Patient Simulation Experience Research Articles

A Generative Pretrained Transformer (GPT)-Powered Chatbot as a Simulated Patient to Practice History Taking: Prospective, Mixed Methods Study.

Communication is a core competency of medical professionals and of utmost importance for patient safety. Although medical curricula emphasize communication training, traditional formats, such as real or simulated patient interactions, can present psychological stress and are limited in repetition. The recent emergence of large language models (LLMs), such as generative pretrained transformer (GPT), offers an opportunity to overcome these restrictions. The aim of this study was to explore the feasibility of a GPT-driven chatbot to practice history taking, one of the core competencies of communication. We developed an interactive chatbot interface using GPT-3.5 and a specific prompt including a chatbot-optimized illness script and a behavioral component. Following a mixed methods approach, we invited medical students to voluntarily practice history taking. To determine whether GPT provides suitable answers as a simulated patient, the conversations were recorded and analyzed using quantitative and qualitative approaches. We analyzed the extent to which the questions and answers aligned with the provided script, as well as the medical plausibility of the answers. Finally, the students filled out the Chatbot Usability Questionnaire (CUQ). A total of 28 students practiced with our chatbot (mean age 23.4, SD 2.9 years). We recorded a total of 826 question-answer pairs (QAPs), with a median of 27.5 QAPs per conversation and 94.7% (n=782) pertaining to history taking. When questions were explicitly covered by the script (n=502, 60.3%), the GPT-provided answers were mostly based on explicit script information (n=471, 94.4%). For questions not covered by the script (n=195, 23.4%), the GPT answers used 56.4% (n=110) fictitious information. Regarding plausibility, 842 (97.9%) of 860 QAPs were rated as plausible. Of the 14 (2.1%) implausible answers, GPT provided answers rated as socially desirable, leaving role identity, ignoring script information, illogical reasoning, and calculation error. Despite these results, the CUQ revealed an overall positive user experience (77/100 points). Our data showed that LLMs, such as GPT, can provide a simulated patient experience and yield a good user experience and a majority of plausible answers. Our analysis revealed that GPT-provided answers use either explicit script information or are based on available information, which can be understood as abductive reasoning. Although rare, the GPT-based chatbot provides implausible information in some instances, with the major tendency being socially desirable instead of medically plausible information.

BUILDING FOUNDATIONAL COMPETENCIES IN OLDER ADULT MENTAL HEALTH: VIRTUAL AND IN-PERSON TRAINING

Abstract Designed to develop foundational knowledge competencies for generalist clinicians, this program was created by a team of geropsychologists, geriatric social workers, geriatric psychiatrists, and neuropsychologists, who reviewed competencies of multiple mental health disciplines, and identified 14 key areas of knowledge for clinicians. Content was created by Rush faculty, externally peer-reviewed, and developed into two versions. The 14-hour online version includes knowledge checks and national expert videos to provide multiple perspectives and voices of experience. Of the first 176 learners in the online version, 96.8% rated the overall program as excellent, with strong agreement (97.4 – 98.3%) that the training was applicable to practice, expectations were met, and learners had intention to apply the knowledge. All learners are required to achieve a minimum of 75% on knowledge post-test to complete each module. The three-day in-person program provided 25 diverse clinicians representing every HHS region with didactic content, interactive exercises, discussion, and a simulated patient experience to practice skills with live expert feedback. Participants demonstrated 14% improvement in knowledge (p<.01). Didactic lectures were rated 100% extremely or very helpful; 82% rated group learning exercises extremely helpful; 100% rated the simulation lab as extremely or very helpful. Balance between activities and match with learning style were rated good to very good. All participants rated the likelihood of recommending the program to a colleague as extremely or very likely. Evaluation of skill implementation is ongoing. Implications for expanding generalist competencies in older adult mental health will be discussed.

