Standardized Patient Encounters Research Articles

Development of a Scoring Rubric Assessing Medical Students' Explanations of Pathology Reports.

With increasing availability of immediate patient access to pathology reports, it is imperative that all physicians be equipped to discuss pathology reports with their patients. No validated measures exist to assess how pathology report findings are communicated during patient encounters. To pilot a scoring rubric evaluating medical students' communication of pathology reports to standardized patients. The rubric was iteratively developed using the Pathology Competencies for Medical Education and Accreditation Council for Graduate Medical Education pathology residency milestones. After a brief training, third- and fourth-year medical students completed 2 standardized patient encounters, presenting simulated benign and malignant pathology reports. Encounters were video recorded and scored by 2 pathologists to calculate overall and item-specific interrater reliability. All students recognized the need for pathology report teaching, which was lacking in their medical curriculum. Interrater agreement was high for malignant report scores (intraclass correlation coefficient, 0.65) but negligible for benign reports (intraclass correlation coefficient, 0). On malignant reports, most items demonstrated good interrater agreement, except for discussing the block (cassette) summary, explaining the purpose of the pathology report, and acknowledging uncertainty. Participating students (N = 9) felt the training was valuable given their limited prior exposure to pathology reports. This pilot study demonstrates the feasibility of using a structured rubric to assess the communication of pathology reports to patients. Our findings also provide a scalable example of training on pathology report communication, which can be incorporated in the undergraduate medical curriculum to equip more physicians to facilitate patients' understanding of their pathology reports.

Measuring the longitudinal impact of a transgender and gender diverse curriculum on nurse practitioner students' and nurse practitioners' cultural competence, knowledge, skills, and attitudes.

Nurse practitioners (NPs) are well positioned to provide inclusive, person-centered care to patients who are transgender and gender diverse (TGD); however, few NPs have been trained on how to do so. This study demonstrates the longitudinal effect of an educational intervention that used readings, lecture, a patient panel, and a standardized patient encounter on NPs' and nurse practitioner students' cultural competency, knowledge, skills, and attitudes toward patients who are TGD. The study followed participants for 3 months and used the Sexual Orientation Counselor Competency Scale version 3 tool to measure changes across three data points. Significant improvements were demonstrated in cultural competency and clinical skills, with knowledge and attitude increases that did not reach significances. The findings from this study have implications for the inclusion of TGD content in graduate nursing curriculum and continuing education activities and provide educators with best practices to integrate this content into learning activities.

Health Care Professional Education on Cancer Screening of SGM Individuals: An Integrative Review.

Sexual and gender minority (SGM) individuals are disproportionately affected by cancer. Health care professional (HCP) and health sciences education rarely includes content on cancer screening in this population. This article aims to synthesize literature on educational programs for HCPs and health sciences students related to cancer screening for SGM individuals. An integrative review methodology guided a systematic search of five databases: CINAHL, PubMed, Embase, PsycInfo, and ERIC. Articles were included if they were empirically-based and described educational programs targeted at HCPs and health sciences students with content of cancer screening for SGM people. Eleven studies met the inclusion criteria. Of these, three were pilot studies and the majority of the articles (n = 9) used pre- and post-test designs. All of the interventions showed efficacy in increasing knowledge, attitudes, skills, and behavior. However, the vastly different programs and the fact that most of the cancer screening content was embedded in programs with broad SGM issues content limit the ability to make firm recommendations for any one particular program. In-person didactic content delivered multiple times incorporating modalities such as standardized patient encounters, case studies, and guest speakers increased knowledge, attitude, and skills of participants. Future studies should incorporate behavioral theories, develop more consistent aspects of educational programs, report demographic and pertinent data on participants, and utilize established instruments to measure outcomes when conducting educational interventions on HCPs and students in this area.

Making Use of Natural Language Processing to Better Understand Medical Students' Self-Assessment of Clinical Skills.

