Standardized Patient Actors Research Articles

Patient actor training improves preexposure prophylaxis delivery for adolescent girls and young women in Kenya: a cluster randomized trial.

To evaluate effectiveness of a standardized patient actor (SP) training intervention to improve quality of preexposure prophylaxis (PrEP) services for adolescent girls and young women (AGYW) in Kenya. Cluster randomized trial and mystery shopper evaluation. Twelve of 24 maternal child health and family planning facilities were randomized to SP training. Providers at intervention facilities participated in 2-day training in adolescent health, PrEP guidelines, values clarification, and communication skills, followed by role-playing and de-briefing with trained actors. Control facilities received standard national training. The primary outcome was quality of care, assessed by unannounced SPs (USPs) or "mystery shoppers" blinded to intervention arm. Quality was measured in two domains: guideline adherence and communication skills. Intent to treat analysis compared postintervention quality scores by randomization arm, clustering on facility, and adjusting for baseline scores and USP. Overall, 232 providers consented to USP visits, and 94 providers completed the training. Following training, USPs posed as AGYW seeking PrEP in 142 encounters (5-6 encounters per site). The mean quality score was 73.6% at intervention sites and 58.4% at control sites [adjusted mean difference = 15.3, 95% confidence interval (CI): 9.4-21.1, P < 0.001]. Mean guideline adherence scores were 57.2% at intervention sites and 36.2% at control sites (adjusted mean difference = 21.0, 95% CI: 12.5-29.4, P < 0.001). Mean communication scores were 90.0% at intervention sites and 80.5% at control sites (adjusted mean difference = 9.5, 95% CI: 5.5-13.6, P < 0.001). SP training significantly improved quality of PrEP care for AGYW in Kenya. Incorporating SP training and unannounced SP evaluation could improve PrEP uptake among AGYW.

Teaching strategy adaptations in undergraduate dental education during the COVID-19 pandemic.

During the COVID-19 pandemic, dental institutions were challenged to rapidly adapt to the inability of teaching in-person lectures and pre-clinical simulations. Strategies had to be quickly developed to guarantee the safety of faculty and students, while also adhering to national guidelines to ensure that educational standards were met and students' graduations and entrance into residency programs were notdelayed. This literature review assesses the novel strategies that dental schools created and implemented to teach in a distance-learning platform and evaluates the advantages and disadvantages of these strategies. In addition, this review talks about the lessons learned during the pandemic and the incorporation of successful strategies after the pandemic ended. This review evaluated the literature using PubMed and ScienceDirect with the following keywords: "teaching strategies," "dental education," and "COVID-19." The search strategy yielded 15 articles that assessed relevant teaching strategies that were implemented during the COVID-19 pandemic. The literature described the swift response of dental institutions in implementing teaching strategies in response to the inability of continuing in-person teaching. An overwhelming majority of institutions moved their didactic lectures to online platforms. Several institutions implemented online simulations with virtual reality models, videos and discussion boards, standardized patient actors, and case-based discussions. Many of the teaching strategies that were implemented as a result of the COVID-19 pandemic were highly effective. Dental schools were able to satisfy Commission on Dental Accreditation standards and meet students' requirements for graduation during the pandemic despite the rapid and unplanned shift away from in-person instruction and simulation secondary to the COVID-19 pandemic.

Comparing Capabilities ofSimulation Modalities forTraining Combat Casualty Care: Perspectives ofCombat Medics.

Combat casualty care requires learning a complex set of skills to treat patients in challenging situations, including resource scarce environments, multiple casualty incidents, and care under fire. To train the skills needed to respond efficiently and appropriately to these diverse conditions, instructors employ a wide array of simulation modalities. Simulation modalities for medical training include manikins, task trainers, standardized patient actors (i.e., role players), computer or extended reality simulations (e.g., virtual reality, augmented reality), cadavers, and live tissue training. Simulation modalities differ from one another in multiple attributes (e.g., realism, availability). The purpose of this study was to compare capabilities across simulation modalities for combat casualty care from the perspective of experienced military medics. To provide a more complete understanding of the relative merits and limitations of modalities, military combat medics (N = 33) were surveyed on the capabilities of simulation modalities during a 5-day technical experimentation event where they observed medical simulations from industry developers. The survey asked them to rate each of eleven modalities on each of seven attributes. To elicit additional context for the strengths, limitations, and unique considerations of using each modality, we also collected open-ended comments to provide further insight on when and how to use specific simulation modalities. Results showed differences among the simulation modalities by attribute. Cadavers, role play, moulage, and live tissue all received high ratings on two or more attributes. However, there was no modality that was rated uniformly superior to the others. Instead, modalities appear to have unique strengths and limitations depending on the training context and objectives. For example, cadavers were seen as highly realistic, but not very reusable. The study furthers our understanding of simulation modalities for medical training by providing insight from combat medics on the benefits, limitations, and considerations for implementing different modalities depending on the training context. These results may be helpful to instructors in selecting modalities for their programs.

