Simulated Patients Research Articles

The effect of practice with the simulated patient on the professionalism attitudes of medical students: An intervention study

Introduction: Medical school education is effective in the professionalization development of students. In this study, it was aimed to evaluate the effectiveness of course training and to investigate the effect of interactions with simulated patients on the professional attitudes of medical students. Methods: The research is an intervention study designed in the pretest-posttest pattern. The sociodemographic questionnaire and Penn State College of Medicine (PSCOM) professionalism attitude scale were used as data collection tools. The scale was applied to the students three times: before the course (1), after the course (2) and after the simulated patient practice (3). Results: The mean age of the students was 21.40±2.07 years and 54.8% (n=148) were female. The PSCOM scale scores of the students were 154.11±10.91, 158.59±10.48, and 164.64±10.81 respectively for score 1, score 2 and score 3, and, there was a statistically significant increase in score (P<0.001). The scale dimension’s scores all increased after the course and simulated patient (SP) practice. The difference between scores 1, 2, and 3 is statistically significant. The score increased significantly for all dimensions after training and SP’ practices, and the difference between scores 1, 2, and 3 was found to be statistically significant (P<0.001 for all). The female students had significantly higher total scores of 1, 2, and 3 than the male students (P<0.001 for scores 1 and 2, P=0.005 for score 3). Conclusion: Training and simulated patient practices increase medical students’ professionalism scores. The highest score was determined after simulated patient applications.

Quantitative analysis of communication changes in online medication counseling using the Roter Interaction System

BackgroundQuantitative analysis and objective evaluation of communication play an important role in medical communication education. In the process of developing an online methodology for medication counseling practice, we felt the necessity of conducting a quantitative evaluation to enhance its effectiveness. ObjectivesThis study aimed to quantitatively evaluate the communication in each scenario to comprehensively identify the differences between face-to-face and online communication in medication counseling practicum. In addition, we examined how patient satisfaction changes between face-to-face and online interactions. MethodsFace-to-face and online role-playing were conducted between simulated patients (SPs) and students acting as pharmacists, and their dialogues were videotaped. The utterances in each recorded dialogue were categorized and analyzed by the Roter interaction analysis system (RIAS). The Japanese version of the Medical Interview Satisfaction Scale (MISS-21J) responses of the SPs were analyzed for the patient satisfaction survey. ResultThe results of the RIAS analysis revealed that the socio-emotional category appeared significantly more frequently in face-to-face communication, with more utterances that were more attuned to the feelings of the other person and more considerate of his or her feelings. The ratio of the number of utterances between students and SPs suggested that the communication was more interactive. ConclusionBased on the respective communication tendencies may have led to higher satisfaction in face-to-face than in online patient satisfaction surveys, less anxiety about illness and medications, and easier trusting relationships. Since it is difficult to grasp the mood of the other party and to open up to them due to the lack of nonverbal information in online dialogue, it is necessary to be more conscious of conversations that capture the feelings of patients in online medication counseling.

Simulation for Teaching on Racial Microaggressions and Bystander Intervention — A Theory-Based Guide for Health Profession Education

Microaggressions are words or behaviour that “subtly and unconsciously express a prejudiced attitude”, and racial microaggressions express these attitudes towards people from racial minority groups. The “Bystander Effect” is when the presence of other people means that an individual is less likely to offer assistance or get involved in a situation — bystander intervention training aims to inform about the best ways to avoid this, equipping students with the necessary strategies. In health profession education, teaching on microaggressions and bystander intervention can be done with the use of simulation. Simulated patients (SPs) and environments would be the most appropriate modality of simulation to use, as roleplay would be central. This guide focuses on how to use simulation for teaching on racial microaggressions and bystander training for healthcare students including tips on preparing the students and SPs, planning for the implementation of the simulation training, setting ground rules, showing different scenarios, checking student understanding throughout, using debriefs and course evaluation feedback, and signposting students to available support afterwards. These are topics which are particularly relevant because there have been calls in recent years for healthcare education to be more inclusive and representative of current issues, as the COVID-19 pandemic and resurgence of the Black Lives Matter movement have highlighted curriculum gaps. So teaching students about this early is a good start, and simulation is an effective teaching method to help with this.