Reflective practice is necessary for self-regulated learning. Helping medical students develop these skills can be challenging since they are difficult to observe. One common solution is to assign students' reflective self-assessments, which produce large quantities of narrative assessment data. Reflective self-assessments also provide feedback to faculty regarding students' understanding of content, reflective abilities, and areas for course improvement. To maximize student learning and feedback to faculty, reflective self-assessments must be reviewed and analyzed, activities that are often difficult for faculty due to the time-intensive and cumbersome nature of processing large quantities of narrative assessment data. The authors collected narrative assessment data (2,224 students' reflective self-assessments) from 344 medical students' reflective self-assessments. In academic years 2019-2020 and 2021-2022, students at the University of Cincinnati College of Medicine responded to 2 prompts (aspects that surprised students, areas for student improvement) after reviewing their standardized patient encounters. These free-text entries were analyzed using TopEx, an open-source natural language processing (NLP) tool, to identify common topics and themes, which faculty then reviewed. TopEx expedited theme identification in students' reflective self-assessments, unveiling 10 themes for prompt 1 such as question organization and history analysis, and 8 for prompt 2, including sensitive histories and exam efficiency. Using TopEx offered a user-friendly, time-saving analysis method without requiring complex NLP implementations. The authors discerned 4 education enhancement implications: aggregating themes for future student reflection, revising self-assessments for common improvement areas, adjusting curriculum to guide students better, and aiding faculty in providing targeted upcoming feedback. The University of Cincinnati College of Medicine aims to refine and expand the utilization of TopEx for deeper narrative assessment analysis, while other institutions may model or extend this approach to uncover broader educational insights and drive curricular advancements.

Assessment of Interprofessional Competence of Leadership Education in Neurodevelopmental and Related Disabilities Trainees through a Virtual Standardized Patient Encounter.

Leadership Education in Neurodevelopmental and Related Disabilities (LEND) programs have an emphasis on developing skills in providing family-centered and interdisciplinary care. Due to Coronavirus pandemic-related restrictions, opportunities for interdisciplinary education were limited for the 2020-2021 LEND Trainee cohort at The Ohio State University Nisonger Center. Standardized Patient (SP) encounters can be a mechanism for instruction and assessment of interprofessional competence. An SP encounter was developed for the The Ohio State University 2020-2021 LEND Cohort. Prior to the activity, participants (N = 11) were given clinic notes to review from their respective disciplines. During the activity, participants met virtually to develop collaborative recommendations which were then delivered to the SP who portrayed the mother of a young child receiving a new diagnosis of autism spectrum disorder. Following the encounter, 4 LEND faculty observers completed the Modified McMaster-Ottawa Team Rating Scale and participants completed the Interprofessional Collaboration Competency Attainment Scale-Revised (ICCAS-R). Eleven LEND trainees completed the ICCAS-R with an overall increase in the mean score from 3.86 to 4.12. Four LEND faculty members completed the Modified McMaster-Ottawa Team Rating Scale, with the Communication domain demonstrating the highest level of competence. This activity was well-received by both faculty and LEND trainees. Although delivered in virtual format, it could easily be transitioned to an in-person encounter for future LEND trainees. The success of this activity further supports that standardized patient encounters can be a feasible mechanism for instruction and assessment of interprofessional competencies and serve as a training mechanism for LEND programs.

Adolescent Interview With a Medical Interpreter: A Standardized Patient Encounter for Pediatric Residents.

Pediatricians can cultivate a more trusting relationship with their non-English speaking patients by emphasizing the importance of upholding patient confidentiality in the presence of an interpreter. We designed a case for pediatric residents to increase comfort when conducting an adolescent interview using a medical interpreter, emphasizing the importance of upholding patient confidentiality, specifically when discussing sensitive health topics. We developed a standardized patient encounter (SPE) for pediatric residents at a large academic institution that focused on exploring sensitive health topics with an adolescent, non-English speaking female patient using an interpreter.A validated survey was administered upon completion of the case, prompting participants to reflect on their comfort and skills with specific activities before and after the case, and was analyzed using paired t-tests. Eighty-nine residents participated; 66 were interns and 23 were in their second year of residency. The mean scores of all paired survey items significantly increased after the case (p<0.01), indicating perceived personal growth in all educational objective categories. The majority of the participants (97%, N=86) agreed that they built skills in understanding cultural humility andcaring for future patients (mean Likert scores: 4.91 and 5.10, respectively). Upon completion of the case, residents reported increased comfort and skills using a medical interpreter for non-English speaking patients within the context of patient-centered care, discussing various sensitive health topics, emphasizing the importance of upholding patient confidentiality, and demonstrating skills in adolescent interviewing. Both medical confidentiality and cultural humility education can be integrated into simulation-based medical education to improve the quality of care for diverse patient populations.