Avoiding the Chill Pill- Results from a Simulation-Based Verbal De-escalation Training for Psychiatry Residents in a Community Mental Health Center

Background: Potentially dangerous encounters with uncooperative, belligerent, or even violent patients in the Emergency Department and Psychiatric Inpatient Units require skilled responses and timely management of episodes of acute agitation. Lack of training and knowledge in these scenarios could compromise the safety of both staff and patients. There have been improvements in knowledge and comfort when dealing with acutely agitated patients documented in previous studies that have used simulation training for junior psychiatry residents. Objectives: Understand the existing knowledge and skill gap and attempt to address it through simulation training. Methods: This is an IRB exempt quality improvement project, supported with funds from the Committee of Interns and Residents. The study was conducted over 3 years (2019-2022). All psychiatry residents (N=36) participated in an online module (4hrs, JCAHO and OMH accredited) and simulation training with 3 standardized patients (actors). All residents were blind to the clinical scenarios and observed by faculty. Each incoming class (2019-2022) has been trained yearly since. Pre and post intervention surveys asked questions about knowledge, comfort, perceived competence, prior training, verbal de-escalation skills (APSP-agitated patient simulation project survey) and the validated Management of Aggression and Violence Attitude Scale (MAVAS). Results: Data from pre- and post- intervention APSP responses were analyzed using the student’s paired t-test. Residents felt significantly more comfortable handling verbal de-escalation post training (score of 6 vs. 8, P&lt;0.0001) and more competent evaluating and managing agitated patients (6 vs. 8, p&lt;0.0001). They showed significant (p&lt;0.05) changes in attitudes around seclusion and restrains and causes of agitation on MAVAS. The most used de-escalation interventions were: Explaining the situation and process, Summarizing the content, and Identifying patient’s feelings, wants and needs. Triggering behaviors included interrupting/ talking over the patient, not prioritizing patient’s needs, insisting on using medications. Conclusion: This project showed simulation-based training successfully addressed an important practice and knowledge gap and lent structure to the tailored protocol-based approach for managing agitated patients, especially in busy ER settings. Residents appreciated the simulation-based training with real life scenarios – they found it useful and engaging and they welcomed the interaction with standardized patients (SPs) during the training.

Measuring antenatal counseling skill with a milestone-based assessment tool: a validation study

BackgroundAntenatal counseling for parents in the setting of expected preterm delivery is an important component of pediatric training. However, healthcare professionals receive a variable amount and quality of formal training. This study evaluated and discussed validity of a practical tool to assess antenatal counseling skills and provide evaluative feedback: the Antenatal Counseling Milestones Scale (ACoMS).MethodsExperts in antenatal counseling developed an anchored milestone-based tool to evaluate observable skills. Study participants with a range of antenatal counseling skills were recruited to participate in simulation of counseling sessions in person or via video with standardized patient actors presenting with preterm labor at 23 weeks’ gestation. Two faculty observers scored each session independently using the ACoMS. Participants completed an ACoMS self-assessment, demographic, and feedback survey. Validity was measured with weighted kappas for inter-rater agreement, Kruskal–Wallis and Dunn’s tests for milestone levels between degrees of expertise in counseling, and cronbach’s alpha for item consistency.ResultsForty-two participants completed observed counseling sessions. Of the 17 items included in the tool, 15 items were statistically significant with scores scaling with level of training. A majority of elements had fair-moderate agreement between raters, and there was high internal consistency amongst all items.ConclusionThis study demonstrates that the internal structure of the ACoMS rubric has greater than fair inter-rater reliability and high internal consistency amongst items. Content validity is supported by the scale’s ability to discern level of training. Application of the ACoMS to clinical encounters is needed to determine utility in clinical practice.

Simulated patient training to improve youth engagement in HIV care in Kenya: A stepped wedge cluster randomized controlled trial.