Evaluating the Benefits of Using Mobile Application (diarrhea management step by step) in the Management of Diarrhea by Community Pharmacists

Diarrhea is one of the most commonly encountered minor ailments in the community pharmacies. It is associated with significant morbidity and mortality. However, the majority of pharmacists in Iraq did not manage diarrheal cases in a proper way. Therefore, the current study aimed to evaluate the benefit of a new mobile application (diarrhea management step by step) to improve the pharmacist's role in the management of diarrhea. The study was conducted from 21th September to 21th October 2021 using a pre-post design via a simulated patient (SP) technique. A validated diarrhea scenario was presented to each pharmacist by the SP twice, once before and the other after giving the mobile application to the pharmacist. Furthermore, pharmacists were asked to rate the application in regard to its ease of use, reducing the time needed for management of diarrhea cases, reducing diagnostic errors, reducing medication errors, and applicability in daily clinical practice. The study sample involved 50 community pharmacists. However, only 47 completed the study. After using the application, all questions necessary to assess diarrhea were significantly improved. Moreover, the average number of questions asked to the SP was significantly increased. On the other hand, providing the SP with an appropriate non-pharmacological and pharmacological treatment was also significantly improved. Additionally, counseling the SP with the necessary information about dispensed medication was improved; however, significant improvement was detected only in regard to information about the drug dose and dosing frequency. Most participated pharmacists strongly agreed with the application ease of use, its ability to reduce diagnosis and medication errors, and its applicability for use in daily clinical practice. In conclusion the tested application is an effective method to improve the pharmacist's role in the assessment and management of diarrhea.

The Impact of Words: Multisource Feedback Provides Students With a Deeper Understanding and Reflection on Goals of Care Discussions.

Background: Physician communication during goals of care (GOC) discussions impact experiences for patients and families at end-of-life (EOL). Simulation allows training in a safe environment where feedback from simulated patients (SP), clinicians, and self-reflection can be incorporated. Objectives: To determine if multisource feedback from SP scenarios enriches feedback provided to trainees. Design: Fourth-medical students participated in two SP GOC discussions during an advanced care planning (ACP) curriculum. Students received feedback from SPs and faculty and completed a video review with self-reflection. Setting and Subjects: Forty-seven fourth-year medical students at the University of Cincinnati College of Medicine participated in the curriculum from 2019-2021. Measurements: An inductive thematic analysis of the narrative data was performed examining all sources of feedback from the SP sessions. Results: Six themes emerged from the feedback: the warning shot: words to say and why it helps; acknowledging emotion: verbal vs non-verbal responses; organization: necessity of a clear path; body language: adding to and distracting from the conversation; terminology to avoid: what jargon encompasses and how it impacts patients; and silence: perceived importance by everyone. SP feedback focused on the personal emotional impact of a student's word choice and body language. Faculty feedback focused on specific learning points through examples from the conversation and expanded to hypothetical scenarios. Student self-reflection after video review allowed students to see challenges that they did not notice while immersed in the encounter. Conclusion: Multisource feedback from simulated GOC discussions provides unique insights for students to guide their development in leading difficult conversations.

The relationship between facilitating emotional cues and medical students’ clinical communication performance in qualifying exams

A cross-sectional study design explored the relationship between medical students’ Objective Structured Clinical Examination (OSCE) clinical communication ratings and their responsiveness to simulated patient (SP) verbal emotional cues in their qualifying OSCE. Data were collected from two cohorts of fourth-year medical students (n = 37), and responses to patient cues that facilitated further disclosure or related discussion – known as provide space responses – from two OSCE communication stations were measured by coding video footage with the Verona Coding Definition of Emotional Sequences (VR-CoDES). The 37 medical students were representative of the larger cohort (n = 508) in terms of age. A significant positive correlation with a medium effect was found between OSCE clinical communication ratings and provide space responses. OSCE clinical communication ratings could differentiate between students who adopted patient-centred facilitative behaviours and those who did not.

The Real Practice Prescribing Antibiotics in Outpatients: A Failed Control Case Assessed through the Simulated Patient Method.

