, 2) Mindset shifts, and 3) Perceptions of other simulation types. Participants from both groups described positive learning experiences in a foreign yet low stakes learning environment emphasizing repetition for learning the skill. The HF group shared beneficial aspects of patient-history-taking opportunities. The SP group shared the benefits and applicability of developing a patient-provider relationship through communicating with their SP. Most participants from both groups could immerse themselves in the encounter for a realistic experience. Both groups discussed how their mindset towards EHS and rectal thermometry changed after their encounter. Lastly, both groups agreed their simulation intervention was superior to practicing on a task trainer. Conclusions: Instructors of athletic training programs should strive to implement realistic simulated encounters for emergency skills training of athletic training students. A safe space for learning in a low-stakes environment should be fostered. Based on the shared perceived benefits of SP encounters for building provider-patient rapport and feedback opportunities, instructors should consider implementing SPs throughout their curriculum.

Observers Have Similar Improvements in Student Learning Outcomes as Participants in Athletic Training Simulation Education: A Pilot Study

Introduction: The use of standardized patient (SP) encounters in athletic training education programs have become more common; however, due to time and space constraints, it is possible that not all athletic training students will be able to participate and some must be observers. The objective of this study was to determine if observers experience similar improvements in student learning outcomes as participants for SP encounters. Methods: A pretest/posttest, non-randomized controlled trial was utilized. Nine athletic training students volunteered to participate in the research study. All participants completed a pretest survey including a knowledge assessment and confidence rating scale, followed by either a telehealth or in-person SP encounter of a lower extremity evaluation, and finished with a posttest survey. Results: Two separate repeated measures ANOVAs of the composite knowledge scores and confidence rating scale found significant differences between the pretest and posttest respectively (F = 14.117, p = 0.007, = 0.669; F = 88.439, p &lt; 0.001, = 0.927), with no significant difference between the participant or observer roles for either knowledge assessment (F = 0.213, p = 0.658, = 0.030) or confidence rating scale (F = 2.669, p = 0.146, = 0.276). Conclusion: Athletic training students demonstrated similar increases in knowledge and confidence as a result of telehealth and in-person SP encounters regardless of their role as an observer or participant. Athletic training educators should consider implementing SP encounters into their educational curriculums even if not all students are be able to be participants.

Analysis of 2-Year Survival Outcomes of Japanese Older Populations on Hemodiafiltration: A Propensity Score-Matched Study Based on Insurance Claims Data

Despite the lack of evidence that suggests hemodiafiltration (HDF) offers a better survival outcome than standard hemodialysis (HD), the number of patients initiating HDF in Japan continues to rise. This study examined the temporal change in the number of HDF incidents, evaluated factors associated with all-cause mortality, and compared the mortality risk and survival time of patients on HDF with patients receiving standard HD in three sets of 2-year cohorts. The primary analyses included the insurance claims data of 460 HDF patients and propensity score-matched 903 standard HD patients who initiated dialysis therapy between 1 April 2012 and 31 March 2018. Patient follow-up was censored at the time of death or the end of the 2-year study period. The number of patients who initiated HDF and the proportion of all-cause mortality cases were evaluated. Additionally, the survival outcomes between propensity score-matched HDF and standard HD patient groups were compared throughout cohorts. The number of HDF patients increased throughout cohorts, but the proportions of mortality cases across cohorts slowly decreased. Adjusting for all study covariates, we observed that HDF patients had a lower mortality risk and longer survival time than patients on standard HD. This study supports the notion that HDF lowers all-cause mortality compared with standard HD in an incident dialysis population in Fukuoka Prefecture, Japan.

Platelet Lysate and Osteoarthritis of the Knee: A Review of Current Clinical Evidence.