Education for Tobacco Use Disorder Treatment: Current State, Evidence, and Unmet Needs.

Tobacco use is undertreated in the medical setting. One driver may be inadequate tobacco use disorder treatment (TUDT) training for clinicians in specialties treating tobacco-dependent patients. We sought to evaluate the current state of TUDT training for diverse professionals and how these skills are assessed in credentialing exams. We performed a focused review of current educational practices, evidence-based strategies, and accreditation exam contents focused on TUDT. Among medical students, participants in reviewed studies reported anywhere from 45 minutes to 3 hours of TUDT training throughout their 4-year programs, most often in the form of didactic sessions. Similarly, little TUDT training was reported at the post-graduate (residency, fellowship, continuing medical education) levels, and reported training was typically delivered as time-based (expected hours of instruction) rather than competency-based (demonstration of mastery) learning. Multiple studies evaluated effective TUDT curricula at varied stages of training. More effective curricula incorporated longitudinal sessions and active learning, such as standardized patient encounters or proctored patient visits. Knowledge of TUDT is minimally evaluated on certification exams. For example, the American Board of Internal Medicine blueprint lists TUDT as <2% of one subtopic on both the internal medicine and pulmonary exams. TUDT training for most clinicians is minimal, does not assess competency, and is minimally evaluated on certification exams. Effective, evidence-based TUDT training incorporating active learning should be integrated into medical education at all levels, with attention paid to inclusion on subsequent certifying exams.

A Refined Teach-back Observation Tool: Validity Evidence in a Pediatric Setting.

Teach Back (TB) is recommended to assess and ensure patient understanding, thereby promoting safety, quality, and equity. There are many TB trainings, typically lacking assessment tools with validity evidence. We used a pediatric resident competency-based communication curriculum to develop initial validity evidence and refinement recommendations for a Teach-back Observation Tool (T-BOT). This study aimed to develop initial validity evidence for a refined T-BOT and provide guidance for further enhancements to improve essential TB skills training among pediatric residents. After an interactive health literacy (HL) training, residents participated in recorded standardized patient (SP) encounters. Raters developed T-BOT scoring criteria, then scored a gold standard TB video and resident SP encounters. For agreement, Fleiss' Kappa was computed for >2 raters, and Cohen's Kappa for two raters. Percent agreement and intraclass correlation (ICC) were calculated. Statistics were calculated for gold standard (GS) and TB items overall for all six raters, and for five faculty raters. Agreement was based on Kappa: no agreement (≤0), none to slight (0.01-0.20), fair (0.21-0.40), moderate (0.41-0.60), substantial (0.61-0.80), almost perfect (0.81-1.00). For six raters, Kappa for the GS was 0.554 (moderate agreement) with 71.4% agreement; ICC = .597; for SP encounters, it was 0.637 (substantial) with 65.4% agreement; ICC = .647. Individual item agreement for SP encounters average was 0.605 (moderate), ranging from 0.142 (slight) to 1 (perfect). For five faculty raters, Kappa for the GS was 0.779 (substantial) with 85.7% agreement; ICC = .824; for resident SP encounters, it was 0.751 (substantial), with 76.9% agreement; ICC = .759. Individual item agreement on SP encounters average was 0.718 (substantial), ranging from 0.156 (slight) to 1 (perfect). We provide initial validity evidence for a modified T-BOT and recommendations for improvement. With further refinements to increase validity evidence, accompanied by shared understanding of TB and rating criteria, the T-BOT may be useful in strengthening approaches to teaching and improving essential TB skills among health care team members, thereby increasing organizational HL and improving outcomes. [HLRP: Health Literacy Research and Practice. 2023;7(4):e187-e196.].

Exploring the Use of a Social Determinants of Health Focused History Script to Facilitate Patient Conversations