The first level of medical care provides the largest number of consultations for the most frequent diseases at the community level, including acute pharyngitis (AP), acute diarrhoea (AD) and uncomplicated acute urinary tract infections (UAUTIs). The inappropriate use of antibiotics in these diseases represents a high risk for the generation of antimicrobial resistance (AMR) in bacteria causing community infections. To evaluate the patterns of medical prescription for these diseases in medical offices adjacent to pharmacies, we used an adult simulated patient (SP) method representing the three diseases, AP, AD and UAUTI. Each person played a role in one of the three diseases, with the signs and symptoms described in the national clinical practice guidelines (CPGs). Diagnostic accuracy and therapeutic management were assessed. Information from 280 consultations in the Mexico City area was obtained. For the 101 AP consultations, in 90 cases (89.1%), one or more antibiotics or antivirals were prescribed; for the 127 AD, in 104 cases (81.8%), one or more antiparasitic drugs or intestinal antiseptics were prescribed; for the scenarios involving UAUTIs in adult women, in 51 of 52 cases (98.1%) one antibiotic was prescribed. The antibiotic group with the highest prescription pattern for AP, AD and UAUTIs was aminopenicillins and benzylpenicillins [27/90 (30%)], co-trimoxazole [35/104 (27.6%)] and quinolones [38/51 (73.1%)], respectively. Our findings reveal the highly inappropriate use of antibiotics for AP and AD in a sector of the first level of health care, which could be a widespread phenomenon at the regional and national level and highlights the urgent need to update antibiotic prescriptions for UAUTIs according to local resistance patterns. Supervision of adherence to the CPGs is needed, as well as raising awareness about the rational use of antibiotics and the threat posed by AMR at the first level of care.

Évolution de l’empathie d’étudiants en 4e année de médecine après un module obligatoire de formation à la relation thérapeutique

IntroductionSome studies have reported a decline in medical students’ clinical empathy during their first-year internships. Empathic skills in doctor–patient relationships have proven to have substantial benefit on the physiological as well as psychological parameters, and on the patients’ and physicians’ satisfaction. A range of experiential and interactive training modules have the potential to limit this decline and even foster the development of empathy, and yet French medical schools do not routinely implement such non-technical training. Moreover, there is no consensus about the concept of empathy, and previous studies rarely coordinate their definition with the method chosen to implement how it is measured. This study aims to evaluate the effectiveness of a training module that combines human simulations (simulated patient interviews and role-playing) and Balint groups in order to develop medical students’ empathy as a measured cognitive attribute, declarative knowledge, and their correlation. MethodsWe implemented a monocentric prospective study of fourth-year medical students from the Île-de-France area, which included pre/post-test assessment. First-year clinical interns initially completed five role-play sessions of one hour and a half each, with a group of 12 to 14 students led by a trained senior medical doctor. The sessions addressed successively issues of the doctor–patient relationship, breaking bad news scenarios, management of chronic conditions, violence and aggression, inappropriate treatment requests, or communication about medical errors. A pre-briefing session provided oral and written instruction and promoted a non-judgmental approach. Then two students role-played the doctor–patient interaction. Finally, a three-stage debriefing supported reflective learning. Subsequently, the students attended six Balint group sessions of one hour and a half each, within the same groups. One of the students was encouraged to bring up a challenging clinical situation. Then, the trained Balint supervisor invited all the students to share their observations, so as to explore the assumptions, beliefs and emotions raised by this account, and to collectively reframe the multiple perspectives on the case. At the end of the year, each student carried out two ten-minute consultations with a simulated patient, without an observer. The clinical scenarios were an HIV diagnosis disclosure and resisting a request for a prescription for antibiotics for a common cold. After each simulation, the simulated patient (SP) provided direct feedback to the student, with at times additional feedback given by their supervisor. The SP feedback was focused on empathy. The level of the medical students’ empathy was assessed using the self-reported Jefferson Scale of Empathy, which measures their declarative knowledge through multiple-choice questions. ResultsOf the 100 students who completed the empathy questionnaires, we found a statistically significant difference between the pre (108.8±11.9) and post-test (113.7±10.4; P<0.001). On the three JSPE-MS subscales, two students reported a statistically significant improvement (perspective taking; and the ability to put themselves in the patient's shoes). Of the 101 students who completed the knowledge questionnaires, we found a significant difference between the pre (2.3±1.1) and post-test (2.9±1.2; P<0.001). Moreover, a weak correlation was found (r=0.256) between improvements of empathy and knowledge assessments. DiscussionThese results in the French context are consistent with those reported in international literature on the benefits of implementing simulation training and Balint groups to limit the decline of empathy during the medical students’ first clinical internships. These results are further reinforced by the consistency between the definition of empathy and the implementation of a means to measure it as a cognitive dimension. The reliance on self-assessment of empathy might lessen the validity of these results and stresses the need for a wider multidimensional approach. The quality of the evidence is also limited by a monocentric, non-randomized and non-controlled design, which calls for further research. ConclusionThe use of human simulations combined with Balint groups seems to support the development of the cognitive empathy of medical students in the French context. Given the recent developments in remote learning worldwide to comply with social distancing measures, their online translation into role-played tele-consultations would appear to be a very topical opportunity, while also avoiding the inherent limitations of virtual reality to address non-technical skills.

