Real Patient Encounters Research Articles

Implementing Telemedicine into Clinical Training Through Pre-recorded Video Consultations

Although the contribution of real patient encounters to medical education is well known, challenges such as a lack of suitable cases, patients not consenting to student involvement, physical space limitations that prevent every student from participating, the inability to replicate the same patient encounter, and reduced patient admissions to healthcare facilities during extraordinary periods are common obstacles that need to be addressed in clinical education. To overcome these challenges, video consultation (VC) recordings, which were made with the consent of patients having a telemedicine consultation, were collected as an archive of medical interview recordings covering a wide spectrum of pulmonary diseases. These recordings were watched by students in a classroom setting during clinical clerkships, with case discussions interspersed. This article, which also discusses the results of clinical clerkship evaluations, indicates that the use of pre-recorded VC sessions can be an effective tool for teaching good clinical practices through the ideal method of medical interviews, diagnostic approaches, evaluation of test results, communication skills with patients and their relatives, and addressing the socio-psychological aspects and social impacts of diseases. As an innovative attempt, sharing this process at an early stage of development may inspire enthusiasm for implementing this approach and open the field for further development.

Patient Feedback Applied in Undergraduate Dental Education for Individual Student Development and Assessment: A Scoping Review.

Active involvement of patients in healthcare professional education is well established, taking a variety of forms. There is a steer towards patient feedback informing the development of dental students and while there is recognition of its potential value to individual students, challenges exist related to collection and use. What is unclear is, within a dental education setting, the extent and use of patient feedback to individual students. A scoping review was conducted to assess and map the volume and characteristics of the research/literature in this area. Systematic searches of bibliographic databases Ovid MEDLINE(R), Scopus, ERIC and Embase were conducted, and wider literature (Google Scholar) was searched. Screening was conducted based on eligibility criteria and a customised data charting form was used. The electronic and citation tracking searches identified 1021 studies. After duplicates were removed, 778 studies were screened by title and abstract, and 718 studies were found to be irrelevant to the current review. Sixty full-text studies were assessed for eligibility, 46 studies were excluded, and 14 studies were included for data charting. This review has identified that patient feedback has been captured through both simulated and real patient encounters. There was a bias towards feedback generated through simulated patient encounters. Feedback was reported to support the development of a range of skills, most frequently communication and patient management. Challenges that were identified by researchers related to staff/student engagement and available resources.

Interprofessional clinical reasoning education.

Clinical reasoning is considered one of the most important competencies but is not included in most healthcare curricula. The number and diversity of patient encounters arethe decisive factors in the development of clinical reasoning competence. Physical real patient encounters are considered optimal, but virtual patient cases also promote clinical reasoning. A high-volume, low-fidelity virtual patient library thus can support clinical reasoning training in a safe environment and can be tailored to the needs of learners from different health care professions. It may also stimulate interprofessional understanding and team shared decisions. Implementation will be challenged by tradition, the lack of educator competence and prior experience as well as the high-density curricula at medical and veterinary schools and will need explicit address from curriculum managers and education leads.

Applied improvisation and transdisciplinary simulation: a necessity for any health curriculum?

From practising a procedure, such as a lumbar puncture, to explaining the aim and method and listening to concerns, the practice of health professionals requires a range of skills, often classified into technical and non-technical skills. Just as gestures and procedures can be taught, so can empathy and communication skills. This article introduces an innovative approach that unites both necessary types of skills. The specific framework of improvisational theatre ("improv") has widespread application, including the training of health professionals (health training improv). By sharing close contexts and skills, health training improv provides a valuable, safe, and effective learning environment that allows practitioners to practice exercises and situations that align with particular objectives. We created a transdisciplinary team to develop a programme of Health Professional Training Improv (HPTI), bringing together the fields of health, psychology, simulation, and arts. Since 2019, various health student groups (nurses, midwives, medical doctors, and speech therapists) have participated in a 16-h applied improv training workshop under the supervision of a professional improv facilitator. Additionally, drama students completed applied improv for health courses, which trained them to act as simulated patients, with a view to the implementation of transdisciplinary improv simulation sessions at SimUSanté (a multidisciplinary health simulation facility located in France). Students' feedback emphasized their interest in HPTI, the realism of the simulation sessions, and the skills they felt had improved. This feedback needs to be supplemented with quantitative data from standardised assessments. The development of this rich pedagogical and research framework, based on a transdisciplinary approach, has brought different fields together to prepare students for real patient encounters. It is essential to continue this training and conduct research to evaluate the curricula developed.