Context Screening for social determinants of health (SDOH) factors is fundamental to addressing barriers to health outcomes and identifying resources needed to provide patient-centered care. However, SDOH can be a difficult area of patient care to navigate without a screening tool. Objective To explore athletic training students’ abilities to screen for SDOH factors via standardized patient (SP) encounters and to describe the experience of screening for SDOH factors. Design Prospective, mixed-methods cohort study. Setting Simulation laboratory. Patients or Other Participants Fifty-four postbaccalaureate professional athletic training students (women = 43, men = 11; age = 23 ± 1 years). Intervention The same SP encounter was completed with 2 cohorts of athletic training students, with 1 intervention cohort (n = 29) screening for the SDOH without an aide and the control cohort (n = 25) screening with the mandatory use of a validated SDOH focused history script. Main Outcome Measures The SP encounters were evaluated using a tool containing an SDOH evaluation by domain and Athletic Training Milestone competencies. Following the SP encounter, each learner completed a postlearning survey. Data were analyzed using descriptive statistics, Mann-Whitney U tests, and thematic qualitative analysis. Results We identified a significant difference (P ≤ .001) for the overall screening for the SDOH, with the intervention cohort that was required to use the focused history script scoring significantly higher than the control cohort. The intervention cohort scored significantly higher (P ≤ .001) on the Athletic Training Milestones than the control cohort, but the intervention cohort self-rated their performance as lower during the reflection. Conclusion The use of the focused history script during the SP encounter highlighted the need for a screening tool to be present during the evaluation to facilitate a conversation about the SDOH. When health care students were not required to use the focused history script to screen for the SDOH, most failed to elicit information about the SDOH factors or performed poorly during the screening.

Athletic Training Students’ Mental Health Recognition and Referral Skills, Part 2: Perceptions of Pedagogical Strategies

Context The increased prevalence of mental health conditions and the use of telehealth for patient care have exposed gaps in athletic training professional and continuing education. Here, we explore athletic training students’ perceptions of virtual pedagogical strategies for the delivery and application of concepts related to mental health recognition and referral, which may help educators determine best practices. Objective To examine students’ experiences and perceptions of Mental Health First Aid (MHFA) training, case-based learning, and standardized patient encounters. Design Qualitative portion of a sequential, explanatory mixed-methods design. Setting Individual interviews via video conference. Patients or Other Participants A convenience sample of graduate athletic training students from Commission on Accreditation of Athletic Training Education-accredited professional athletic training programs who participated in the MHFA training and secondary encounters were recruited. Twenty-two participants (11 from each intervention group; 45.5% male, 54.5% female; age = 24.59 ± 2.3) were interviewed. Data Collection and Analysis Interviews were recorded using Zoom and then transcribed. The Qualitative Analysis Guide of Leuven method was used to analyze the data to determine emergent themes. Strategies to enhance trustworthiness included an audit trail, member checks, and peer debriefing. Results Five higher order themes emerged from the interview data, as follows: (1) perceived value of MHFA training, (2) engaged learning and facilitated feedback, (3) capability, (4) comfort and confidence, and (5) authenticity. These themes were organized into the following 3 overarching dimensions: knowledge, skills, and pedagogy. Participants described how the opportunity to apply their knowledge and practice their skills with an athletic training-specific scenario helped them feel more equipped for future patient care. Conclusions Regardless of simulation strategy, the opportunity to practice influenced participants’ knowledge and feelings of confidence and capability. The MHFA training and simulated encounters were engaging techniques that incorporated feedback and provided elements of authentic patient interaction.

Engaging Premedical Students in Medical Education Research: Benefits of Clinical Skills Observation Studies.

Observations requiring evaluation and critical thinking can be powerful learning experiences. Video-recorded standardized patient encounters are underused resources for evaluation and research. The authors engaged premedical students in medical education research reviewing standardized patient encounters. This study aims to explore participant perceptions of the research experience and how they gained clinical skills. This mixed-method study was completed between 2019 and 2022. Premedical participants coded medical students' clinical skills in video-recorded standardized patient encounters. Each participant also completed their own new patient history in a standardized patient encounter at both the beginning and end of their research project. Participants then completed an end-of-program debrief to discuss their experiences coding the clinical skills encounters. The authors coded communication skills implemented in the pre/postencounters and completed a thematic analysis of the debrief transcripts. All 21 participants demonstrated significant clinical skills gain after their research project, which included spending more time with the patient (pre-M=5 minutes, post-M=19 minutes, t=13.2, P<.001) and asking more questions (pre-M=13, post-M=40, t=9.3, P<.001). Prior clinical experience did not influence pre- or postoutcomes, but the number of videos coded was associated with asking more questions in the postencounter. Participants described learning actively and reflected that their clinical skills research project gave them greater insight into patient-care aspects of medical school and how medical students learn. These data demonstrate that observational studies in which premedical students evaluate standardized patient encounters gave the students context to medical education while enabling them to develop and transfer their own clinical skills. Studies observing standardized patient encounters provide rich insight into clinical skills development, and this work generates both research outcomes and actionable program evaluation data for medical educators. Purposefully engaging premedical students in such experiential learning opportunities benefits the students and helps cultivate early medical education pathways for these learners.