Gender minority portrayal in patient simulation: transgender and non-binary healthcare providers consider the priorities and ethics of practice

Gender minorities experience extensive health inequities. Discrimination and bias in healthcare are contributing factors. Increasingly, medical educators are utilizing patient simulation to teach gender-affirming clinical skills. However, institutional practices vary widely in case authoring, casting and training. To date, no guidance for ethical practice has been established. Gender minority healthcare providers offer an important perspective on this due to their patient simulation experience and embodied knowledge. Transgender and non-binary healthcare providers and trainees ( Casting gender minorities in gender minority roles is the gold standard. In situations where this is not possible, participant opinion diverged on whether it is preferable to cast cisgender simulated patients or cancel the case. Participants described gender-affirming patient simulation as impactful. They noted the potential for harm to gender minority simulated patients due to repeated learner errors. The study provides a point of reference for educators designing simulation activities. Developing gender minority case content is important and should be undertaken with care. If recruiting gender minority simulated patients proves difficult, programs should engage their local transgender and non-binary community for input on recruitment and next steps. Increasing the simulated patient-to-learner ratio, engaging gender minority simulated patients remotely and/or involving gender minorities in case development and training may be viable alternatives.

Can a simulated hospital interprofessional experience between allied health and nursing students change self-efficacy beliefs?

While literature supports the use of interprofessional education (IPE) and the use of simulated patient experiences for individual disciplines, there is limited literature on the use of (IPE) in a simulated patient experience to enhance self-efficacy. The purpose of this study was to determine if participation in a hospital simulation experience could change the students' self-efficacy to engage in interprofessional communication and collaboration. This single-group pre-test, post-test design study utilized student participants from the following health science programs: Occupational Therapy (38), Physical Therapy (37), and Nursing (18). The student participants assumed their designated roles as health-care practitioners collaboratively in a simulated hospital IPE session (SHIPES) while they managed patients admitted to the hospital played by live actors. The student participants completed the Self-Efficacy for Interprofessional Experiential Learning (SEIEL) questionnaire that consists of a total score and two subscales scores (Interprofessional interaction and Interprofessional team evaluation and feedback) before and after this IPE experience. Results: significant (p<0.001) increase in the total and two subscales scores of the SEIEL indicating an increased student self-efficacy to engage in interprofessional learning after participation in the SHIPES. Increased self-efficacy is a positive indicator of future behavior and could facilitate more interprofessional collaboration in clinical settings.

Simulated Patient Experiences to Improve Pharmacy Student Empathy for Patients with Chronic Diseases

Simulated Patient Experiences to Improve Pharmacy Student Empathy for Patients with Chronic Diseases

Assessment of Dispensing Malpractice in Community Drug Retail Outlets in South Gondar Zone, Northwest Ethiopia: A Simulated Patient Experience.

Pharmacy professionals in community drug retail outlets, as the most accessible personnel for the community, are engaged in consultation and responding to health problems in addition to filling prescriptions. In doing so, different dispensing malpractices are observed and much is not known on the issue in Ethiopia. The study aimed at assessing dispensing malpractice at pharmacies, drug stores and drug vendors in South Gondar zone. A cross-sectional study design with a descriptive approach was applied from April 1 to June 30. The data was collected using the simulated patient method. Seven prescription-only medicines and a diarrheal case were requested during visit. All drug retail outlets in South Gondar zone that were in service during data collection were visited. Almost all prescription-only medications were dispensed without prescription at all community drug retail outlets. Of all the dispensaries, 19 (82.6%) provided a partial dosage regimen of amoxicillin. Presence of fever and pregnancy status were asked about by dispensers in only 8% and 20% of visits for diarrhea, respectively. Medication history was also rarely requested. Medication was dispensed in 80% of visits for diarrhea, all of which included antimicrobials. Oral rehydration salt was considered in only two (10%) dispensaries. Dispensing medications without a prescription is common in community drug retail outlets in South Gondar zone in Amhara Regional State. Our findings also showed that detailed assessments of patients' signs and symptoms are not performed properly by the dispensers to understand the diarrheal case. Training of pharmacy professionals and strict regulatory control are needed.

Interviewing Teen Parents: Simulated Patient Experience for Clinical Education and Outreach.