Restructuring an internal medicine rotation to take on a fully virtual experience in a resource-limited setting: A mixed-methods study

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, medical schools in the Philippines accelerated the adoption of virtual learning. Course developers were challenged to provide equal opportunities for clinical exposure given the differential access of students to technology. This study describes the modifications in the course design of an internal medicine rotation for third-year medical students and the perceptions of the faculty and students toward these changes. MATERIALS AND METHODS: Course evaluations by students and faculty were reviewed. Using a concurrent mixed-methods approach, we analyzed the quantitative and qualitative responses and triangulated the results of the faculty and student surveys. RESULTS: Shifting to a virtual learning platform decreased the number of student–patient interactions. Observing a telemedicine consultation done by faculty substituted for real patient encounters. In consideration of students with limited Internet access, synchronous activities were made nongraded. The survey response rate was 51% (93/181) for students and 34% (32/94) for faculty. Survey participants indicated high overall satisfaction toward the virtual course with a general agreement between students and faculty respondents in most domains. Recurrent themes were the demand for more patient encounters, more synchronous activities, and better evaluation tools. Only the faculty were critical of technical issues, such as audibility and Internet connectivity. CONCLUSION: The experiences of a single institution in redesigning and implementing an undergraduate medical course in internal medicine for a fully virtual platform were described. Strategies for augmenting patient exposure and tailored clinical assessment tools are needed to improve stakeholder satisfaction. In resource-limited settings, access to appropriate technology must be considered to ensure equitable learning.

Perceptions of medical students and their facilitators on clinical communication skills teaching, learning, and assessment.

Despite various efforts to develop communication skills (CS) in the classroom, the transfer of these skills into clinical practice is not guaranteed. This study aimed to identify barriers and facilitators of transferring CS from the classroom to clinical environments. A qualitative study was conducted at one Australian medical school to explore the experiences and perceptions of facilitators and students in relation to teaching and learning clinical CS. Thematic analysis was used to analyze data. Twelve facilitators and sixteen medical students participated in semi-structured interviews and focus-group discussions, respectively. Primary themes included the value of teaching and learning, alignment between approaches to teaching and actual clinical practices and students' perceptions of practice, and challenges in different learning environments. This study reinforces the value of teaching and learning CS by facilitators and students. Classroom learning provides students with a structure to use in communicating with real patients, which can be modified to suit various situations. Students have limited opportunities, however, to be observed and receive feedback on their real-patient encounters. Classroom session that discussed CS experiences during clinical rotation is recommended to strengthen learning both the content and process of CS as well as transitioning to the clinical environment.

A survey of motivational interviewing training experiences among internal medicine residents

ObjectiveAssess resident physicians’ training experiences and self-reported application of motivational interviewing (MI) skills. MethodsA cross-sectional nationally representative survey of internal medicine and medicine/pediatric residents from October 2021 - May 2022. Residents reported their MI skill training settings: lectures, standardized patients, role plays, group exercises, direct observation of patient encounters, and a full day or more course. Respondents reported frequency of using specific MI skills in the prior six months during behavior change conversations with patients. ResultsThe response rate 71.2% (202/281). Respondents received MI training in medical school (67.7%), residency (27.2%), both (22.7%), or none (23.5%). Respondents reported MI training through formal lectures/information discussion (77.5%), MI exercises (77.5%), direct observation of a real patient encounter (38.7%), and one or more full-day workshops (8.5%). Most respondents never or only sometimes elicited change talk statements (73.2%), responded to a patient’s sustain talk (64.3%), and developed discrepancies in behavior between individuals’ current actions and desired behaviors (75%). ConclusionsSignificant training gaps exist within resident MI education, which may reduce the application of MI skills. Practical implicationsBehavior change is crucial to many aspects of patient health outcomes. This lack of knowledge may impact future physicians’ ability to comprehensively care for patients.

The effects of diverse fidelity scenarios on stress in medical students when taking patients' medical histories: A longitudinal study.