Just-in-Time, Just-in-Place Virtual Training in the Pediatric Emergency Department: A Novel Approach to Impact the Perfusion Exam.

Early identification of shock is vital in decreasing morbidity and mortality in the pediatric population. Although residents are taught the perfusion portion of the rapid cardiopulmonary assessment at our institution, they perform it at the bedside with 8.4% completing 1 part of the assessment and 9.7% verbalizing their findings. Newer technologies, including virtual reality (VR), offer immersive training to close this clinical gap. To assess senior pediatric residents' performance of a perfusion exam and verbalization of their perfusion assessment following VR-based Just-in-Time/Just-in-Place (JITP) training compared to video-based JITP training. We hypothesized that JITP media training was feasible, and VR JITP was more effective than video-based training. Residents were randomized to VR or video-based training during shifts in the emergency department. Clinical performance was assessed by review of a video-recorded patient encounter using a standardized assessment tool and by an in-person, two question shock assessment. Residents completed a survey assessing attitudes toward their intervention at the time of training. Eighty-five senior pediatric residents were enrolled; 84 completed training. Sixty-four (76%) residents had a patient encounter available for video review (VR 33; Video 31). Fourteen residents in the VR group (42.4%, 95% CI 25.5% to 60.8%) and 13 residents in the video group (41.9%, 95% CI 24.6% to 60.9%) completed a perfusion exam AND verbalized an assessment during their next clinical encounter (X2 p-value 1.00). Fifty-one of 64 residents (79.7%) completed the two-step shock assessment; 50 (98%) agreed with supervising physician's assessment. VR was rated more effective than reading, low-fidelity manikin, standardized patient encounters, traditional didactic teaching, and online learning. Video was rated more effective than online learning, traditional didactic teaching, and reading. Novel video and VR JITP perfusion exam and assessment trainings are impactful and well-received by senior pediatric residents.

Preparing student-pharmacists to utilize motivational interviewing techniques to address COVID-19 vaccine hesitancy in underrepresented racial/ethnic patient populations

Background and purposeVaccine hesitancy disproportionally impacts racial/ethnic minority populations. Regarded as trusted, accessible, and knowledgeable, pharmacists are strategically positioned to address this threat using effective communication strategies such as motivational interviewing (MI). Little data exists on programs that prepare student-pharmacists to use MI to combat vaccine hesitancy in underrepresented populations. Educational activity and settingStudent pharmacists elected to participate in co-curricular training on addressing COVID-19 vaccine hesitancy in racial/ethnic minority populations. The training included a web-based module on using MI to address COVID-19 vaccine hesitancy and a live group objective structured clinical examination (OSCE) with standardized patient encounters that included prevalent COVID-19 vaccine concerns. Faculty assessed the group's ability to employ core elements of MI to correct vaccine misinformation. After the OSCE, students received feedback from the standardized actors and evaluators. Change in student confidence was assessed. After the training, students volunteered at eight different community events to utilize MI to address vaccine hesitancy in underrepresented patient populations. FindingsA total of 17 students completed the training. Four out of the six groups received a passing score on the OSCE. Students performed satisfactory in the major domains of MI but struggled to answer knowledge-based questions regarding COVID-19 vaccines. As a result of the training, a significant increase in student confidence was seen. All participating students rated the training as either “excellent” or “good.” SummaryA novel, co-curricular educational initiative was an effective tool to prepare student-pharmacists to utilize MI to combat vaccine hesitancy in underrepresented racial/ethnic minority populations.

Enhancing Physician Assistant Psychiatry Interviewing Skills Using Standardized Patients.