Many medical students' initial experience obtaining a history from a pediatric patient happens in their clerkship years. There is a shift in medical education to provide early clinical experiences to train physicians. To increase the exposure to pediatric history in the pre-clinical years, we developed this simulation-based session involving students in their second year of medical school. They are tasked with eliciting a history from a babyprovided by a teenager who functions both as a standardized patient (SP)and the parent of the infant. Our goal was to have second-year medical students learn and practice interviewing an adolescent while obtaining history about an infant to assist in the transition to Year three Pediatric clerkship. Collaborating with the Office of Diversity at our medical school, we recruited students registered in medical academies in public middle and high schools in our county and asked them to be part of this simulation-based activity. A majority of these medical academy students are underrepresented in medicine (URiM). The students functioned as SPs for pre-clerkship medical studentswhile gaining exposure to a career in medicine and the medical school environment. The medical students obtained a history, with faculty providing formative feedback, followed by documentation of the encounter. Medical students felt they gained skills to communicate with caregivers of pediatric patients. They also practiced the skill of eliciting a pediatric history from an infant whose parent is a teenager. The middle and high school students that functioned as SPs gained a better appreciation for the medical education systemand felt that the experience was valuable for all parties involved. This session exposed pre-clerkship medical students to the nuances of eliciting a pediatric history from pediatric caregiverswhile also engaging URiM from middle and high school in the medical education process. This session could be used at other institutions to expand diversity in the medical fieldwhile also providing pre-clerkship medical students with pediatric experiences. This article was previously presented as an oral presentation at the AAMC Group on Education Affairs (GEA) Virtual Regional Spring Meeting on April 21, 2021.

Dermatology residency preparation curriculum: a model for initiating new residents into dermatology clinical care.

Entering dermatology residency is an immersive experience requiring new specialty-specific skills. There is no standard Accreditation Council for Graduate Medical Education (ACGME) protocol for orienting new dermatology residents. We aimed to design, develop, and evaluate a curriculum for incoming first-year dermatology residents focusing on practical introduction to dermatologic clinical care emphasizing ACGME dermatology milestones. A concentrated 8-hour residency preparation course for first-year dermatology residents was designed and developed by faculty. The course encompassed clinical competencies, procedural techniques, and professionalism and collegiality principles. Teaching methods included lectures, video demonstrations, simulated patient experiences, and one-on-one practical instruction. Surveys were distributed before, immediately after, and 6-months following the course from 2016-2018 to assess participants' skill-based confidence level and perceived usefulness of the course. A total of 24 first-year dermatology residents participated in the residency preparation course over 3 years from 2016-2018. Residents' confidence levels in performing dermatology-specific skills immediately increased following the course and continued to increase 6 months into training. The majority of first-year residents "agreed" or "strongly agreed" that the course was helpful for improving clinical competence. Our residency preparation course increased first-year residents' confidence and perceived competence in performing clinical skills related to ACGME dermatology milestones.

Nursing Students' Satisfaction and Self-Confidence Levels After Their Simulation Experience.

Nursing students should be well prepared before going to clinical setting as they provide direct care to patient. Simulation gives the learners the opportunity to be active learners who practice, train, and give a reflection on a specific experience. To obtain an understanding of the human patient simulation experience and nursing students' perceptions of satisfaction and self-confidence. Cross-sectional, descriptive design was undertaken. Using purposive sampling, 273 nursing students were enrolled in basic adult nursing courses at levels four and five at female nursing college at King Saud University, Riyadh, Saudi Arabia. A questionnaire was used to measure the demographic characteristics, simulation design characteristics, and simulation educational practice context. Student Satisfaction and Self-confidence in Learning Scale was used to measure students' satisfaction and self-confidence. Bivariate analyses were utilized where needed and multiple linear regression analysis was performed to find the relationship between variables. The current study revealed overall, nursing students were satisfied and self-confident after their human patient simulation experience. A relationship was observed between demographic characteristics, simulation design characteristics, and simulation educational practice context with students' satisfaction and self-confidence. Simulation is an effective teaching strategy that prepares nursing students for real clinical practice. Findings provided policymakers with information on nursing students' current levels of satisfaction and self-confidence that can lead to developing future policies.

Systematic Curriculum Mapping of Virtual Patient Assignments to End-of-Program Outcomes.

During the COVID-19 pandemic, virtual clinical learning assignments replaced onsite clinical instruction in many prelicensure nursing programs, but the alignment of those learning experiences to end-of-program outcomes was unknown. This article describes the process and results of mapping student competencies gained via virtual patient simulation experiences to a program's end-of-program outcomes and accrediting standards. A faculty team followed the process of curriculum mapping as described in the literature to evaluate the effectiveness of the program's virtual clinical learning product in addressing end-of-program outcomes. The mapping process identified where competencies were being met, which needed enhancing or were redundant, and where gaps existed. Curriculum mapping is an effective strategy in evaluating whether virtual patient simulation learning experiences support end-of-program outcomes. Mapping learning activities to outcomes will be fundamental to curriculum development and evaluation as schools of nursing integrate accrediting standards.