Taking patients' medical history correctly is the basis of diagnosis and therapy. Medical students as a vulnerable group may perceive patient-physician interactions as stressful. This study examines stress among medical students in different degrees of fidelity when taking a patient's medical history. In this longitudinal study, students' stress levels were assessed during scenarios with different degrees of fidelity (role-play, simulated patient encounters and real patient encounters) using standardised questionnaires (State-Trait Anxiety Inventory and a distress scale) and the physiological measurement of heart rate variability. The stress level of participating medical students (N=128) was expected to significantly increase during scenarios of increasing fidelity (Mroleplay =2.08±0.92; SPEs: Msimulatedpatient =2.68±1.08; RPEs: Mrealpatient =3.35±1.08; p<0.001). Whereas physiological stress was significantly higher with real patients (N=106), psychological stress was not affected by the fidelity of the scenarios (N=85). Medical students experienced stress when taking patients' medical history. Medical students might be unaware of their perceived stress based on the results. Thus, they should know how to cope with stress in such situations.

Feasibility and Acceptability of Web-Based Structured Oral Examinations for Postgraduate Certification: Mixed Methods Preliminary Evaluation.

The COVID-19 pandemic disrupted postgraduate certification examinations globally. The Colleges of Medicine of South Africa continued hosting certification examinations through the pandemic. This was achieved by effecting a rapid transition from in-person to web-based certification examinations. This formative evaluation explored candidates' acceptability of web-based structured oral examinations (SOEs) hosted via Zoom (Zoom Communications Inc). We also reported the audiovisual quality and technical challenges encountered while using Zoom and candidates' overall experience with these examinations conducted during the early part of the COVID-19 pandemic. Additionally, performance in web-based certification examinations was compared with previous in-person certification examinations. This mixed methods, single-arm evaluation anonymously gathered candidates' perceptions of web-based SOE acceptability, audiovisual quality, and overall experience with Zoom using a web-based survey. Pass rates of web-based and previous in-person certification examinations were compared using chi-square tests, with a Yates correction. A thematic analysis approach was adopted for qualitative data. Between June 2020 and June 2021, 3105 candidates registered for certification examinations, 293 (9.4%) withdrew, 2812 (90.6%) wrote, and 2799 (99.9%) passed, and 1525 (54.2%) were invited to a further web-based SOE. Examination participation was 96.2% (n=1467). During the first web-based examination cycle (2020), 542 (87.1%) of 622 web-based SOE candidates completed the web-based survey. They reported web-based SOEs as fair (374/542, 69%) and adequately testing their clinical reasoning and insight (396/542, 73.1%). Few would have preferred real patient encounters (173/542, 31.9%) or in-person oral examinations (152/542, 28%). Most found Zoom acceptable (434/542, 80%) and fair (396/542, 73.1%) for hosting web-based SOEs. SOEs resulted in financial (434/542, 80%) and time (428/542, 79%) savings for candidates. Many (336/542, 62%) supported the ongoing use of web-based certification examinations. Only 169 technical challenges in using Zoom were reported, which included connectivity-related issues, poor audio quality, and poor image quality. The thematic analysis identified 4 themes of positive and negative experiences related to web-based SOE station design and content, examination station environment, examiner-candidate interactions, and personal benefits for candidates. Our qualitative analysis identified 10 improvements for future web-based SOEs. Candidates achieved high pass rates in web-based certification examinations in 2020 (1583/1732, 91.39%) and 2021 (850/1067, 79.66%). These were significantly higher (2020: N=8635; χ21=667; P<.001; 2021: N=7988; χ21=178; P<.001) than the previous in-person certification examination pass rate of 58.23% (4030/6921; 2017-2019). Web-based SOEs conducted by the Colleges of Medicine of South Africa during the COVID-19 pandemic were well received by candidates, and few technical difficulties were encountered while using Zoom. Better performance was observed in web-based examinations than in previous in-person certification examinations. These early findings support the ongoing use of this assessment method.

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

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.

Documentation from trained medical students has a low rate of relative downcoding for emergency medicine encounters.