Assessment of an observed clinical skills exam in undergraduate medical education: a patient with opioid use disorder and chronic pain

It is crucial that future physicians understand the nature of opioid use disorder (OUD). We designed a pilot Observed Structured Clinical Examination (OSCE) using simulated patients (SPs) experiencing OUD with concurrent chronic pain. The case was piloted in 2021 and 2022 during the multi-station OSCE that all the medical school clerkship students take at the end of their third year of medical school. A total of 111 medical students completed the OSCE in 2021 and 93 in 2022. The authors developed a case description and an assessment instrument for the SP to evaluate the student’s performance on history taking, communication and professionalism. The evaluation was mixed-methods using SP evaluation data and a qualitative assessment of medical students’ answers to 4 questions which were analyzed with a priori codes. In both years, the total scores for the case were slightly slower than the established OSCE cases in both years. A total of 75% (148/197) of students who responded to the assessment found the case difficult to manage. Strengths of the case included a majority of the students reporting the case helped them to identify strengths and weakness in assessing and treating OUD. Weaknesses included the lack of enough patient history and the perception that the SP was unrealistic (too nice). This pilot OSCE was challenging for the third year medical students based on the evaluative data. Given the scope of OUD and deaths, training students to identify and treat OUD during undergraduate medical education is of paramount importance.

Anti-Black racism in clinical supervision: asynchronous simulated encounters facilitate reflective practice.

Background Racist interactions in clinical practice remain a pervasive reality for Black healthcare providers. We sought to develop a framework to inform supervisors' actions when confronting racism in clinical practice and protecting trainees under their oversight. Methods We conducted a qualitative study in which experienced supervisors responded to seven short, videotaped interactions between: 1) Black trainees and a simulated patient (SP) in a racist role; 2) the trainees and their respective supervisors; and 3) the trainees and their supervisors together with the SP. The clinical exchanges exemplified different types of racist (entrenching) or antiracist (uprooting) behaviors by the supervisors. After viewing each clip, participants wrote their reflections confidentially; they later joined a structured debriefing together. We used thematic analysis to identify supervisors' behavioral patterns when confronting racist interactions. Results Based on the input of 52 participants recruited into five two-hour-long sessions, we categorized the behaviors of supervisors facing anti-Black racial injuries involving learners under their oversight. We organized supervisor behaviors into five interlocking domains, each with a range of possible themes: 1) Joining: from conciliatory to confrontational in communicating with the aggressor; 2) Explicitness: from avoiding to naming racism; 3) Ownership: from individual to shared responsibility of the event and the response to it; 4) Involving: from excusing to including the aggrieved party when confronting the aggressor; and 5) Stance: from protective to paternalistic in supporting the learner's autonomy. Conclusions Our qualitative findings can provide a framework for facilitated discussion toward reflective practice among healthcare providers who may have experienced, witnessed, or intervened in anti-Black racist interactions. They can also help medical educators to inform faculty development to fight anti-Black racism in clinical practice. The video materials we developed are available for viewing and download and can be used or adapted as springboards for reflective discussion or faculty development activities.