Osteoarthritis (OA) of the knee affects millions of people with sizable socioeconomic burden. Conventional treatment modalities are prioritized, turning to surgical intervention only when they have failed. However, these traditional modalities have shortcomings, only aiming to reduce pain rather than targeting the underlying pathophysiology. Recently, the use of biologics, including autologous peripheral blood-derived orthobiologics (APBOs), has increased and demonstrated great promise for the management of knee OA. Platelet-rich plasma (PRP) is the most widely used APBO, but its efficacy is still uncertain, attributed to lack of standardized formulation protocols, characterization, and patient variables. To overcome the limitations posed by PRP, the use of other APBOs such as platelet lysate (PL) has been considered. This review summarizes the outcomes of clinical studies involving PL to manage OA of the knee. Multiple databases (Scopus, Embase, PubMed, and Web of Science) were searched employing terms "platelet lysate" and "knee osteoarthritis" for articles published in the English language to August 15, 2024, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only three clinical studies fulfilled our search and inclusion criteria. Intra-articular injection of three doses of PL injected every 3-4weeks is safe and efficacious, resulting in statistically significant improvements in different patient-reported outcome measures at 6-12months follow-up. The existing published peer-reviewed literature suggests that intra-articular injection of PL is safe and can decrease pain and increase function in patients with knee OA. Nonetheless, given the dearth of pertinent literature, more adequately powered, multicenter, prospective, non-randomized and randomized controlled studies with extended follow-up are needed to confirm the effectiveness of PL in knee OA. Further comparative studies to help clinicians in choosing the best APBO for knee OA treatment are also warranted.

Assessment of the effectiveness of hospital external disaster functional drills on health care receivers’ performance, using standardized patients and mass cards simulation: a pilot study from Saudi Arabia

BackgroundGiven the increasing frequency of disasters globally, it is critical that healthcare systems are prepared for these mass casualty events. The Saudi health system’s preparedness for mass casualty incidents needs to be more robust, potentially due to limited disaster drills and inadequate standardized patient (SP) simulation training. This study aims to (i) assess the performance of front-line hospital staff in Saudi Arabia through a functional drill and (ii) evaluate the drill’s effectiveness using SP and MAC-SIM cards, providing detailed insights into its design and execution.MethodsA functional drill was conducted at a government hospital in Riyadh, Saudi Arabia, on December 19, 2022, using a cross-sectional approach with two phases. 141 healthcare receivers served as subjects, while 23 volunteers acted as SPs. The scenario simulated a building collapse to assess the emergency department (ED) response, interdepartmental communication, and surge capacity. Data were collected through direct observation of healthcare practitioners’ interactions with the SPs, analysis of SP data, and participant feedback. Quantitative data were analyzed descriptively, while qualitative data were examined for patterns and themes related to simulation performance and effectiveness.ResultsThe hospital receivers’ performances demonstrated accurate triage categories. The ED team assessed most patients (67%) in less than 5 min. For patients requiring definitive care, such as intensive care unit, 95% spent less than 2.5 h in the ED. Most patients (65%) required ‘other treatments’. Communication was efficient in the triage zone and the yellow treatment area. Participants’ feedback on using MAC-SIM cards during the simulation was overwhelmingly positive with 82.61% reporting that MAC-SIM use helped them respond better. Experienced SPs (paramedics) with prior disaster knowledge and experience outperformed inexperienced SPs (nurses) in the functional exercise.ConclusionThis groundbreaking study is the first in the Arabic Gulf region to use SPs with MAC-SIM cards in functional drills. The findings highlight the potential of simulation exercises to improve hospital team knowledge and performance when responding to disasters. Multiple evaluation techniques can effectively identify participant strengths and weaknesses, informing future disaster improvement plans. This information is a valuable resource for Arabic and middle-income countries where disaster medicine is still developing.

Anesthesiological Preoperative Interview with a Palliative Care Patient: A Simulation-Based Experiment Using Standardized Patients.