BackgroundSince 2018, the Centers for Medicare & Medicaid Services (CMS) guidelines have allowed teaching physicians to bill for evaluation and management services based on medical student documentation. Limited previous data suggest that medical student documentation suffers from a high rate of downcoding relative to faculty documentation. We sought to compare the coding outcomes of documentation performed by medical students, and not edited by faculty, with documentation edited and submitted by faculty.MethodsA total of 104 randomly selected notes from real patient encounters written by senior medical students were compared to the revised notes submitted by faculty. The note pairs were then split and reviewed by blinded professional coders and assigned level of service (LoS) codes 1–5 (corresponding to E&M CPT codes 99281–99285).ResultsWe found that the LoS agreement between student and faculty note versions was 63%, with 23% of all student notes receiving lower LoS compared to faculty notes (downcoded). This was found to be similar to baseline variability in professional coder LoS designations.ConclusionsNotes from medical students who have completed a focused documentation curriculum have less LoS downcoding than in previous reports.

Medical Students' Perspectives on the Factors Affecting Empathy Development During Their Undergraduate Training.

This study investigated the perspectives of medical students on the factors influencing empathy development during their undergraduate training. A descriptive phenomenological approach was used to generate illustrations of empathy development and decline that had educational significance and applicability. Individual online semi-structured interviews were conducted to elicit experiential details from twelve final-year medical students. The interview recordings were transcribed verbatim, and data were analysed employing Braun and Clarke's thematic analysis method. The self-reported empathic behavior of medical students seemed to have improved with time in medical school. Students attributed their empathy development to real patient encounters, positive role-modelling by teachers, and attainment of confidence and personal maturity. They identified exams, academic overload, time constraints, personal stresses, negative role models, unconducive learning environments, and lack of formal empathy training as barriers to empathy development. Medical institutes should identify and address the barriers to empathy development and encourage the holistic development of medical students. Furthermore, medical educators should model their behavior accurately for their increasing roles and responsibilities and support the students in their empathic expressions with patients.

Analyzing Expert Criteria for Authentic Resident Communication Skills

Phenomenon : Training and assessing communication skills requires flexible and holistic approaches, including feedback practices. Historically, assessing communication skills has predominantly relied on itemized scoring, which is less useful for providing meaningful feedback to learners. Even more troublesome, theoretical scoring criteria tend to become a refractive lens allowing observation of only the conduct that aligns with the theory. Few skills assessment efforts have embraced a holistic understanding of how physician-patient communication skills are enacted in real patient care. Therefore, this study focused on what experts refer to when they speak about physicians’ communication skills and what they treat as important when evaluating these skills enacted during real patient encounters. Approach : This qualitative study was based on observations and grounded theory. Residents’ encounters with real patients were recorded as part of a formative communication skills assessment program from July 2015 to June 2016. Evaluation panels with diverse backgrounds (e.g., medicine, education, communication, conversation analysis, and layperson) listened to these recordings and jointly developed feedback comments for the resident from January 2016 to July 2017. For this study, we recorded forty-one panel discussions to observe their consensus evaluation. We conducted open and axial coding using a constant comparison approach to generate themes from the data. Findings : Elements of communication skills were connected and interdependent around the concepts of thoroughness and natural flow, which were not addressed by formative assessment criteria. Themes included (1) thoroughness within a boundary via agenda-setting; (2) natural yet, controlled flow: authentic conversation by active listening and questioning; (3) making agenda setting explicit to all parties in the beginning; (4) designing questions using both open-ended and closed questions; (5) pre-/post-conditions for patient education: patient contextual factors and teach-back; (6) preconditions for shared decision-making: patient education and patient contextual factors; and (7) multifaceted empathy demonstrated in multiple ways. Insights : The main message of the study findings is that communication skills criteria should be treated as organically interrelated and connected in assessing physicians’ communication skills. Current communication skills assessment practice should be revisited as it itemizes physicians’ communication skills as distinct and separate constructs rather than mutually affecting dynamics. Rather than imposing a theoretical rubric, assessment criteria should evolve through naturalistic observations of physician-patient communication.

Longitudinal Outcome of Programmatic Assessment of International Medical Graduates.