Conflict resolution styles and skills and variation among medical students

BackgroundConflict is inevitable on healthcare teams, yet few professional school curricula teach or assess conflict resolution skills. Little is known about the variation in conflict resolution styles across medical students and how these styles might impact conflict resolution skills.MethodsThis is a prospective, single blinded, group randomized quasi experimental trial to assess the impact of knowing one’s own conflict resolution style on conflict resolution skills in a simulated encounter. Graduating medical students completed a mandatory conflict resolution session with standardized patients acting as nurses during a transition to residency course. Coaches reviewed videotapes of the simulation, focusing on students’ skills with negotiation and emotional intelligence. Retrospectively, we assessed the impact of the students knowing their conflict resolution style prior to simulation, student gender, race, and intended field of practice on conflict resolution skills as judged by coaches.ResultsOne hundred and eight students completed the simulated conflict session. Sixty-seven students completed the TKI before the simulated patient (SP) encounter and 41 after. The most common conflict resolution style was accommodating (n = 40). Knowing one’s conflict resolution style in advance of the simulation and one’s identified race/ethnicity did not impact skill as assessed by faculty coaches. Students pursuing diagnosis-based specialties had higher negotiation (p = 0.04) and emotional quotient (p = 0.006) scores than those pursuing procedural specialties. Females had higher emotional quotient scores (p = 0.02).ConclusionsConflict resolution styles vary among medical students. Male gender and future practice in a procedural specialty impacted conflict resolution skills but knowing conflict resolution style did not.

Perceptions of two versions of a large-group simulated patient encounter: a comparative analysis

This paper presents comparisons of learner perceptions between an in-person and distance interprofessional educational activity. A retrospective comparative analysis of data collected during post-activity evaluations following two versions (in-person; distance simulation-based) of a large-group simulated patient (SP) interprofessional education (IPE) simulation depicting a complex patient was used. The distance simulation-based encounter run in 2020 (the reformed event) was found to have more favourable opinions compared to the 2019 in-person one. The 2019 participants’ responses were more indicative of neutral and negative feelings of the activity compared to the participants from the 2020 distance simulation-based encounter. This study demonstrates that large-group SP encounters can serve as appropriate platforms for IPE activities when in-person or at a distance. The findings of this study help to demonstrate how distance-simulation encounters used for IPE can be used to provide meaningful learning.

Three perspectives on learning in a simulated patient scenario: a qualitative interview study with student, simulated patient, and teacher

IntroductionPatient simulation can be useful for medical students in developing communication skills for vulnerable situations. Three participants are primarily involved in the patient simulation activities: the student, the simulated patient (SP), and the teacher. We here aimed to explore these participants’ perceptions of learning in a patient simulation scenario.MethodsWe conducted individual interviews with eight students, three teachers, and one SP at a psychiatry placement of a Medical Doctor Program (5th year). During the interviews we asked the participants to watch a video of their participation in a patient simulation session. Thus, we obtained three perspectives on each of the eight recordings. We analysed our data with qualitative content analysis.ResultsThree themes were generated: identity formation, collaborative learning, and learning intentions. This highly emotional scenario forced students out of their comfort zone, to the intersection of their roles as private person and professional. The SP perceived the collaborative creation of the scenario as significant learning. The teacher took a professional position and perceived the learning in the perspective of a future colleague.ConclusionsThe mutually created emotionally loaded scenario was found to be important from all three perspectives, forcing the students to identify unexpected ways of communicating.This possibly enhanced their professional identity development. Implications for future research can be to explore the process of skills transfer.

Using standardized patients for undergraduate clinical skills training in an introductory course to psychiatry