The aim of this pilot study was to assess whether supplemental psychiatry training in the didactic year increases the scores on the Physician Assistant Education Association (PAEA) Psychiatry and Behavioral Health End of Rotation examination and psychiatry preceptor evaluation. Data were obtained from the physician assistant (PA) students on PAEA Psychiatry and Behavioral Health End of Rotation examination and psychiatry preceptor evaluation for a single institution. Then, a comparison was performed for PA students who did not participate in supplemental psychiatry/behavioral health training (Cohort 1/historical control group; n = 62) and PA students who participated in supplemental psychiatric and behavioral health training (Cohort 2/experimental group; n = 63) to determine the effects of the groups. An independent t test demonstrated that the experimental group performed significantly better than the control group on both the Psychiatry and Behavioral Health PAEA End of Rotation examination and preceptor evaluation {control group (M = 83.4) and experimental group (M = 86.3; t [117] = 2.8; P < .05)} and the preceptor evaluation {control group (M = 90) and experimental group (M = 92.6; t [112] = 2.1; P < .05)}. In addition, both analyses demonstrated a moderate effect size (End of Rotation examination, d = 0.51; preceptor, d = 0.62). A multiple regression analysis was used to control for age, sex, grade point average (GPA), and training intervention. Age, sex, and GPA were found not to affect the results. However, treatment intervention was statistically significant for both the End of Rotation examination and preceptor evaluation scores. Supplemental training in behavioral health and psychiatry, which included a standardized patient encounter and an interactive session dedicated to psychiatry interviewing techniques, resulted in students performing better on the Psychiatry and Behavioral Health PAEA End of Rotation examination and preceptor evaluation.

A pilot clinical skills coaching program to reimagine remediation: a cohort study.

Background New approaches are needed to improve and destigmatize remediation in undergraduate medical education (UME). The COVID-19 pandemic magnified the need to support struggling learners to ensure competency and readiness for graduate medical education (GME). Clinical skills (CS) coaching is an underutilized approach that may mitigate the stigma of remedial learning. Methods A six-month CS coaching pilot was conducted at Harvard Medical School (HMS) as a destigmatized remedial learning environment for clerkship and post-clerkship students identified as 'at risk' based on objective structured clinical examinations (OSCE). The pilot entailed individual and group coaching with five faculty, direct bedside observation of CS, and standardized patient encounters with video review. Strengths-based coaching principles and appreciative inquiry were emphasized. Results Twenty-three students participated in the pilot: 14 clerkship students (cohort 1) and 9 post-clerkship students (cohort 2). All clerkship students (cohort 1) demonstrated sustained improvement in CS across three OSCEs compared to baseline: at pilot close, at 6-months post pilot, and at 21-24 months post-pilot all currently graduating students (10/10, 100%) passed the summative OSCE, an HMS graduation requirement. All post-clerkship students (cohort 2) passed the HMS graduation OSCE (9/9,100%). Feedback survey results included clerkship students (9/14; 64%) and post-clerkship students (7/9; 78%); all respondents unanimously agreed that individual coaching was "impactful to my clinical learning and practice". Faculty and leadership fully supported the pilot as a destigmatized and effective approach to remediation. Conclusion Remediation has an essential and growing role in medical schools. CS coaching for remedial learning can reduce stigma, foster a growth mindset, and support sustained progress for 'at risk' early clerkship through final year students. An "implementation template" with suggested tools and timelines can be locally adapted to guide CS coaching for UME remediation. The CS coaching pilot model is feasible and can be generalized to many UME programs.

The Use of Mock Standardized/Simulated Patient Encounters in Facilitating Development of Clinical Competence in Medical Students.

Background Standardized patient (SP) encounters are used in medical school to mimic clinical practice by exposing students to possible clinical situations they may encounter in future practice. SP includes trained individuals who portray the roles of patients to help medical students practice recording medical histories, physical exam skills, communication skills, and typing a subjective, objective, assessment and plan (SOAP) note. The goal of SP is to prepare medical students adequately during their didactic years before beginning clerkships. SP encounters have becomestandard in medical school curriculums, but the option for a mock SP encounter has not. Methods In this study, a total of 34 participants completed an eight-question survey before a mock SP experience and after their graded SP encounters to assess the students' confidence levels and preparedness. Each question addressed a different aspect of the student's satisfaction and attitude regarding the SP encounters. The answers were measured on a Likert scale from 1 (not prepared) to 5 (very prepared). The central tendency (mean) was analyzed using a T-test with Welch's method. The standard deviation was analyzed using Bonett's test.A Cronbach's alpha was used to show the reliability of the survey used. Results The first four questions addressed the student's satisfaction with their mock SP experience. The mean student satisfaction with being able to ask questions to improve their knowledge and understanding improved, with a p-value of< 0.001. Student satisfaction with having the opportunity to record a patient's history improved, with a p-value of < 0.001. The overall satisfaction with having a chance to practice physical exam skills improved, with a p-value of < 0.001. Mean student satisfaction with practicing treatment and counseling of patients improved, with a p-value of <0.001. The final four questions addressed the students' attitudes regarding their experience. The mean confidence of students improved, with a p-value of <0.001. Students also reported an improved attitude towards the feedback they received, with a p-value of <0.001. The final two questions did not show a statistically significant difference in answers. Students rated the final two questions equally before and after the mock SP experience, with p-values > 0.05. These questions addressed whether mock SP encounters would be beneficial and asked if they wanted additional mock simulation opportunities built into the curriculum. Conclusions The students showed improved confidence, attitudes, and satisfaction surrounding standardized patient encounters. The results supported the hypothesis that there would be a difference between the responses before and after the SP encounter.The questionnaire showed that the students reported subjective changes in their competence following the encounter.

