Standard Participants Research Articles

Weight bias reduction intervention among nurse practitioner students using simulation-based experiences.

Few nurse practitioner (NP) programs include obesity and weight bias education in their curriculum. However, NPs will likely provide care for people living with obesity, many of whom have been discriminated against based on their weight by previous providers, and many NP students may feel unprepared to navigate weight management competently. This pilot study included a weight bias reduction (WBR) intervention, which included a simulation-based experience (SBE) with a standardized participant (SP) and educational activities embedded within the NP curriculum. Nineteen NP students participated in this pilot study, but only seven students had matching data for preintervention to postintervention scores. There were no statistically significant differences in preintervention and postintervention Attitudes Toward Obese Persons (ATOP) or Beliefs About Obese Persons (BAOP) scores. Despite this small sample size and not achieving statistical significance, SBE-SP holds promise to depict realistic patient encounters to improve NPs' attitudes and beliefs toward persons with obesity and to reduce weight bias. Therefore, incorporating SBE-SP may be a feasible component of the NP curriculum.

The use of simulation-based learning to increase the confidence level of oncology advanced practice providers when discussing palliative care.

265 Background: The increase in cancer cases globally has dramatically strengthened the need in introducing palliative care upon a cancer diagnosis. Oncology advanced practice providers (APPs) are essential in integrating palliative care concurrently with treatment. SinceAPPs have limited to no hands-on training in palliative care, they often feel unprepared and less confident in discussing palliative care with cancer patients, resulting in a gap in care. This can result in a decreased in quality of life (QoL), absence of symptom management, increased healthcare costs and usage of healthcare resources, increased emergency room visits and hospital admissions. This quality improvement (QI) project sought to increase the confidence level of APPs, when discussing palliative care using simulation-based training in an effort to address this educational gap and provide palliative care support alongside standard of care. Methods: The project utilized a sample of 15 APPs working in an academic outpatient oncology facility. Participants completed a pre-and post-survey consisting of 12 Likert-type questions to measure their confidence level in palliative care before and after the simulation training session. Simulation-based learning with standardized participants (SPs) was utilized to increase the confidence level of APPs in the outpatient oncology setting. A pancreatic cancer patient case was utilized for the simulation. The Wilcoxon’s signed-rank test was used to compare the results of the pre and post test scores. Results: The results showed positive changes between the pre- and post-survey results in confidence level. Post-survey results were statistically significant (p value of < 0.05) and respondents reported greater confidence following the simulation-based training. Referrals also increased to palliative care post simulation. Conclusions: Palliative care simulation with SPs closed educational gaps and improved the APPs confidence levels when discussing palliative care with cancer patients. As a result, simulation-based learning is an effective strategy to train newly hired oncology APPs or enhance skill deterioration as needed to integrate palliative care concurrently with treatment as the standard for cancer patients. Furthermore, from this QI project, a computer-based module was developed for new oncology APPs onboarding to the organization. Future directions are to expand to non-oncology APPs that directly care for cancer patients.

A Program of Simulated Learning Experiences to Develop Clinical Judgment and Clinical Competence Among Sophomore Baccalaureate Nursing Students

BackgroundClinical judgment and competence are two essential skills for undergraduate nursing students to learn. These two skills have been taught mostly in upper division nursing courses. MethodA single group repeated measures design was used to evaluate the effect of three simulated learning experiences using standardized participants (SP) in the development of clinical judgment and clinical competence among 47 sophomore nursing. The study also examined the relationship between clinical judgment skills and clinical competence among the study participants. ResultsStudy participants demonstrated increased abilities in clinical judgment skills (F [2, 92] = 11.41, p < .001, η2p = 0.20) as well as clinical competence (F [2, 92] = 10.79, p < .001, η2p = 0.19), and the relationship between the them was positive and significant at each measurement (Measurement # 1: r = 0.66, p < .001; Measurement # 2: r = 0.36, p = .013; Measurement # 3: r = 0.55, p < .001). ConclusionSimulation is an effective teaching strategy to develop clinical judgment and competence among nursing students early in a curriculum.

The Effects of a Simulation-Based Experience with Standardized Participants on Learning and Clinical Decision-Making Related to Nursing Management of Oncologic Emergencies.