BackgroundThe goal of this study was to assess the value and acceptance of Standardized or Simulated Patients (SPs) for training clinically inexperienced undergraduate medical students in psychiatric history taking, psychopathological assessment, and communication with psychiatric patients.MethodsAs part of a newly developed introductory course to psychiatry, pairs of 3rd year medical students conducted psychiatric assessments of SPs, including history and psychopathological state, under the supervision of a clinical lecturer. Prior to the assessment, students attended introductory lectures to communication in psychiatry and psychopathology but were clinically inexperienced. After the interview, the students’ summary of their findings was discussed with other students and the lecturer. Students, lecturers, and actors were invited to a survey after the course. Questions for the students included self-reports about perceived learning success and authenticity of the interviews.Results41 students, 6 actors and 8 lecturers completed the survey (response rates of 48%, 50%, and 100%, respectively). The survey results indicated that, despite their lack of clinical experience, students learned how to conduct a psychiatric interview, communicate in a non-judgmental and empathetic manner, take a psychiatric history and perform a psychopathological examination. SPs were perceived as authentic. The survey results suggested that this setting allowed for an enjoyable, non-distressful and motivating learning experience within a restricted time frame of just two afternoons.ConclusionThe results indicated that the SP approach presented is useful for teaching clinical skills in psychiatry to students with limited previous clinical experience and knowledge of psychiatry. We argue that SPs can be used to teach practical psychiatric skills already during an early phase of the curriculum. Limitations of our study include a limited sample size, a temporal gap between the course and the survey, reliance on self-reports, and lack of comparison to alternative interventions.

Compassion training: Towards a better understanding of patients through self-exposure.

In healthcare, clinicians are expected to communicate in a compassionate way with patients.1 Although medical training for students at the University of Bern offers communication training, for example, breaking bad news or motivational interviewing, compassion or compassionate behaviour is not yet specifically addressed. An interdisciplinary team (medical education, psychology, communication and palliative care) designed and piloted an elective blended course with 1 day of classroom training to improve sixth-year medical students' compassion in patient–physician communication. The learning goals of the pilot included (a) understanding the role of compassion in the patient-physician relationship; (b) characterise the components of compassion; (c) reflecting one's own emotions and developing self-compassion techniques; (d) demonstrate understanding a patient's situation; and (e) developing a compassionate care plan together with the patient. In order to learn about the existing concepts and the importance of compassion, students (n = 8) received preparatory e-learning material in advance. Its contents were discussed and reflected upon during the classroom training. Preparatory reading included directions regarding self-compassion techniques and two case descriptions to initiate reflection about one's own emotions. These materials were contemplated during the training with an expert input about self-compassion and group discussions about integrating these techniques into daily clinical practice. Using simulation, students then explored their feelings and emotions from a patient perspective through self-exposure to various life conditions, such as physical restrictions (wearing bariatric suits or age simulator) or having stigmatising skin diseases (using a moulage of psoriasis or acne). The goal was to foster a deeper understanding of the patient's situation through own experiences. Based on these experiences (‘how did I feel myself, and what might be the related feeling of my patient?’), students created a communication guide for a conversation with simulated patients (SP). In a second step, students used this guide in SP interactions trying to shift from medical reasoning and counselling to assessing and addressing emotions and individual suffering. The final step in this interaction then was to create a compassionate care plan yielding to integrate medical treatment and emotional comfort. The evaluation of the course included (a) students' verbal feedback immediately after the training, (b) students' written evaluation in respect of content and learning goals as well as methodological and didactic aspects and (c) students' self-assessment of skills in compassionate communication using the Sinclair Compassion Questionnaire (SCQ) prior and after the training (www.compassionmeasure.com). Our interactive compassion training seems to address students' needs and expectations in terms of a high quality and compassionate patient-physician interaction. Students very much appreciated the exchange and the reflections within the group about compassion, communication and their own experiences during simulation. Before the training, the majority rated themselves according to the SCQ in most items as ‘somewhat competent’ or ‘neutral’. After the training, students' ratings were more differentiated, ranging from ‘somewhat lacking competence’ to ‘very competent’. All participants strongly recommended offering this ‘compassion training’ to all medical students as a mandatory class; one student even regarded this training as being one of the most important aspects of medical school. Andrea Lörwald, Seraina Petra Lerch, Daniel Bauer, Steffen Eychmüller and Sibylle Jeanine Felber made substantial contributions to conception and design of the course. Daniel Bauer, Steffen Eychmüller, Sibylle Jeanine Felber, Seraina Petra Lerch, Florence Liaudet and Andrea Lörwald conducted the training and acquired the data for evaluation. Florence Liaudet, Sibylle Jeanine Felber, Steffen Eychmüller, Seraina Petra Lerch and Andrea Lörwald analysed and interpreted the data. Sibylle Jeanine Felber and Andrea Lörwald drafted the manuscript. Daniel Bauer, Steffen Eychmüller and Seraina Petra Lerch revised it critically for important intellectual content. All authors approved the version to be published and agree to be accountable for all aspects of this study.