Youth living with HIV (YLHIV) report that negative interactions with health care workers (HCWs) affects willingness to return to care. This stepped wedge randomized trial evaluated effectiveness of a standardized patient actor (SP) HCW training intervention on adolescent engagement in care in Kenya. HCWs caring for YLHIV at 24 clinics received training on adolescent care, values clarification, communication, and motivational interviewing, with 7 SP encounters followed by facilitated feedback of videotaped interactions. Facilities were randomized to timing of the intervention. The primary outcome was defined as return within 3 months after first visit (engagement) among YLHIV who were either newly enrolled or who returned to care after >3 months out of care. Visit data was abstracted from electronic medical records. Generalized linear mixed models adjusted for time, being newly enrolled, and clustering by facility. YLHIV were surveyed regarding satisfaction with care. Overall, 139 HCWs were trained, and medical records were abstracted for 4,595 YLHIV. Median YLHIV age was 21 (IQR 19-23); 82% were female, 77% were newly enrolled in care, and 75% returned within 3 months. Half (54%) of trained HCWs remained at their clinics 9 months post-training. YLHIV engagement improved over time (global Wald test, p = 0.10). In adjusted models, the intervention showed no significant effect on engagement [adjusted Prevalence Ratio (aPR) = 0.95, 95% Confidence Interval (CI): 0.88-1.02]. Newly enrolled YLHIV had significantly higher engagement than those with prior lapses in care (aPR = 1.18, 95%CI: 1.05-1.33). Continuous satisfaction with care scores were significantly higher by wave 3 compared to baseline (coefficient = 0.38, 95%CI: 0.19-0.58). Despite provider skill improvement, there was no effect of SP training on YLHIV engagement in care. This may be due to temporal improvements or turnover of trained HCWs. Strategies to retain SP-training benefits need to address HCW turnover. YLHIV with prior gaps in care may need more intensive support. Registration CT #: NCT02928900. https://clinicaltrials.gov/ct2/show/NCT02928900.

Applying Diversity Principles and Patient-Centered, Cultural Curriculum Through Simulation and Standardized Patient Actors

As the U.S. population is becoming more diverse, nursing students need enhanced clinical experiences to become proficient in patient-centered, culturally appropriate nursing care. The addition of cultural care simulation curriculum utilizing a live standardized patient aims to enhance student understanding of cultural care by applying care in a safe, controlled setting. Incorporating the curricular principles of diversity, equity, and inclusion into simulation allows nursing students to apply their understanding of cultures and cultural behaviors in clinical environments. By using a standardized patient and simulation scenario of a patient with cultural needs, students are provided the opportunity to assess, plan, implement, and evaluate culturally appropriate care.

Codesigning simulations and analyzing the process to ascertain principles of authentic and meaningful research engagement in childhood disability research

BackgroundIncluding youth with disabilities and their families as partners in childhood disability research is imperative but can be challenging to do in an authentic and meaningful way. Simulation allows individuals to learn in a controlled environment and provides an opportunity to try new approaches. The objectives of the research study were to (1) codesign a suite of simulations and facilitation resources and understand how stakeholders engaged in the codesign process; and (2) describe the principles of authentic and meaningful research engagement as identified by stakeholders.MethodsInterdisciplinary stakeholder groups, including youth with disabilities, parents, researchers, and trainees, codesigned simulation training videos by developing shared storylines about challenges with research engagement that were then performed and digitally recorded with standardized patient actors. Two forms of data were collected: (1) observations via field notes and video recordings were analyzed to understand the codesign process; and (2) interviews were analyzed to understand principles of authentic and meaningful engagement.ResultsFour simulation training videos were developed, and topics included: (1) forming a project team; (2) identifying project objectives and priorities; (3) reviewing results; and (4) navigating concerns about knowledge translation. Thirteen participants participated in the simulation codesign; nine of whom consented to be observed in the codesign process and seven who completed follow up interviews. We identified two themes about authentic and meaningful engagement in research: (1) whether the invitation to engage on a project was authentic and meaningful or was extended to ‘tick a box’; and (2) whether there were authentic and meaningful opportunities to contribute (e.g., valued contributions aligned with people’s lived experience, skills, and interests) or if they only served as a ‘rubber stamp’. Communication and expectations tied the ‘tick box’ and ‘rubber stamp’ themes together and underlie whether engagement was authentic and meaningful.ConclusionsFor research engagement to be authentic and meaningful, researchers and families need to set clear expectations, build rapport, have tangible supports, use clear communication, and build time and space to work together. Future work will explore the utility of the simulations and whether they improve knowledge and attitudes about authentic and meaningful engagement in research.