IntroductionAustralia depends on international medical graduates (IMGs) to meet workforce shortages. The current standard assessment for IMGs is by clinical examination in observed structured clinical encounter (OSCE) format lasting 200 minutes. There are concerns about adequateness of this assessment as it does not test the qualities required to practice in a new country. We introduced a programmatic performance-based assessment for IMGs to prepare them to meet these challenges. The workplace-based assessment (WBA) program involves six-month longitudinal programmatic assessments comprising of 12 mini-clinical evaluation exercises (Mini-CEX), five case-based discussions (CBD), two in-training assessments (ITAs) and two sets of multisource feedback (MSF) assessments. We assessed 254 IMGs since 2010. We conducted a survey to evaluate the satisfaction with the program and the outcomes of these doctors.MethodsWe surveyed 254 candidates from 2010 to 2020. The survey used “SelectSurvey” tool with 12 questions and free-text comments. All candidates were sent the survey link to their last registered mobile phone using “Telstra Instant Messaging Service”. We analysed the data using Microsoft “Excel”.ResultsWe received 153 (60%) responses. Amongst them, 141 (92%) candidates did not require further supervised practice for general registration and 129 (84%) candidates hold general/specialist registration. The candidates found the program useful and felt well supported. They appreciated real patient encounters. The feedback with positive critiquing was helpful in improving their clinical practice. The negative themes were program costs and frustration with the length of the program.ConclusionUpon completion of the WBA program and obtaining the AMC certificate, most of the doctors were able to gain general registration. Seventy-eight (50%) candidates chose to continue their careers within the local area with 124 (80%) of them within the state. Our survey shows a comprehensive assessment program with immediate constructive feedback produces competent doctors to fill the medical workforce shortages.

Transfer of communication teaching skills from university to the clinical workplace \u2013 does it happen? A mixed methods study

BackgroundCommunication skills learned in the classroom do not transfer easily into clinical practice because they are not reinforced by teachers in the workplace setting and because lack of faculty training restricts the transfer of communication skills in real patient encounters. Trained university-based communication skills teachers often work simultaneously as doctors in clinics. This study explored if and how the skills of these teachers play a role in communication skills training in the clinical workplace.MethodsWe used an exploratory sequential design: a mixed method approach that combined a survey with communication skills teachers, and qualitative individual interviews with these teachers and their educational leaders in clinical departments. The questionnaire was analysed using descriptive statistics. The interviews were analysed using content analysis.ResultsThe response rate was 34 %. A majority (93 %) used their communication skills when communicating with patients and relatives. Less than half taught communication in clinical departments. Approximately half of the respondents stated that encouragement from their leaders or colleagues would inspire them to use their teaching skills in the workplace. However, only 20 % had told their leaders about their competencies in teaching communication. One third thought that they needed further teacher training to teach in the clinical workplace.Qualitative analysis showed that teaching opportunities existed but mainly consisted of random, one-off sessions that came about through the initiative of the communication skills teachers themselves. The teachers described several barriers, such as the challenge of teaching colleagues, as communication relates to identity and hierarchical structures, as well as a lack of requests from colleagues or management, and department culture prioritizing topics relating to medical expertise. None of the educational leaders made use of the teachers’ specific communication skills in a structured way: some saw it as unimportant, while others saw it as a potential resource.ConclusionTransfer of the teaching skills of communication skills teachers trained for university-based clinical communication training happened, but to a limited degree. Although both opportunities and barriers for transferring communication skills existed, barriers seemed to dominate, and opportunities for communication skills training in the workplace setting were not used to their full potential.

Development of a Scale for Assessing Basic Psychotherapeutic Skills

Abstract. Background: Well-established scales for the observation-based assessment of psychotherapy competence encompass multiple domains, require extensive rater training, and are rather cost-intensive. Objective: To develop a comprehensive but easy-to-administer instrument for the observation-based assessment of basic communication and counseling skills in both real and simulated patient encounters, the Clinical Communication Skills Scale (CCSS). Methods: We investigated the content validity and applicability of this scale. We then presented videos of simulated therapy sessions conducted by a competent vs. noncompetent therapist online to N = 209 laypersons and psychology students. Results: Results suggested a one-factorial solution. Internal consistency was excellent ( α = .94). For most aspects, convergent validity with established scales was moderate to high. The CCSS effectively differentiated between both levels of skill. Conclusions: The CCSS appears to be a feasible, reliable, and valid instrument. Nonetheless, its psychometric criteria should be investigated further in clinical samples, with licensed therapists, and in other languages.

Paramedic student encounters with patients during clinical placements: A multi-institutional cohort study.