A simulated patient experience in the self-care aisle utilizing Flipgrid as a platform for sharing nonprescription product information

Background and purposeStudents visiting local pharmacies can enhance their learning about nonprescription products while improving their understanding of the patient self-care experience. This study was designed to examine student perceptions of an activity utilizing Flipgrid to share a simulated patient experience in the nonprescription aisle. Educational activity and settingStudent groups traveled to local pharmacies to review available products pertaining to a self-care scenario. Students submitted brief video recordings with product recommendations and counseling points via the Flipgrid platform. Following the activity, students submitted brief reflections. At course conclusion, students completed a questionnaire regarding perceptions of Flipgrid. FindingsSixty-eight students completed the activity. Response rates were 91.2% for the project reflection and 79.4% for the Flipgrid questionnaire. In the reflections (n = 62), the majority of students (87.1%) found it easy or extremely easy to locate pertinent nonprescription products; no student found it extremely difficult. All except four students indicated the assignment helped develop empathy, and all except two indicated a greater likelihood to help a patient in the aisle. In the Flipgrid questionnaire (n = 54), most students found the platform enjoyable (74.1%) and easy to use (79.6%). SummaryStudents perceived that the project increased empathy for assisting patients with selection of nonprescription products. Students found the Flipgrid platform enjoyable and easy to use. This activity can be utilized to simulate a patient self-care experience, and the Flipgrid platform is a novel way to share information between student groups in pharmacy education.

Utilization of an Online Education Module and Standardized Patient Simulation Experience to Improve Nursing Student Learning Outcomes With Heart Failure Patients.

The aim of this experimental study was to examine whether nursing students' participation in an online comprehensive heart failure educational module enhances their knowledge and ability to apply heart failure education skills in a simulated standardized nurse-patient interaction. Findings suggest that students who received a heart failure educational module scored significantly higher on both an exam of heart failure knowledge and a simulated nurse-patient interaction. The results suggest that large gains can be made in nursing education by using innovative teaching strategies that move beyond normal classroom/lecture teaching techniques.

Impact of a modified early warning score on nurses' recognition and response to clinical deterioration.

(a) Improve nurse knowledge of and confidence in responding to clinical deterioration through implementation of the Modified Early Warning Score tool and (b) improve nurse ability to react to patient deterioration in a timely manner. Recognition of clinical deterioration in hospitalized inpatients often occurs far after those signs initially present. The Modified Early Warning Score has been shown to assist with recognition earlier in the deterioration process. Eighty-five nurses participated in a simulation-based intervention to implement the Modified Early Warning Score into their rural hospital. Group classroom sessions and individual high-fidelity simulation experiences were provided for participants. Twenty-nine nurses also participated in self-confidence and knowledge assessment testing. The simulation-based intervention significantly improved nurse knowledge (t=4.029, p<.01) and self-confidence (t=3.698, p=<.01). Chart reviews found a 34.1% increase in nurse action taken in response to signs of clinical deterioration. Current study found that the Modified Early Warning Score tool as taught through a simulated patient experience is useful to prevent unrecognized deterioration. Suggests that a simulation-based intervention is effective for teaching and evaluating post-licensure nurses on acute clinical deterioration in inpatients.

The Effect of Case Presentation on Student Physical Therapists' Clinical Reasoning Hypotheses

Purpose: Clinical reasoning is an essential skill for Physical Therapists to develop for making sound decisions regarding patient care. Case-method teaching is an instructional strategy commonly implemented in physical therapy professional education programs for facilitating clinical reasoning skill acquisition. One advantage of case-method teaching is the various ways cases can be portrayed. The purpose of this study was to identify how a case is portrayed effects student thinking and their subsequent clinical decision making. Method: Third-year student physical therapists (n = 14) working in dyads clinically reasoned through a hypothetical musculoskeletal case presented via written case study or simulated patient experience. Talk aloud methodology via concurrent reports was implemented for data collection. Mann-Whitney U-tests followed by manual calculations of effect sizes were conducted for comparing hypothesis category generation between groups. Results: A total of 14 hypothesis categories were generated by the student dyads during the problem-solving sessions. Specifically, students generated more ideas regarding health condition, and contextual factors when thinking through a written case study whereas significantly more thoughts regarding symptom characteristics, client perspectives, and minimizing reasoning errors were generated during simulated patient experiences. Conclusion: When implementing case-method teaching, physical therapy academic educators need to be aware that the manner a case is portrayed affects the clinical judgements students generate and their learning of clinical reasoning. Future research should continue to investigate these effects and how they ultimately impact clinical practice.