The influence of active listening on parents’ perceptions of clinical empathy in a stuttering assessment: A preliminary study

PurposeThe primary purpose of this preliminary study was to explore whether a clinician's use of active listening skills (i.e., client-directed eye gaze and paraphrasing) influenced parents’ perceptions of clinical empathy in a stuttering assessment. A secondary purpose was to determine whether parent age, education, or parent concern predicted perceived clinical empathy. MethodParticipants (n = 51 parents/guardians of children who stutter) watched two counter-balanced videos of a clinician demonstrating either high or low frequency use of active listening skills during the clinician's initial assessment with a standardized patient actor portraying a parent of a child who stutters. After each video, parents rated the clinician's empathy and active listening skills via the Jefferson Scale of Physician Empathy for Observers (JSPEO; Hojat et al., 2017) and the Counselor Activity Self-Efficacy Scales - Modified (Victorino & Hinkle, 2018). Participants then completed a demographic questionnaire and rated their concern about their child's stuttering. ResultsPaired t-tests demonstrated significantly higher ratings of perceived clinical empathy in the high frequency active listening condition compared to the low frequency condition (d = 0.548). Simple linear regression analyses indicated parent age or level of education did not predict perceived clinical empathy. An independent samples t-test indicated that parent concern about stuttering did not predict perceived clinical empathy. ConclusionsPreliminary findings suggest that the clinician was viewed as significantly more understanding, concerned, and caring (i.e., perceived as empathic) when active listening skills were used. Parents’ ratings of empathy on the JSPEO, based on high levels of active listening by the clinician, were not associated with parents’ ages, education levels, or concern about their children's stuttering. This may reflect the value of active listening in clinical relationships regardless of variables specific to the recipient (e.g., parent of a child who stutters). Given that parents are more apt to share thoughts and emotions about their child's communication with clinicians who demonstrate empathic qualities, this preliminary study suggests that the use of active listening skills warrant emphasis in clinical training.

Evaluating feasibility of a novel mobile emergency medical dispatch tool for lay first responder prehospital response coordination in Sierra Leone: A simulation-based study

IntroductionThe global injury burden, driven by road traffic injuries, disproportionately affects low- and middle-income countries, which lack robust emergency medical services (EMS) to address injury. The WHO recommends training lay first responders (LFRs) as the first step toward formal EMS development. Emergency medical dispatch (EMD) systems are the recognized next step but whether small groups of LFRs equipped with mobile dispatch infrastructure can efficiently respond to geographically-dispersed emergencies in a timely fashion and the quality of prehospital care provided is unknown. Materials and methodsWe piloted an EMD system utilizing a mobile phone application in Sierra Leone. Ten LFRs were randomly selected from a pool of 61 highly-active LFRs trained in 2019 and recruited to participate in an emergency simulation-based study. Ten simulation scenarios were created matching proportions of injury conditions across 1,850 previous incidents (June-December 2019). Fifty total simulations were launched in randomized order over 3 months, randomized along 10 km of highway in Makeni. Replicating real-world conditions, highly-active LFR participants were blinded to randomized dispatch timing/scenario to assess response time and skill performance under direct observation with a checklist using standardized patient actors. We used novel cost data tracked during EMD pilot implementation to inform the calculation of a new cost-effectiveness ratio ($USD cost per disability-adjusted life year averted (DALY)) for LFR programs equipped with dispatch, following WHOCHOICE guidelines, which state cost-effectiveness ratios less than gross domestic product (GDP) per capita are considered “very cost-effective.” ResultsMedian total response interval (notification to arrival) was 5 min 39 s (IQR:0:03:51, 0:09:18). LFRs initially trained with a 5-hour curriculum and refresher training provide high-quality prehospital care during simulated emergencies. Median first aid skill checklist completion was 89% (IQR: 78%, 90%). Cost-effectiveness equals $179.02USD per DALY averted per 100,000 people, less than Sierra Leonean GDP per capita ($484.52USD). ConclusionLFRs equipped with mobile dispatch demonstrate appropriate response times and effective basic initial management of simulated emergencies. Training smaller cohorts of highly-active LFRs equipped with mobile dispatch appears highly cost-effective and may be a feasible model to facilitate efficient dispatch to expand emergency coverage while conserving valuable training resources in resource-limited settings.