Extent of cardiovascular medications dispensing practice without a prescription: Self-reported and simulated patient-based study at community pharmacies in Northwest Ethiopia

BackgroundCritical actions are required for the proper administration of medications to patients with cardiovascular diseases. However, there has been an increase in irrational use of cardiovascular drugs. The purpose of this study was to determine the extent of non-prescription cardiovascular medicine dispensing practices at community drug retail outlets (CDROs) in Gondar, Northwest Ethiopia.MethodsA cross-sectional survey and simulated patient-based visits were employed at the CDROs in Gondar City, Northwest Ethiopia between June 1 and July 20, 2022. The cross-sectional component that assessed the self-reported practices used a standardized self-reported questionnaire. A simulated patient (SP) case scenario, using different tracer prescriptions only for cardiovascular medications, allowed for the observation of real-world dispensing procedures. SPSS version 22 was used for the data entry and analysis.ResultsThe cross-sectional study approached 76 CDROs, and 71 of them agreed to take part (93.4% response rate). More than half of the respondents (53.5%) were males, with a mean (SD) age of 33.5 ± 9.1 years. Overall, the current self-reported survey showed that 59.2% of the participants provided cardiovascular drugs without a prescription. A total of 213 simulated visits were conducted. Considering all SP scenarios, the percentage of cardiovascular drugs dispensed without a prescription increased to 88.7%. Besides, more than 90% of pharmacists did not demand the SP to have a prescription, did not advise them to visit doctors or clinics, and did not inquire as to whom the medication was required.ConclusionA significant proportion of CDROs dispensed cardiovascular medications without a prescription. The findings highlight the disparity between self-reported and actual CDRO practices. Additionally, nearly all of the CDROs approached made it simple to obtain cardiovascular medications. Stakeholders could adherently follow the CDROs’ practices to improve their proper dispensing procedures.

Anti-Black racism in clinical supervision: asynchronous simulated encounters facilitate reflective practice

Background Racist interactions in clinical practice remain a pervasive reality for Black healthcare providers. We sought to develop a framework to inform supervisors’ actions when confronting racism in clinical practice and protecting trainees under their oversight. Methods We conducted a prospective study in which experienced supervisors responded to seven short, videotaped interactions between: 1) Black trainees and a simulated patient (SP) in a racist role; 2) the trainees and their respective supervisors; and 3) the trainees and their supervisors together with the SP. The clinical exchanges exemplified different types of racist (entrenching) or antiracist (uprooting) behaviors by the supervisors. After viewing each clip, participants wrote their reflections confidentially; they later joined a structured debriefing together. We used thematic analysis to identify supervisors’ behavioral patterns when confronting racist interactions. Results Based on the input of 52 participants recruited into five two-hour-long sessions, we categorized the behaviors of supervisors facing anti-Black racial injuries involving learners under their oversight. We organized supervisor behaviors into five interlocking domains, each with a range of possible themes: 1) Joining: from conciliatory to confrontational in communicating with the aggressor; 2) Explicitness: from avoiding to naming racism; 3) Ownership: from individual to shared responsibility of the event and the response to it; 4) Involving: from excusing to including the aggrieved party when confronting the aggressor; and 5) Stance: from protective to paternalistic in supporting the learner’s autonomy. Conclusions Our qualitative findings can provide a framework for facilitated discussion toward reflective practice among healthcare providers who may have experienced, witnessed, or intervened in anti-Black racist interactions. They can also help medical educators to inform faculty development to fight anti-Black racism in clinical practice. The video materials we developed are available for viewing and download and can be used or adapted as springboards for reflective discussion or faculty development activities.

Community pharmacists' response to complaints of gastroesophageal reflux: A simulated patient study in the Northern United Arab Emirates.