Upon entry-to-practice, graduate nurses must be able to effectively manage oncologic emergencies to ensure best patient and family outcomes. Thus, nurse educators must develop active teaching strategies to prepare prelicensure nursing students with appropriate nursing oncology knowledge and skills. The purposes of this study were to determine the effect of simulation-based experiences (SBEs) with standardized participants (SPs) involving a patient and family member on baccalaureate nursing students' confidence and competence, anxiety and self-confidence with clinical decision-making, and satisfaction and self-confidence in learning using SBEs related to management of oncologic emergencies within a seminar-style course. A longitudinal, one-group, convergent mixed-methods design was used. Baccalaureate nursing students enrolled in a senior seminar participated in two SBEs. Study data were collected pre-seminar, pre-SBE, and post-SBE. Twenty-five senior nursing students participated in this study. There was a significant increase in students' confidence and self-perceived competence, and a significant decrease in anxiety and increase in self-confidence with clinical decision-making related to the nursing management of oncologic emergencies over time. All seven student groups in the hypercalcemia SBE, and five student groups in the hypersensitivity reaction SBE demonstrated objective competence. Qualitative themes identified included: realism, critical thinking, and benefits for professional practice. Study findings support the use of SBEs with SPs to enhance nursing students' confidence and competence, and to increase self-confidence and reduce anxietywith clinical decision-making related to the management of oncologic emergencies in a seminar-style course. The inclusion of a family member enhanced the realism of complex SBEs.

A novel simulation-based approach to training for recruitment of older adults to clinical trials

BackgroundThe need to engage adults, age 65 and older, in clinical trials of conditions typical in older populations, (e.g. hypertension, diabetes mellitus, Alzheimer’s disease and related dementia) is exponentially increasing. Older adults have been markedly underrepresented in clinical trials, often exacerbated by exclusionary study criteria as well as functional dependencies that preclude participation. Such dependencies may further exacerbate communication challenges. Consequently, the evidence of what works in subject recruitment is less generalizable to older populations, even more so for those from racial and ethnic minority and low-income communities.MethodsTo support capacity of research staff, we developed a virtual, three station simulation (Group Objective Structured Clinical Experience—GOSCE) to teach research staff communication skills. This 2-h course included a discussion of challenges in recruiting older adults; skills practice with Standardized Participants (SPs) and faculty observer who provided immediate feedback; and debrief to highlight best practices. Each learner had opportunities for active learning and observational learning. Learners completed a retrospective pre-post survey about the experience. SP completed an 11-item communication checklist evaluating the learner on a series of established behaviorally anchored communication skills (29).ResultsIn the research staff survey, 92% reported the overall activity taught them something new; 98% reported it provided valuable feedback; 100% said they would like to participate again. In the SP evaluation there was significant variation: the percent well-done of items by case ranged from 25–85%.ConclusionsResults from this pilot suggest that GOSCEs are a (1) acceptable; (2) low cost; and (3) differentiating mechanism for training and assessing research staff in communication skills and structural competency necessary for participant research recruitment.

Assessing the quality of Objective Structured Clinical Examination (OSCE) reports in pharmacy education: A review of the literature

This article was migrated. The article was not marked as recommended. Objective: The purpose of this systematic review was to identify and assess the quality of published reports of objective structured clinical examinations (OSCEs) in pharmacy education. Methods: English-language articles published between 2000-2015 describing OSCEs in pharmacy education were included. Search terms included ‘pharmacy education’, ‘objective structured clinical examination’, ‘clinical skills assessment’, and ‘clinical skills examination’. A previously published checklist of reporting standards for OSCEs in medical education was used to assess the quality of published OSCE reports in specific areas: encounter characteristics, standardized participant (SPs) characteristics, training methods, and behavioral methods. Results: Forty-two articles were identified for inclusion. Forty (95%) articles reported the number of encounters with the median being 3.0 (SD=4.7). All articles reported the level of learner participating, with most US pharmacy schools conducting OSCEs with third year pharmacy students. Most articles reported training for SPs prior to the OSCE (n=23, 55%), however most did not report if training was provided to OSCE raters (n=22, 52%). Thirty-six (86%) articles reported the type of behavior measure used during OSCEs, however almost half (n=18, 42%) did not report the scale used. Few articles (n=19, 45%) reported if psychometric properties had been obtained for the specific behavior measures used. Conclusions: Overall, published descriptions of OSCEs are varied and inconsistent. Most OSCEs conducted in US pharmacy schools were in third year pharmacy students. Just over half of published articles reported OSCE training. The lack of published psychometric properties may make implementation of valid OSCEs difficult.