Mystery Shopper Assessment of PrEP Service Delivery Quality for Adolescent Girls and Young Women in Kenya: A Cross-sectional Study.

Pre-exposure prophylaxis (PrEP) uptake and adherence among adolescent girls and young women (AGYW) may be negatively influenced by poor interactions with health care providers. We assessed PrEP counseling using unannounced standardized patient actors (USPs) at routine care clinics in Kenya. Trained actors posed as AGYW seeking PrEP services following case scripts and completed a checklist of provider adherence to national guidelines and communication skills. Scores were converted into a percentage and compared using linear regression. The overall mean quality score was 52.1 and varied across case scripts: a married new initiator yielded higher scores than portrayals of adherence/stigma challenges, transactional sex, and a minor adolescent. Mean guideline scores (31.4) were lower than communication scores (72.8), although in 36.5% of encounters, USPs stated they would not seek help from that provider again. Unannounced standardized patients reported provider reluctance to offer PrEP to AGYW. Interventions to strengthen provider counseling skills are needed.

Integration and Outcomes of a Hybrid Simulation for Simple Laceration Suturing

Context Emergency and immediate care skills are often difficult to practice in real time during clinical education. One immediate care skill requiring advanced training that may not be implemented during clinical education is wound closure via suturing. Simple laceration management with sutures can be advantageous skill for athletic training students to learn and practice; however, deliberate practice with feedback in a realistic manner is necessitated. Objective To describe the use of hybrid simulation to practice suturing in professional and postprofessional athletic training programs. Background The practice of immediate and emergency skills is predominately classroom based and removes the patient experience. Simulation-based learning has provided athletic training educators an opportunity for skill practice with patient simulators and standardized patients to fill the gap. Description The hybrid simulation incorporates the use of a standardized live patient actor with an attached part-task–training simulated arm for suturing in a safe and realistic manner. Clinical Advantage(s) Incorporating a hybrid simulation encounter for practice of suturing skills requires multitasking and delivery of patient-centered care and promotes proper skill execution while receiving questions and direct feedback from the standardized patient. Conclusion(s) Suturing should be taught and assessed in a tiered format using part-task trainers such as pig skin and artificial skin pads. After skill development, a hybrid simulation as a summative assessment allows for the educator to evaluate the learners' interpersonal communication and technical skills in a safe manner.

AD-LAST! An interdisciplinary clinical workshop to improve cultural and spiritual awareness in advance care planning skills.

Clinicians report training deficits in advance care planning (ACP), including limits to their understanding of cultural/spiritual influences on patient decision-making and skills in interdisciplinary teamwork. This study describes Advance Directives-Live Action Simulation Training (AD-LAST), an interdisciplinary experiential and didactic training program for discussing ACP and end-of-life (EOL) care. AD-LAST highlights cultural/spiritual variations in medical decision-making. Prospective educational cohort study with pre-post intervention survey. AD-LAST incorporated standard curricular tools for didactic and experiential training in ACP/EOL communication. Study conducted in an urban community teaching hospital in Queens, NY, one of the most diverse counties in the USA. Participants included physicians, house staff, nurses, therapists, and other disciplines. AD-LAST format was a one-day workshop. The morning focused on didactic teaching using widely available curricular tools. The afternoon involved experiential practice with standardized patient-actors. Pre-post intervention questionnaires assessed ACP operational knowledge and self-efficacy (i.e., self-confidence in skills) in ACP and EOL communication. Repeated measure ANOVAs evaluated changes from pretest to posttest in knowledge and self-efficacy. A total of 163 clinical staff participated in 21 AD-LAST training sessions between August 2015 and January 2019. Participants displayed a significant increase from pretest to posttest in total knowledge (p < 0.001), ACP procedural knowledge (p < 0.001), ACP communication/relationships knowledge (p < 0.001), and self-efficacy (p < 0.001). Knowledge and self-efficacy were not correlated and represented independent outcomes. Postprogram evaluations showed greater than 96% of participants were highly satisfied with AD-LAST, especially the opportunity to practice skills in real-time and receive feedback from members of other professional groups. AD-LAST, a multifaceted training program deployed in an interdisciplinary setting, is effective for increasing ACP knowledge and self-efficacy, including the capacity to address cultural/spiritual concerns. The use of standard tools facilitates dissemination. The use of case simulations reinforces learning.