Improvement of Medical Student Performance in Telemedicine Standardized Patient Encounters Following an Educational Intervention.

The Association of American Medical Colleges identifies telemedicine competence as an important skill for graduating medical students, but which educational methods are effective in improving student performance is unclear. We aimed to assess the impact of two educational interventions on student performance in telemedicine standardized patient encounters. Sixty second-year medical students participated in the telemedicine curriculum during their required longitudinal ambulatory clerkship. Students first completed a preintervention telemedicine standardized patient (SP) encounter in October 2020. They subsequently were assigned to two intervention groups (ie, a role-play intervention, N=30; a faculty demonstration, N=30) and completed a teaching case. In December 2020, they completed a postintervention telemedicine SP encounter. Each case was a unique clinical scenario. SPs scored the encounters across six domains based on a standardized performance checklist. We compared the median scores for these domains and the median total score pre- and postintervention (using Wilcoxon signed rank and rank-sum tests) and the difference in median score by intervention type. Students scored highly in history-taking and communication performance but had low physical exam (PE) and assessment/plan scores. Postintervention, median scores in PE (ie, median score difference 2, interquartile ranges [IQR] 1-3.5, P&lt;.001), assessment/plan (ie, median score difference 0.5, IQR 0-2, P=.005), and overall performance improved significantly (ie, median score difference 3, IQR 0-5, P&lt;.001). Early medical students had low performance at baseline in telemedicine PE and assessment/plan skills, but both a role-play intervention and faculty demonstration led to significant increases in student performance.

Innovating the hematology/oncology (H/O) curriculum for internal medicine (IM) residents: A modified flipped classroom (FC) approach.

11014 Background: Nationally, a framework for H/O education for IM residents that is simultaneously clinically relevant, concordant with the ABIM Blueprint, and efficient in delivery is lacking at the graduate medical education (GME) level. At our institution, based on feedback from our residents we recognized an opportunity to innovate the H/O curriculum through active learning approaches to better meet the needs of our residents. Methods: Adopting the Kern Model of curriculum development, a needs assessment was performed to gauge resident opinions on the current H/O didactics and towards active learning approaches. Survey results informed the development of 4 FC modules, meant to seamlessly integrate into the existing didactics of morning report (MR) and noon conference (NC). Each module consisted of a video on a cancer type viewed during MR, cased-based activity during NC, and an instructor's guide. Following the Kirkpatrick model, resident opinions were assessed via surveys and feedback sessions. Pre/post-tests at 3 time points were used to assess learning. Standardized patient encounters (SPEs) with clinical competency scoring scales were developed to assess clinical reasoning skills. Results: 43% of residents (33/76) completed the needs assessment. A majority of respondents (82%) indicated the existing H/O didactics did not provide enough foundational knowledge. 87% of residents indicated a need for more active learning and 72% expressed interest in a FC approach. 43% (33/76) of residents attended ≥1 session (NC or MR). Post-intervention, 81% of residents strongly agreed the FC modules were relevant to clinical practice and board exams. 93% of residents strongly or somewhat agreed it was feasible and manageable to incorporate the FC format. Pre/post-test results showed statistically significant improvement in scores from before to after viewing the MR video (1-way ANOVA, p&lt;0.011) with a medium effect size of 0.11. Significant change was not seen when the same test was taken after the case-based NC activity (p=1). Clinical competency scores from SPEs of full-participant residents were significantly higher compared to residents who did not participate in a FC module (t-test, mean 8.4 vs. 6.2/10, p&lt;0.001). Conclusions: Our pilot H/O FC curriculum was overwhelmingly viewed as favorable and reported as clinically relevant, feasible, and manageable by our residents. Pre/post test results suggest that viewing the pre-session video during MR resulted in significant learning as compared to attending the case-based session during NC. Superior performance on SPEs by residents attending in full as compared to non-participants provides strong evidence supporting our modified FC approach in improving clinical reasoning skills. Overall, our study supports a broader application of our innovative FC model into existing traditional lecture-based resident H/O curricula.