Talk the Talk: Implementing a Communication Curriculum for Surgical Residents

The Accreditation Council for Graduate Medical Education milestones provide a framework of specific interpersonal and communication skills that surgical trainees should aim to master. However, training and assessment of resident nontechnical skills remains challenging. We aimed to develop and implement a curriculum incorporating interactive learning principles such as group discussion and simulation-based scenarios to formalize instruction in patient-centered communication skills, and to identify best practices when building such a program. The curriculum is presented in quarterly modules over a 2-year cycle. Using our surgical simulation center for the training, we focused on proven strategies for interacting with patients and other providers. We trained and used former patients as standardized participants (SPs) in communication scenarios. Surgical simulation center in a 900-bed tertiary care hospital. Program learners were general surgery residents (postgraduate year 1-5). Trauma Survivors Network volunteers served as SPs in simulation scenarios. We identified several important lessons: (1) designing and implementing a new curriculum is a challenging process with multiple barriers and complexities; (2) several readily available facilitators can ease the implementation process; (3) with the right approach, learners, faculty, and colleagues are enthusiastic and engaged participants; (4) learners increasingly agree that communication skills can be improved with practice and appreciate the curriculum value; (5) patient SPs can be valuable members of the team; and importantly (6) the culture of patient-physician communication appears to shift with the implementation of such a curriculum. Our approach using Trauma Survivors Network volunteers as SPs could be reproduced in other institutions with similar programs. Faculty enthusiasm and support is strong, and learner participation is active. Continued focus on patient and family communication skills would enhance patient care for institutions providing such education as well as for institutions where residents continue on in fellowships or begin their surgical practice.

Coordinating a Team Response to Behavioral Emergencies in the Emergency Department: A Simulation-Enhanced Interprofessional Curriculum.

IntroductionWhile treating potentially violent patients in the emergency department (ED), both patients and staff may be subject to unintentional injury. Emergency healthcare providers are at the greatest risk of experiencing physical and verbal assault from patients. Preliminary studies have shown that a team-based approach with targeted staff training has significant positive outcomes in mitigating violence in healthcare settings. Staff attitudes toward patient aggression have also been linked to workplace safety, but current literature suggests that providers experience fear and anxiety while caring for potentially violent patients. The objectives of the study were (1) to develop an interprofessional curriculum focusing on improving teamwork and staff attitudes toward patient violence using simulation-enhanced education for ED staff, and (2) to assess attitudes towards patient aggression both at pre- and post-curriculum implementation stages using a survey-based study design.MethodsFormal roles and responsibilities for each member of the care team, including positioning during restraint placement, were predefined in conjunction with ED leadership. Emergency medicine residents, nurses and hospital police officers were assigned to interprofessional teams. The curriculum started with an introductory lecture discussing de-escalation techniques and restraint placement as well as core tenets of interprofessional collaboration. Next, we conducted two simulation scenarios using standardized participants (SPs) and structured debriefing. The study consisted of a survey-based design comparing pre- and post-intervention responses via a paired Student t-test to assess changes in staff attitudes. We used the validated Management of Aggression and Violence Attitude Scale (MAVAS) consisting of 30 Likert-scale questions grouped into four themed constructs.ResultsOne hundred sixty-two ED staff members completed the course with >95% staff participation, generating a total of 106 paired surveys. Constructs for internal/biomedical factors, external/staff factors and situational/interactional perspectives on patient aggression significantly improved (p<0.0001, p<0.002, p<0.0001 respectively). Staff attitudes toward management of patient aggression did not significantly change (p=0.542). Multiple quality improvement initiatives were successfully implemented, including the creation of an interprofessional crisis management alert and response protocol. Staff members described appreciation for our simulation-based curriculum and welcomed the interaction with SPs during their training.ConclusionA structured simulation-enhanced interprofessional intervention was successful in improving multiple facets of ED staff attitudes toward behavioral emergency care.