Sexual Assault Forensic Examiner Recruitment and Retention: Using Simulation to Teach a Trauma-Informed Interview.

Traditionally, sexual assault nurse examiner training focuses on examination skills and evidence collection. Gathering history and supporting the patient in a trauma-informed approach are equally important components of postassault care. Simulation is an established tool in healthcare education; however, there is limited research on applying simulation to the training of sexual assault nurse examiners. The Sexual Assault Forensic Examiner Recruitment and Retention program developed and delivered standardized patient-simulated scenarios to teach elements of trauma-informed sexual assault interviews. Simulation allowed trainees the opportunity to practice interviews and receive direct feedback from the standardized patient actor and experienced examiners. Evaluation results showed that learners valued this opportunity, endorsing that it improved their ability to conduct a forensic interview. This innovative program introduced a framework for training new examiners on trauma-informed interview techniques, using standardized patients.

"I Have Actually not Lost any Adolescent Since I Started Engaging Them one on one:" Training Satisfaction and Subsequent Practice among Health Providers Participating in a Standardized Patient Actor Training to Improve Adolescent Engagement in HIV Care.

Background: Poor health care worker (HCW) interactions with adolescents negatively influence engagement in HIV care. We assessed the impact of standardized patient actor training on HCW competence in providing adolescent HIV care in Kenya. Methods: We conducted pre-post cross-sectional surveys and qualitative exit interviews during a stepped wedge randomized trial. Cross-sectional surveys assessed self-rated competence in providing adolescent services before and after the intervention, and training satisfaction. In-depth interviews with a subset of HCW participants one year after training. Results: Over 90% of HCWs reported satisfaction with the training and there was significant improvement in self-rated competence scores (mean = 4.63 [highest possible score of 5] post-training vs 3.86 pre-training, p < 0.001). One-year following training, HCWs reported using skills in patient-centered communication and structuring an adolescent clinical encounter. Conclusions: This SP training intervention improved self-rated competence and showed sustained perceived impact on HCW skills in adolescent HIV service provision one year later.

Flow diversion device for the management of an extracranial internal carotid artery aneurysm.

Our patient is a 60-year-old woman with a history of hypertension, hypothyroidism, and glossal hemangioma. She works as a standardized patient actor in our simulation center. A neck ultrasound scan performed during one of the simulation sessions demonstrated a left internal carotid artery aneurysm, which prompted a consultation with Vascular Surgery. She denied any symptoms associated with this aneurysm. On physical examination, there was a palpable pulsatile mass below the left mandibular angle. On computed tomography angiography, a 2.3- × 1.9- × 2.2-cm saccular aneurysm of the extracranial left internal carotid artery was noted (A). After multidisciplinary discussion, the decision was made to proceed with endovascular treatment using flow diversion due to the patient's desire of avoiding a scar in the neck, aneurysm size, and risk for thrombus formation and embolization. A 5.0- × 25-mm Pipeline flow-diversion device (PED; Medtronic) was deployed across the lesion with no event. The patient was observed overnight and discharged the following day with a normal neurological examination and on aspirin 81 mg and clopidogrel 75 mg daily as an antiplatelet regimen. On 1-month follow-up computed tomography angiography, the stent demonstrated excellent apposition to the wall of the artery and excellent flow through this vessel (B). Extracranial carotid artery aneurysm has a prevalence of 0.4%-1% among all peripheral artery aneurysms.1Qiu J. Zhou W. Zhu X. Zhou W. Zeng Q. Huang L. et al.Treatment of extracranial carotid artery aneurysm: fifteen years' experience at a single institution.Ann Vasc Surg. 2020; 69: 174-181Google Scholar The neurologic symptoms experienced by patients include transient ischemic attacks and ischemic strokes.2Welleweerd J.C. den Ruijter H.M. Nelissen B.G. Bots M.L. Kappelle L.J. Rinkel G.J. et al.Management of extracranial carotid artery aneurysm.Eur J Vasc Endovasc Surg. 2015; 50: 141-147Google Scholar The first successful treatment for an aneurysm in this location was performed by Sir Astley Cooper in 1808 through ligation of the proximal carotid artery.3Kraemer C.J.K. Zhou W. Carotid aneurysm review.Int J Angiol. 2019; 28: 17-19Google Scholar Then, in 1952, Dimtza4Dimtza A. Aneurysms of the carotid arteries; report of two cases.Angiology. 1956; 7: 218-227Google Scholar reported the first successful resection with end-to-end anastomosis. In the past 10 years, with the development of endovascular techniques, the treatment options of carotid artery aneurysms have included open surgery, endovascular procedures, and hybrid techniques.1Qiu J. Zhou W. Zhu X. Zhou W. Zeng Q. Huang L. et al.Treatment of extracranial carotid artery aneurysm: fifteen years' experience at a single institution.Ann Vasc Surg. 2020; 69: 174-181Google Scholar A review published by Qiu et al1Qiu J. Zhou W. Zhu X. Zhou W. Zeng Q. Huang L. et al.Treatment of extracranial carotid artery aneurysm: fifteen years' experience at a single institution.Ann Vasc Surg. 2020; 69: 174-181Google Scholar reports that the optimal management option for the treatment of carotid artery aneurysms is dependent on the morphology of the artery and the properties of the aneurysm. Recent advances in endovascular treatment allow for the utilization of flow diversion outside the skull, and treatment of extracranial internal carotid artery pseudoaneurysms with flow diversion has been shown to be safe and effective in selected patients.5Akinduro O.O. Gopal N. Hasan T.F. Nourollah-Zadeh E. Vakharia K. De Leacy R. et al.Pipeline embolization device for treatment of extracranial internal carotid artery pseudoaneurysms: a multicenter evaluation of safety and efficacy.Neurosurgery. 2020; 87: 770-778Google Scholar Informed consent was obtained from this patient for this publication.