64. Using Standardized Patient Encounters to Prepare Medical Students to Address Microaggressions in a Clinical Setting

PURPOSE: Health inequities result from structural obstacles related to social, economic, and political factors. To address these, anti-racism and anti-bias training in all levels of medical education are necessary. This study aims to evaluate the comfort of medical students in broaching difficult conversations to address microaggressions, and assess how that differs in a professional setting to those in power versus a personal setting. METHODS: Third-year NYMC medical students received optional training in implicit bias and microaggressions, through a 12-minute lecture, followed by two unique standardized patient encounters and educational debriefs highlighting specific microaggressions in clinical settings. Pre- and post-intervention surveys included 16 Likert-scale questions and were distributed through Qualtrix. Responses were converted to a numeric scale and groups were compared using the Wilcoxon rank-sum test with significance set to p<0.05. RESULTS: There were 210 participants; the response rate was 96.2% (n=202) for pre-intervention and 94.3% (n=198) for post-intervention surveys. Prior to enrolment, most students stated they recognized internal implicit biases and stereotypical beliefs about social identity groups (87.1%), and felt comfortable communicating empathy and concern for anyone regardless of social identity group (>67.3%%). Most students felt comfortable speaking up to counteract microaggressions in a personal setting (73.8%), but not a professional setting (26.2%). After participating in the program, students were significantly more likely to recognize internal implicit biases and stereotypical beliefs (91.6%, p=0.025), to communicate empathy and concern regardless of social identity group (>71.8%, p<0.022), and to speak up to counteract microaggressions in a personal setting (89.1%, p<0.001) and professional setting with power differential (40.1%, p=0.033). CONCLUSION: The use of a lecture component, followed by standardized patients with immediate educational debrief, significantly improves trainee recognition of internal implicit bias, communication across social identity group, and countering microaggressions in personal settings. Trainees were significantly more likely to counteract microaggressions in a professional setting with power differential, but even after the intervention, fewer than half of trainees felt comfortable.

A pilot clinical skills coaching program to reimagine remediation: a cohort study

Background New approaches are needed to improve and destigmatize remediation in undergraduate medical education (UME). The COVID-19 pandemic magnified the need to support struggling learners to ensure competency and readiness for graduate medical education (GME). Clinical skills (CS) coaching is an underutilized approach that may mitigate the stigma of remedial learning. Methods A six-month CS coaching pilot was conducted at Harvard Medical School (HMS) as a destigmatized remedial learning environment for clerkship and post-clerkship students identified as ‘at risk’ based on objective structured clinical examinations (OSCE). The pilot entailed individual and group coaching with five faculty, direct bedside observation of CS, and standardized patient encounters with video review. Strengths-based coaching principles and appreciative inquiry were emphasized. Results Twenty-three students participated in the pilot: 14 clerkship students (cohort 1) and 9 post-clerkship students (cohort 2). All clerkship students (cohort 1) demonstrated sustained improvement in CS across three OSCEs compared to baseline: at pilot close, at 6-months post pilot, and at 21-24 months post-pilot all currently graduating students (10/10, 100%) passed the summative OSCE, an HMS graduation requirement. All post-clerkship students (cohort 2) passed the HMS graduation OSCE (9/9,100%). Feedback survey results included clerkship students (9/14; 64%) and post-clerkship students (7/9; 78%); all respondents unanimously agreed that individual coaching was “impactful to my clinical learning and practice”. Faculty and leadership fully supported the pilot as a destigmatized and effective approach to remediation. Conclusion Remediation has an essential and growing role in medical schools. CS coaching for remedial learning can reduce stigma, foster a growth mindset, and support sustained progress for ‘at risk’ early clerkship through final year students. An “implementation template” with suggested tools and timelines can be locally adapted to guide CS coaching for UME remediation. The CS coaching pilot model is feasible and can be generalized to many UME programs.