A Qualitative Examination Detailing Medical Student Experiences of a Novel Competency-Based Neuroanatomy eLearning Intervention Designed to Bridge a Gap Within an Integrated Medical Curriculum.

Background:A 1-year time-gap between first- and second-year neuroanatomy courses was created at our institution as a result of restructuring the curriculum from systems-based to an integrated format. Additionally, neuroanatomy hours decreased significantly (48.8%) when transitioning to an integrated curriculum, similar to other medical schools. Competency-based eLearning in medical education has shown promising results with decreasing overall learning time and improving accuracy. To date, competency-based eLearning has not yet been explored in neuroanatomy education.Objective:The purpose of this study is to develop and assess a novel competency-based neuroanatomy eLearning intervention for second-year medical students designed to bridge a 1-year time-gap, without adding significant instructional hours, in an integrated curriculum.Methods:A competency-based eLearning intervention encompassing the major tracts, brainstem anatomy, and an interactive case featuring a simulated patient experience was developed in the Articulate Storyline® platform. Student usage data, single-session course evaluations, and a focus group were used to evaluate the module’s effectiveness.Results:Student usage data showed an average completion time of M = 2:59:25 hours which fit within the scheduled 3-hour timeframe. Students rated the module’s overall effectiveness as M = 3.65 (out of 4) on a single-session evaluation. A focus group provided qualitative feedback suggesting improvements to the eLearning module in the domains of content, mechanics, and timing.Conclusion:A competency-based neuroanatomy eLearning intervention shows promising initial results to bridge a 1-year educational gap within an integrated curriculum. Overall, students described this educational tool as helpful and outlined ways in which to improve this resource.

Five-Year Cost-Effectiveness Modeling of Primary Care-Based, Nonmydriatic Automated Retinal Image Analysis Screening Among Low-Income Patients With Diabetes.

Artificial intelligence-based technology systems offer an alternative solution for diabetic retinopathy (DR) screening compared with standard, in-office dilated eye examinations. We performed a cost-effectiveness analysis of Automated Retinal Image Analysis System (ARIAS)-based DR screening in a primary care medicine clinic that serves a low-income patient population. A model-based, cost-effectiveness analysis of two DR screening systems was created utilizing data from a recent study comparing adherence rates to follow-up eye care among adults ages 18 or older with a clinical diagnosis of diabetes. In the study, the patients were prescreened with an ARIAS-based, nonmydriatic (undilated), point-of-care tool in the primary care setting and were compared with patients with diabetes who were referred for dilated retinal screening without prescreening, as is the current standard of care. Using a Markov model with microsimulation resulting in a total of 600 000 simulated patient experiences, we calculated the incremental cost-utility ratio (ICUR) of the two screening approaches, with regard to five-year cost-effectiveness of DR screening and treatment of vision-threatening DR. At five years, ARIAS-based screening showed similar utility as the standard of care screening systems. However, ARIAS reduced costs by 23.3%, with an ICUR of $258 721.81 comparing the current practice to ARIAS. Primary care-based ARIAS DR screening is cost-effective when compared with standard of care screening methods.

Getting comfortable with disability: The short- and long-term effects of a clinical encounter

BackgroundPhysicians report discomfort when interacting with patients with disabilities, which can negatively impact the quality of healthcare they provide. Objective/HypothesisAn intervention structured around a formative clinical encounter was assessed for its effectiveness in changing comfort towards treating patients with disabilities. It was predicted that this encounter would have a positive short- and long-term impact on medical students. MethodDuring the 2017–2018 academic year, 169 third-year medical students conducted a patient encounter with a person who had a disability. Students met individually with the “patient” and completed a brief social and medical history as if they were meeting a new patient to establish care. A measure of perceived comfort caring for patients with disabilities was administered to students before and after the encounter. One year after the patient encounter, 59 students were surveyed about their satisfaction and the impact of the patient encounter. ResultsThe impact of encountering people with disabilities in a clinical setting was positive, with statistically significant improvements across all items on the measure of perceived comfort. Students were highly satisfied with the experience and anticipated feeling more confident, more comfortable, less awkward, and more skilled and efficacious when encountering a person with a disability in their future practice. A thematic analysis of the one year follow-up data suggest that students valued the encounter and desired more content on disability throughout their education. ConclusionsMedical education should include dedicated exposure to persons with disabilities and a simulated patient experience allowing for a safe environment to gain skills and confidence.