Patients frequently use gastric acid-reducing agents (ARAs) to treat symptoms affecting the gastrointestinal tract. Thus, the risk for drug-drug interactions (DDI) is a serious concern. This potentially makes the community pharmacist (CP) act as a primary intervention by providing the appropriate counseling and dispensing practice. To evaluate CPs' counseling and dispensing practices regarding complaints of Gastroesophageal Reflux Disease (GERD), including recommending an appropriate course of action to prevent possible DDIs. A simulated patient (SP) methodology was used in this study. The community pharmacies in Ajman and Sharjah were visited by SP who's responsible for acting as a patient, and by an observer who's responsible for focusing on the interaction between the SP and the CPs without engagement. Data were recorded using a preprepared data collection form. Performance feedback was sent to the CPs after concluding all visits. Counseling and dispensing scores were classified based on the total scores to poor, inadequate, and complete. Appropriateness of the pharmacist's decision was defined as dispensing antacid and advising of separating doses apart in time. A total of 150 community pharmacies was included in the data analysis. The findings of the current study demonstrated poor counseling and dispensing for the vast majority of the participants (81.3% and 67.3% of respondents, respectively). Only 4% of the CPs advised the SP to have a time interval between antacid and cefuroxime axetil. A significant difference in counseling scores was found between pharmacies located in Ajman and Sharjah (p = 0.01). Also, there was a significant difference in dispensing scores between independent and chain pharmacies (p = 0.003). The findings revealed inadequate counseling and dispensing practice by CPs. This study highlighted the need for continuous professional training programs to endow the CPs with the knowledge necessary for improving the CPs' counseling and dispensing practices.

"Fit for the finals" - project report on a telemedical training with simulated patients, peers, and assessors for the licensing exam.

Undergraduate medical students take the licensing exam (M3) as a two-day oral-practical examination. The main requirements are to demonstrate history taking skills and coherent case presentations. The aim of this project was to establish a training in which students can test their communication skills during history taking and their clinical reasoning skills in focused case presentations. In the newly developed training, final-year students took four telemedical histories in the role of physicians from simulated patients (SP). They received further findings for two SPs and presented these in a handover, in which they also received a handover of two SPs which they had not seen themselves. Each student presented one of the two received SPs in a case discussion with a senior physician. Feedback was given to the participants on their communication and interpersonal skills by the SPs with the ComCare questionnaire and on the case presentation by the senior physician. Sixty-two students from the universities of Hamburg and Freiburg in their final year participated in September 2022 and evaluated the training. Participants felt that the training was very appropriate for exam preparation. The SPs' feedback on communication and the senior physician's feedback on clinical reasoning skills received the highest ratings in importance to the students. Participants highly valued the practice opportunity for structured history taking and case presentation and would like to have more such opportunities in the curriculum. Essential elements of the medical licensing exam can be represented, including feedback, in this telemedical training and it can be offered independent of location.

The Extent of Antibiotic Dispensing in Self-Medication Encounters in Sudan: A Simulated Patient Study Focusing on Cefixime Sale.

Antibiotics play an important role in decreasing morbidity and mortality worldwide. However, inappropriate use of them by patients or healthcare professionals contributes to their resistance rendering them less efficacious. Community pharmacists (CPs) have a significant part in reducing antibiotic resistance. Therefore, this study aimed to investigate the dispensing of antibiotics without prescription in community pharmacies with an emphasis on cefixime dispensing. A cross-sectional, simulated patient (SP) study was conducted in the Khartoum locality. A total of 238 community pharmacies were randomly chosen using simple random sampling. One scenario of uncomplicated urinary tract infection was designed, and six female pharmacy students who were trained to act as SPs presented the scenario. Descriptive statistics were applied to report the study outcomes. In the 238 pharmacy visits, at least one antibiotic was dispensed without a prescription in 69.3% of the simulated visits. Among the dispensed antibiotics, ciprofloxacin was the most dispensed antibiotic followed by cefixime representing 51.5% and 41.8%, respectively, of total dispensed antibiotics. Cefixime was dispensed as a first choice by CPs in 29% of the visits, and in the rest of the visits, only 37.3% of CPs refused to dispense cefixime after SP demand. The findings revealed a high rate of antibiotics dispensing without prescription by CPs in Khartoum state, and cefixime was obtained with ease before and after the patient's demand. Urgent corrective actions such as imposing strict regulations, monitoring pharmacists' practice, and endorsing educational programs for pharmacists are needed to prevent inappropriate antibiotic dispensing practices.