Background and Objectives: Anesthesiologists come into contact with patients under palliative care in different clinical settings. They also routinely encounter these patients in their primary field of work, the operating room. Patients receiving palliative care who are scheduled for surgery will pose unique challenges in perioperative management, often presenting with advanced disease and with different psychosocial and ethical issues. This study aims to evaluate whether anesthesiologists without specialty training in palliative medicine will spot perioperative challenges presented by patients under palliative care and address them adequately. Materials and Methods: In this study, we simulated a preoperative anesthesiological interview using standardized patients and anesthesiologists (specialists as well as trainees). The standardized patients were asked to represent a patient under palliative care in need of surgery because of a mechanical ileus. We conducted 32 interviews, dividing the anesthesiologists into two groups. In one group, the standardized patients were instructed to address four problems, i.e., use of a port catheter for anesthesia, nausea and vomiting, pain medication, and an advance directive including a limitation of treatment (DNR-order). In the other group, these problems were also present, but were not actively addressed by the standardized patients if not asked for. The interviews were recorded, transcribed, and then analyzed. Results: In most cases, the medical problems were spontaneously identified and discussed. In only a few cases, however, was a therapy recommendation made for improved symptom control. The advance directive was spontaneously discussed by only 3 of the 32 (9%) anesthesiologists. In another 16 cases, the advance directive was discussed at the request of the standardized patients. The limitation of treatment stayed in place in all cases, and the discussion of the advance directives remained short, with an average duration of just over 5 min. Conclusions: In this study, the complex problems of patients under palliative care are not sufficiently taken into account in a preoperative anesthesiological interview. To improve treatment of the medical problems, therapists who have palliative medicine expertise, should be involved in the perioperative medical care, ideally as a multi-professional team. The discussion about perioperative limitations of treatment should be held beforehand, for example, as part of a structured advanced care planning discussion.

Tolerability of Diquas LX on tear film and meibomian glands findings in a real clinical scenario.

Long-acting diquafosol ophthalmic solution (DQS-LX) has significant advantages regarding patient adherence owing to the reduced frequency of required eye drops; however, some patients prefer conventional diquafosol ophthalmic solution (DQS) over DQS-LX. Herein, to clarify the characteristics of patients according to their preference for ophthalmic solutions, dry eye (DE) and meibomian gland (MG) findings were retrospectively investigated. This study enrolled 341 patients with DE (mean age, 62.1 ± 11.7 years) treated at the Itoh Clinic between November 8, 2022, and July 31, 2023, who switched from DQS to DQS-LX. Patients were divided into two groups: those who continued DQS-LX administration (DQS-LX group) and those who wished to revert to conventional DQS (DQS group). Data regarding subjective symptoms assessed using the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, tear film breakup time (BUT), tear meniscus height (TMH), corneal and conjunctival fluorescein staining (CFS), conjunctival hyperemia/papilla, meiboscore, plugging, vascularity, meibum grade, and Schirmer's score at the time of DQS-LX switch were evaluated. Of the 341 patients, 31 (9.1%) wished to revert to conventional DQS. In total, 16 eyes of 16 patients in the DQS group and 32 eyes of 32 patients in the DQS-LX group-for whom complete data were available-were included in the analysis. The DQS-LX group had higher SPEED scores, lower TMHs (P < 0.001, respectively), shorter FBUTs, greater CFS findings, larger meibum grades, lower Schirmer scores, and more pluggings compared with the DQS group (P = 0.005, 0.001, 0.001, 0.046, 0.003, respectively). Meiboscores and vascularity did not differ significantly between the two groups (P = 0.73 and 0.39, respectively). In conclusion, patients with low tear film volume and DE complicated by moderate or severe meibomian gland dysfunction (MGD) preferred DQS-LX, while those with allergic findings preferred conventional DQS.

Fever Prevention in Patients With Acute Vascular Brain Injury: The INTREPID Randomized Clinical Trial.