Creation and Implementation of a Large-Scale Geriatric Interprofessional Education Experience.

The care of the older adult requires an interprofessional approach to solve complex medical and social problems, but this approach is difficult to teach in our educational silos. We developed an interprofessional educational session in response to national requests for innovative practice models that use collaborative interprofessional teams. We chose geriatric fall prevention as our area of focus as our development of the educational session coincided with the development of an interprofessional Fall Risk Reduction Clinic. Our aim of this study was to evaluate the number and type of students who attended a pilot and 10 subsequent educational sessions. We also documented the changes that occurred due to a Plan-Do-Study-Act (PDSA) rapid-cycle improvement model to modify our educational session. The educational session evolved into an online presession self-study didactic and in-person educational session with a poster/skill section, an interprofessional team simulation, and simulated patient experience. The simulated patient experience included an interprofessional fall evaluation, team meeting, and presentation to an expert panel. The pilot session had 83 students from the three sponsoring institutions (hospital system, university, and medical university). Students were from undergraduate nursing, nurse practitioner graduate program, pharmacy, medicine, social work, physical therapy, nutrition, and pastoral care. Since the pilot, 719 students have participated in various manifestations of the online didactic plus in-person training sessions. Ten separate educational sessions have been given at three different institutions. Survey data with demographic information were available on 524 participants. Students came from ten different schools and represented thirteen different health care disciplines. A large-scale interprofessional educational session is possible with rapid-cycle improvement, inclusion of educators from a variety of learning institutions, and flexibility with curriculum to accommodate learners in various stages of training.

A simulated patient experience to improve pharmacy student empathy for patients on hemodialysis

IntroductionThe aim of this study was to increase student empathy towards hemodialysis patients through an educational intervention that simulates a hemodialysis patient experience. MethodsSecond-year pharmacy students (n = 83) in a required therapeutic module were asked to follow key lifestyle modifications of a hemodialysis patient for two weeks. Students' self-perceived empathy level was assessed using the Kiersma-Chen Empathy Scale (KCES) pre- and post-intervention and post-reflection questions captured students' perceptions of the experience. Data were analyzed using frequencies and Wilcoxon signed ranks tests to assess pre-post changes. Reflection questions were assessed using a grounded analysis to identify themes. ResultsSignificant differences were found on 13 of 15 KCES items and KCES composite scores. Of the 13 significant KCES items, nine were related to the cognitive domain and four were related to the affective domain. When asked how the experience impacted the student personally, 38 responded that it provided them with a better understanding of the challenges associated with managing hemodialysis treatments. In response to how this experience would change their professional interactions with a hemodialysis patient, students explained that they felt more equipped to empathize with patients (n = 22). ConclusionsThis intervention improved students' cognitive and affective empathy towards hemodialysis patients, which may prepare them to be more compassionate healthcare professionals. Experiencing first-hand some of the quality-of-life challenges hemodialysis patients face significantly influenced student empathy levels towards this population.

Impact of simulated patients on students' self-assessment of competency in practice of geriatric dentistry.

The evaluation of the effectiveness of simulation training in dentistry has previously been focused primarily on psychomotor hand skills. This study explored the impact of simulated patient (SP) encounters in simulation on students' self-assessment of competency in their clinical and communication abilities with geriatric patients. Students from 2 cohorts were recruited for this study. Cohort 1 (n=30) participated in the standard curriculum with no simulation training and served as the control group. Cohort 2 (n=34) participated in a SP experience, simulating the initial stages of a care visit for 2 nursing home patients. Students' perceptions of competency to perform these clinical and communication tasks were assessed. A group debriefing session was held 5 weeks post-simulation where Cohort 2 completed a student feedback form. A statistically significant change (P<0.00001) was noted for both cohorts in their self-reported competence to perform clinical tasks following exposure to an independent clinical experience. In addition to this gain, individuals in Cohort 2 demonstrated improvements following simulation and expressed different responses of impact to questions related to treatment, pharmacology, and managing a complex medical history. This study suggests that simulation of patient interactions using SPs can strengthen students' self-assessment of competency in their abilities, leading to more genuine interactions with actual patients. These findings will help inform the design of future SP encounters as a component of an evolving humanistic curriculum.