ObjectiveParamedic students in the US are required to complete clinical placements to gain supervised experience with real patient encounters. Given wide variation in clinical placement practices, an evidence‐based approach is needed to guide programs in setting realistic and attainable goals for students. This study's goal was to describe patient encounters and hours logged by paramedic students during clinical placements.MethodsA retrospective review of prospectively collected quality assurance data entered by US paramedic students between 2010 and 2014 was conducted. De‐identified electronic records entered in the Field Internship Student Data Acquisition Project (FISDAP) Skill Tracker database were included from consenting paramedic students whose records were audited and approved by instructors. Descriptive statistics were calculated.ResultsA total of 10,645 students encountered 2,239,027 patients; most encounters occurred in hospital settings (n = 1,311,967, 59%). The median total number of patient encounters per paramedic student was 206 (142–269) and the median total clinical placement hours per student was 626 (504–752). The median number of team leads per student was 56 (30–84). Students encountered a median of 22 (12–31) pediatric patients, ages 0–12 years, and 181 (126–238) adolescent or adult patients. For pediatric patient encounters, the most common clinical impressions were respiratory distress, other medical complaints, and extremity trauma. Among adult patient encounters, the most common clinical impressions included other medical, trauma, and cardiac conditions.ConclusionsUS paramedic students experienced a variable range of patient encounter types and volumes. The findings of this study offer an evidence base from which programs can set realistic and attainable clinical placement requirements.

Factors in Successful Humanities Integration: A Case Study of One Physical Therapist Education Program

Introduction. Humanities have been recognized as an effective pedagogical tool for developing professional behaviors and a patient-centered approach. Physical therapy education programs may aspire to add humanities to their curricula but lack knowledge of how to do it successfully. The purpose of this study was to examine methods of humanities integration and supporting factors contributing to success in one physical therapist education program. Methods. This research used a qualitative single case study approach. Seventeen participants from one physical therapist education program were interviewed, including faculty, students, and alumni. An onsite visit to campus also included review of artifacts and observations of campus events. Interviews were transcribed, coded, and analyzed for themes. Results. Four main themes emerged: learning about the human experience through real patient encounters, including narrative writing, guest speakers, and experiential learning; pedagogical approaches can increase successful use of humanities, including repeated exposure, explicitness about the benefits, and sensitivity to time constraints; strong support systems help with success of humanities integration, including culture, leadership, mentorship, and resources; and challenges remain in humanities integration, including lack of buy-in and comfort, time constraints, difficulty with assessment, and devaluing of the humanities by the profession. Discussion. Successful humanities integration may be cultivated by informed pedagogical approaches and attention to the institutional and departmental factors which support humanities. Conclusion. This study helps to guide programs looking to increase presence of humanities by providing an example of how the humanities are integrated throughout the curriculum at one physical therapist education program and the factors that have affected the success of the integration.

36. DOES EMOTIONAL FIDELITY MATTER? PEDIATRIC RESIDENTS’ PERSPECTIVES DURING EXPECTED VS UNEXPECTED SIMULATION SESSIONS

Introduction Simulation-based education has become pervasive in residency. Fidelity is important for relevance and transference of skills to real patient encounters and can be divided into three parts: physical, conceptual, and emotional 1 , 2 . There have been few studies to date evaluating the impact of emotional fidelity, or how close to “real” the simulation feels. Only 26% of Tufts pediatric residents felt they were “comfortable” in their ability to lead a rapid response event, which may be impacted by the unexpected nature of rapid responses. Objective: Evaluate whether being called to a simulation of a decompensating patient without advanced warning affects pediatric residents’ perception of the emotional (EF) and overall fidelity (OF) of the simulation. Methods Pediatric residents participated in a simulation involving a child with respiratory distress. Residents were randomized to one of two groups: Advanced Warning (AW) or No Advanced Warning (NAW). The AW group (control) was notified via text message several hours prior to receiving a page to report to the simulation. The NAW group (intervention) was not notified prior to receiving the page to report to the simulation. All residents completed surveys about their perceptions of fidelity. Results Nineteen residents have provided data to date. Mean scores on a 5-point Likert item rating EF of the simulation (1 = extremely unrealistic, 5 = extremely realistic) were 2.9 (AW) and 3.8 (NAW) (p-value 0.04). Mean scores for OF were 2.6 (AW) and 3.3 (NAW) (p-value 0.28). Discussion Reported experience of EF but not OF was higher for residents given NAW than those given AW. Data collection is ongoing. Limitations of this study include low physical fidelity and small sample size.

Dell Medical School at the University of Texas, Austin.

Dell Medical School at the University of Texas, Austin.