Fever is associated with worse outcomes in patients with stroke, but whether preventing fever improves outcomes is unclear. To determine whether fever prevention after acute vascular brain injury is achievable and impacts functional outcome. Open-label randomized clinical trial with blinded outcome assessment that enrolled 686 of 1176 planned critically ill patients with stroke at 43 intensive care units in 7 countries from March 2017 to April 2021 (last date of follow-up was May 12, 2022). Patients randomized to fever prevention (n = 339) were targeted to 37.0 °C for 14 days or intensive care unit discharge using an automated surface temperature management device. Standard care patients (n = 338) received standardized tiered fever treatment on occurrence of temperature of 38 °C or greater. Primary outcome was daily mean fever burden: the area under the temperature curve above 37.9 °C (total fever burden) divided by the total number of hours in the acute phase, multiplied by 24 hours (°C-hour). The principal secondary outcome was 3-month functional recovery by shift analysis of the 6-category modified Rankin Scale, which is scored from 0 (no symptoms) to 6 (death). Major adverse events included death, pneumonia, sepsis, and malignant cerebral edema. Enrollment was stopped after a planned interim analysis demonstrated futility of the principal secondary end point. In total, 686 patients were enrolled, and 9 were consented but not randomized, leaving a primary analysis population of 677 patients (254 ischemic stroke, 223 intracerebral hemorrhage, 200 subarachnoid hemorrhage; 345 were female [51%]; median age, 62 years) with 433 (64%) completing the study through 12 months. Daily mean (SD) fever burden was significantly lower in the fever prevention group (0.37 [1.0] °C-hour; range, 0.0-8.0 °C-hour) compared with the standard care group (0.73 [1.1] °C-hour; range, 0.0-10.3 °C-hour) (difference, -0.35 [95% CI, -0.51 to -0.20]; P < .001). Between-group differences for the primary outcome by stroke subtype were -0.10 (95% CI, -0.35 to 0.15) for ischemic stroke, -0.50 (95% CI, -0.78 to -0.22) for intracerebral hemorrhage, and -0.52 (95% CI, -0.81 to -0.23) for subarachnoid hemorrhage (all P < .001 by Wilcoxon rank-sum test). There was no significant difference in functional recovery at 3 months (median modified Rankin Scale score, 4.0 vs 4.0, respectively; odds ratio for a favorable shift in functional outcome, 1.09 [95% CI, 0.81 to 1.46]; P = .54). Major adverse events occurred in 82.2% of participants in the fever prevention group vs 75.9% in the standard care group, including 33.8% vs 34.5% for infections, 14.5% vs 14.0% for cardiac disorders, and 24.5% vs 20.5% for respiratory disorders. In patients with acute vascular brain injury, preventive normothermia using an automated surface temperature management device effectively reduced fever burden but did not improve functional outcomes. ClinicalTrials.gov Identifier: NCT02996266.

Young Doctors Program-Colorado: An Elective Elementary School Program to Improve Health Literacy, Utilization of the Healthcare System, and Osteopathic Awareness

AbstractThe Young Doctors Program (YDP) is a “mini medical school” series for fifth-grade elementary children. The YDP was designed and led by medical students in the Academic Medicine and Leadership Track at the Rocky Vista University College of Osteopathic Medicine in Colorado. The curriculum of the program was designed around the State of Colorado Learning Standards with the purpose of educating students about emergencies and common ailments in five body systems (cardiovascular, respiratory, gastrointestinal, musculoskeletal, and renal) while also providing exposure to healthcare as a profession. YDP provides children with insights into the healthcare system, an introduction to osteopathic medicine, and it enhances community outreach. This article provides a framework for the semester-long YDP curriculum as well as our final event which synthesizes learned information using standardized patients. We describe successes including community outreach and healthcare exposure in the elementary school, and challenges initiating connections with local schools and funding. Future goals include expanding outreach to other fifth-grade schools as well as growth to different age levels. Authors plan to pursue IRB approval for research to examine the benefits and efficacy of the YDP.

Oncologists’ communication about tobacco and alcohol use during treatment for esophagogastric cancer: a qualitative observational study of simulated consultations

PurposeTobacco and alcohol use influence cancer risk as well as treatment outcomes, specifically for esophageal and gastric cancer patients. Therefore, it is an important topic to discuss during consultations. This study aims to uncover medical, radiation, and surgical oncologists’ communication about substance use, i.e., tobacco and alcohol use, in simulated consultations about curative and palliative esophagogastric cancer treatment.MethodsSecondary analyses were performed on n = 40 standardized patient assessments (SPAs) collected in three Dutch clinical studies. Simulated patients with esophagogastric cancer were instructed to ask about smoking or alcohol use during treatment. The responses of the 40 medical, radiation, and surgical oncologists were transcribed verbatim, and thematic analysis was performed in MAXQDA.ResultsOncologists consistently advocated smoking cessation during curative treatment. There was more variation in their recommendations and arguments in the palliative compared to the curative setting and when addressing alcohol use instead of smoking. Overall, oncologists were less stringent regarding behavior change in the palliative than in the curative setting. Few oncologists actively inquired about the patient’s perspective on the substance use behavior, the recommended substance use change, or the support offered.ConclusionClear guidelines for oncologists on when and how to provide unequivocal recommendations about substance use behavior change and support to patients are needed. Oncologists might benefit from education on how to engage in a conversation about smoking or alcohol.