Board #202 - Program Innovation Simulated Organ Donation Requests (Submission #9770)

Objectives To use simulation to train Family Services Coordinators (FSCs) to apply best practices for organ donation requests. To recognize the value of using simulation to train Family Services Coordinators to apply best practices for organ donation requests. To identify key components of using simulation to train Family Services Coordinators to apply best practices for organ donation requests. Description Though organ transplantation is an unequaled intervention for the reversal of terminal illness, a critical shortage of donated organs exists. Misconceptions about donating organs are the primary reasons people decline. Hence, Family Services Coordinators who make donation requests must be highly competent. The purpose of our simulation education program is to promote best practices by FSCs when making organ donations requests. Our Simulation Center collaborated with the Arkansas Regional Organ Recovery Agency (ARORA) to plan and conduct a series of simulations. Cases are designed for registered donors and non-registered donors. Standardized participants (SPs) are trained to portray family members with common misconceptions and emotional needs. One session is designed for African-American donors, among which unique cultural misconceptions exists. FSCs engage the SPs to request organ donation. Best practices include dual advocacy, in which the FSCs advocate for the potential organ recipients as well as the donor’s family. The simulations were observed by the ARORA Manager, a debriefing expert on our simulation staff as well as other FSCs. An in-depth debriefing followed each simulation in which all of the learners and observers participated. Conclusion The simulations are well-received by ARORA and appear to have benefited both ARORA and our Medical Center. Pre- and post-simulation comparisons of the annual rates of authorization for organ donations among the FSCs demonstrate a clinically significant increase in post-simulation donation rates. In one FSC, the annual rate of donation has increased over three-fold, from 29% to 100%. The ARORA Manager attributed the simulation education as the catalyst for this FSC’s improvement. A pre- and post-simulation comparison of the annual number of transplants at our Medical Center also demonstrated a clinically significant improvement. In 2012, our Medical Center transplanted 17 livers from ARORA organ donors. In 2013, 32 livers were transplanted from ARORA organ donors. Our data suggests that one of the contributing factors associated with this increase may have been the simulation education intervention, which the ARORA Manager described as a quality and safe learning environment for the FSCs to practice and get feedback about facilitating donation conversations that are compassionate, thorough, non-anxious and value positive. Collaboration between a Simulation Center and an organ donation organization is feasible and can potentially improve performance and clinical outcomes. Disclosures None

Assessment of patient communication skills during OSCE: Examining effectiveness of a training program in minimizing inter-grader variability

ObjectiveTo assess effectiveness of a training program in reducing inter-grader variability in grading communication skills during an objective structured clinical exam (OSCE). MethodsGlobal communication (GC) skills are assessed by standardized participants (SP) and faculty during each OSCE using a 6 item rubric. Despite criteria delineated in the GC rubric, inter-grader variability was observed. During 2008–2009 academic year, a training program was implemented before each OSCE to achieve more consistent interpretation and grading in GC skills. GC grades between SP and faculty for 2nd and 3rd level student OSCEs during 2008–2009 (post-training) were compared to 2007–2008 (pre-training). Data was analyzed using repeated measures ANOVA. Results274 and 281 students participated in OSCEs during 2007–2008 and 2008–2009 academic years, respectively. Training significantly (P<.001) decreased grader variability between SPs and faculty. There was a greater mean difference between faculty vs. SP before training (faculty 14.68, SP 15.87) compared to after training (faculty 13.51, SP 13.78). Mean GC scores for both faculty and SPs also decreased significantly after training. Conclusion and practice implicationsA training program may be necessary to reduce inter-rater variability in assessment of OSCE communication skills if it is to be truly helpful to student pharmacists learning to counsel patients.

Real-Time Standardized Participant Grading of an Objective Structured Clinical Examination

Objectives. To determine the reliability of using standardized participant (SP) actors as real-time graders for an objective structured clinical examination (OSCE). Methods. All students enrolled in Therapeutics I participated in a 3-station OSCE. Faculty and SP actors graded student performance in real time using a dichotomous performance checklist. Standard setting for the OSCE was done using the borderline method. Inter-rater reliability between the faculty members and SP was determined. Results. Fifty-one students completed the morning examination and 30 completed the afternoon examination. The inter-rater reliability between the faculty members and SPs were 0.84, 0.88, and 0.93 for the morning examination and 0.90, 0.92, and 0.98 for the afternoon examination. The standard determined by faculty members and SPs for the morning examination was 66.9% and 63.8%, and for the afternoon examination was 72.6% and 73.1%, respectively. Conclusions. These data support the use of SP actors as graders for compreh...