2 Training Emergency Physicians for Mass Casualty Triage during Mass Shooting Events: A New York City- based Pilot Curriculum

Recent literature suggests that emergency departments may be underprepared for the influx of “self-referred” patients following a mass shooting event. Following the mass shootings in Orlando and Las Vegas, the Greater New York Hospital Association determined there was a need to increase the preparation of emergency department clinicians for these events in New York. Through a partnership with the Center for Disaster Medicine at New York Medical College an 8-hour, innovative physician-oriented education program was created and piloted at 5 hospitals using a combination of didactics, table-top exercises, live ultrasound scanning, and in-situ high-fidelity simulation. The results of these pilot course deliveries were used to standardized course curricula available to all New York-area hospitals and identify additional educational needs for physicians and other emergency department staff. Didactic content was created using lessons-learned reports, comprehensive literature reviews, and consultation with physician subject matter experts in the area of trauma surgery, disaster medicine, and emergency ultrasound. Hands-on training was created based on lessons-learned consisted of three afternoon break-out sessions including a hospital-specific bed status management exercise to simulate decompressing the ED and critical care units in advance of the arrival of mass casualties, an immersive ED in-situ mass casualty management scenario utilizing high-fidelity trauma simulators and standardized patient actors, and a breakout session on innovative applications of point-of-care ultrasound for triage and clinical decision making using live standardized patients for scanning. Post-course surveys were distributed to participants and survey items aggregated for analysis and curriculum improvement and revision. Didactic content areas showed universal improvement among all pilot sites using Likert confidence scales to evaluate pre-course vs post-course provider self-efficacy. Practical skills and psychomotor evaluations also showed universal improvement following skills practice consistent with current emergency medicine educational literature. Gaps in the pilot course content reported by participants varied by facility but included wanting similar educational content available for non-physician ED clinicians, and wanting to include non-ED physicians, who might “float” to the ED during a mass casualty, to be included in the training. Additionally, physicians at some hospitals had better mastery of POCUS than others. A suggestion was to offer a stand-alone 4-hour course on emergency ultrasound for hospitals who would like to offer this to their ED physicians. Emergency physicians are the leaders of the hospital response to a mass casualty as the primary clinicians responsible for the triage and treatment of victims from out-of-hospital events. Nevertheless, many emergency physicians report not having the opportunity to receive education on new trends and innovations in mass casualty management, which could make them more effective when responding to a disaster. Departments should consider how they might enrich existing preparedness-related CME and leverage their resources in high-fidelity simulation and ultrasound to offer opportunities to practice skills and techniques that are not often utilized during annual in-service training.

The Effectiveness of a Simulation Program to Enhance Readiness to Engage in Difficult Conversations in Clinical Practice.