General dentists’ treatment plans in response to cosmetic complains; a field study using unannounced-standardized-patient

BackgroundThis field study explored general dentists' treatment plans in response to the request for cosmetic services of an unannounced standardized patient (USP) in Mashhad, Iran. MethodsThe researcher, as a USP, visited 24 and 23 offices in a high-income and a low-income area, respectively. The primary complaint was that, according to her friend's comments, a dental student, her smile was "crooked and yellow" due to the congenitally missing tooth number 10 and peg-shaped tooth number 8. The dentists' treatment plans for teeth color and form and the cosmetic services expenses were recorded. The treatment plans of the two areas were compared. ResultsFor dental form, most dentists' treatment plans were categorized as "No intervention" (privileged area: 37.5 %, less-privileged area: 56.53 %, and total: 46.80 %). The percentage of dentists in the privileged area who prescribed cosmetic services was twice that of the less-privileged area (33.33 % versus 17.39 %). The intervention for dental form varied from placing 1 unit of composite veneer to 10 units of ceramic laminates or orthodontics with a wide range of treatment costs ($42.09 to $1079.14). For tooth color, most dentists (privileged area: 62.50 %, less-privileged area: 30.43 %, and total: 46.80 %) were categorized as "Interventionists." For tooth color, the treatment plans varied from scaling and root planing, bleaching, and composite veneer with various costs ($7.19 to $197.84). ConclusionCosmetic treatment plans and expenses varied significantly for a single USP, with many not aligning with the standard treatment plan. Some dentists offered treatments even without a chief complaint from the patient. Dentists in privileged areas were twice as likely to prescribe cosmetic treatments compared to those in less privileged areas. Therefore, cosmetic services necessitate monitoring, establishing clear diagnostic criteria, and implementing educational interventions.

Incorporating Social Needs Screening in Simulation for Family Nurse Practitioner Students.

A pilot simulation was implemented at a private university school of nursing to provide an opportunity for family nurse practitioner (FNP) students to apply their knowledge of assessing and addressing social determinants of health (SDOH). The Social Needs Screening Tool (SNST), developed by the American Academy of Family Physicians, and SDOH content were incorporated into a tele-health simulation-based learning experience. Using Zoom [Zoom Video Communications, Inc.], students encountered a standardized patient who sought care for shoulder pain and shared concerns about transportation and finances. Thirty-nine FNP students individually completed the simulation. Evaluation was conducted via an adapted Simulation Effectiveness Tool-Modified and written feedback to assess confidence and skills. Eighty-nine percent of students reported they felt more comfortable using the SNST following the simulation. Incorporating SDOH content and the SNST within simulation-based learning is an effective learning activity to enhance FNP student confidence and skills in assessing and addressing SDOH. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Implementation of a New Classification and Stratification System for Solitary Bone Tumor: Osseous Tumor Radiological and Interpretation and Management System (OT-RIMS)

Abstract Objectives To propose a histological-grades-based Osseous Tumor Radiological Interpretation and Management System (OT-RIMS) that would simplify the radiological evaluation of bone tumors, categorize key radiological features into severity levels, and inform corresponding patient management actions. Methods This retrospective study between January 2015 and August 2022 evaluated patients with solitary bone tumors confirmed by pathology and imaging follow-up received two or three imaging modalities of radiographs, CT, or MRI. Three radiologists independently assessed radiological features, categorized bone lesions based on OT-RIMS criteria, and reached a consensus. Kappa statistics and observed agreement were calculated. Results A total of 341 patients (mean age, 26.0 years; 159 women) were included, with 102 malignant, 177 benign, and 62 intermediate or low-grade malignant bone lesions. Sensitivity and specificity of readers 1, 2, and 3, respectively, in the identification of malignant tumors into OT-RIMS 4 were 93.1% (95 of 102) and 93.3% (223 of 239), 96.1% (98 of 102) and 91.6% (219 of 239), 92.2% (94 of 102) and 89.5% (214 of 239). Inter-reader agreement of OT-RIMS category for three readers was considered excellent (Kendall’s W = 0.924, p &amp;lt; 0.001) with a kappa value of reproducibility in categories 1&amp;2, 3, and 4 of 0.764, 0.528, and 0.930, respectively. Conclusion The OT-RIMS category demonstrated excellent reproducibility despite the reader’s expertise level in categorizing the risk stratification of bone tumors and informing patient management, with histological grades used as the reference standard. Advances in knowledge The OT-RIMS category reliably stratifies bone tumors into four categories corresponding to histological grades and standardized patient management.

Educational research on medical residency programs in Chile: a scoping review and analysis of the impact of the new accreditation policy

BackgroundAccrediting medical specialties programs are expected to influence and standardize training program quality, align curriculum with population needs, and improve learning environments. Despite global agreement on its necessity, methods vary widely. In the Chilean context, a recent new accreditation criteria includes research productivity in relation to educational research on resident programs, so we aimed to define it. What is the profile of publications in educational research produced by Chilean medical specialty residency programs in the last five years? Based on these results, we intend to analyze the potential impact of the new accreditation policy on medical specialty programs in Chile.MethodsWe performed a preliminary bibliometric search to identify the use of the term “resident” in literature. After that, we conducted a literature search, using a six-step approach to scoping reviews, including the appraisal of the methodological quality of the articles.ResultsBetween 2019 and 2023, an average of 6.2 articles were published yearly (19%). The bibliometric analysis revealed that the dominant thematic area of the journals was clinical, accounting for 78.1%. Most articles focused on residents (84.38%), with only two articles including graduates as participants. One university was responsible for 62.50% of the articles and participated in all multicenter studies (9.38%). Surgical specialties produced 15 research articles focused on procedural training using simulation. Psychiatry was the second most productive specialty, with 5 articles (15.63%) covering standardized patients, well-being, and mental health assessment. The most frequent research focus within residency programs over the five-year period was teaching and learning methodologies, with 19 articles representing almost 60% of the total analyzed.ConclusionsResearch on medical education in Chile’s postgraduate residency programs is limited, with most studies concentrated in a few universities. The new accreditation criteria emphasize educational research, posing challenges for many institutions to meet higher standards. Understanding unexplored areas in educational research and learning from successful programs can enhance research productivity and align efforts with accreditation expectations. Continuous evaluation and new research on residents’ satisfaction, skills acquisition, and well-being are needed to ensure training quality and accountability.

Based on Medicine, The Now and Future of Large Language Models.

This review explores the potential applications of large language models (LLMs) such as ChatGPT, GPT-3.5, and GPT-4 in the medical field, aiming to encourage their prudent use, provide professional support, and develop accessible medical AI tools that adhere to healthcare standards. This paper examines the impact of technologies such as OpenAI's Generative Pre-trained Transformers (GPT) series, including GPT-3.5 and GPT-4, and other large language models (LLMs) in medical education, scientific research, clinical practice, and nursing. Specifically, it includes supporting curriculum design, acting as personalized learning assistants, creating standardized simulated patient scenarios in education; assisting with writing papers, data analysis, and optimizing experimental designs in scientific research; aiding in medical imaging analysis, decision-making, patient education, and communication in clinical practice; and reducing repetitive tasks, promoting personalized care and self-care, providing psychological support, and enhancing management efficiency in nursing. LLMs, including ChatGPT, have demonstrated significant potential and effectiveness in the aforementioned areas, yet their deployment in healthcare settings is fraught with ethical complexities, potential lack of empathy, and risks of biased responses. Despite these challenges, significant medical advancements can be expected through the proper use of LLMs and appropriate policy guidance. Future research should focus on overcoming these barriers to ensure the effective and ethical application of LLMs in the medical field.