Health care providers are often tasked with communicating difficult, emotionally charged news, including delivering an unwelcome diagnosis and planning end-of-life care. Patients and family members often cannot recall specifics of these conversations, although their perceptions of how information was communicated by health care providers impact not only their evaluation of the quality of care received, but also their abilities to cope with the communicated bad news. What can be done to better prepare novice clinicians to have these types of conversations? This quality improvement project used a simulation-based difficult conversation workshop given to adult-gerontology acute care nurse practitioner students in their final year of study. The workshop comprised both standardized patient actors and a structured communication curriculum. A pretest/posttest was conducted to show that this intervention was effective in increasing student confidence to facilitate difficult conversations in clinical practice.

Teaming and Thinking Outside the Box for Trainee Redeployment During the COVID-19 Pandemic.

We applaud Meo and colleagues' article, “Redeploying Residents and Fellows in Response to COVID-19: Tensions, Guiding Principles, and Lessons from the University of Washington,”1 for outlining 10 tenets based on the University of Washington redeployment experience. Furthermore, we suggest that hospital strategic and educational leaders could think outside the box and seek additional workforce reinforcements from trainees outside of Accreditation Council for Graduate Medical Education programs.Per the Interprofessional Education Collaborative Expert Panel,2 clinical practice is shifting toward team-based collaboration to deliver optimal patient-centered care. Yet, clinicians have limited training working within interprofessional teams. The COVID-19-related challenges of increased clinical demands combined with workforce shortages create unique opportunities for novel interprofessional models of redeployment.During the first wave of the pandemic, emergency department (ED) and internal medicine (IM) personnel found they needed more staff to facilitate communication with patients and families, given high caseloads, restricted visitations, and over-extended clinicians. As stated in guiding principle No. 3, program directors are the point persons to determine the scope of training for trainees. With buy-in from dental and oral pathology (D/OP) program directors and residents, we executed a novel redeployment model with D/OP residents at our academic community hospital. D/OP residents were trained as “communication partners” for ED and IM staff in anticipation of a second surge.We trained 9 residents over 3 weeks, with goals to identify appropriate surrogates for patients and to provide brief updates and emotional support. The curriculum highlighted role introduction, advance directives (AD), and empathic communication skills. Each resident practiced the skills with standardized patient actors, with real-time feedback.Educational and clinical leaders from IM and ED collaborated across disciplines with palliative medicine leaders and D/OP program directors to prepare and execute this redeployment plan. D/OP residents would be supervised by palliative care faculty.Per guiding principle No. 8, trainees should have opportunities to provide feedback and program evaluation. Post training, D/OP residents completed anonymous surveys. Their comments reflected both appreciation for the training and reluctance to engage in high-stakes communication with families of severely ill patients. Comments included:Even though the D/OP residents completed communication skills training, the ED and IM teams reported hesitation for using them in the role of “communication partner,” due to uncertainty in D/OP residents' ability to engage in difficult discussions around complex medical issues. Similarly, D/OP residents' confidence level for carrying out this new role varied by individual. Lipworth et al3 reported successful implementation of a communication liaison program to provide support and medical updates to family members of critically ill patients, utilizing subspecialists such as ophthalmologists and pathologists.The COVID-19 pandemic has brought havoc to our health care system, but also has provided opportunities for exploring new roles, more interprofessional “teaming,”4 and innovative thinking outside the box strategies for patient care.

Student Perspectives and Standardized Patient Feedback on an Innovative Simulated Patient Encounter

This retrospective survey analysis sought to explore student perspectives and application of therapeutic use of self during a simulated standardized patient encounter (SSPE) with standardized patient actors portraying serious mental illness (SMI). Researchers collected retrospective data from post SSPE student surveys dating between 2009 and 2019 and standardized patient actor surveys dating between 2017 and 2019. Students’ level of expertise with therapeutic use of self and self-perceptions of the SSPE were analyzed for response categories. Descriptive analysis was conducted on all items. Student survey responses were organized into response categories. Standardized patient actor surveys were analyzed for frequencies of yes/no responses. Post-SSPE student surveys showed that many students found the SSPE to be a great learning experience, allowed them to practice therapeutic use of self, and felt that it reflected a realistic experience working with someone with SMI. Surveys of the standardized patient actors revealed that they observed student use of therapeutic use of self in the vast majority of their interactions. These results lead the researchers to conclude SSPEs are an effective way of teaching necessary occupational therapy skill sets and familiarizing students to populations experiencing SMI prior to Level II fieldwork and clinical practice.