Standardized Patient Interaction Research Articles

Standardized patient interactions improve dental student confidence following procedural errors.

Standardized patient interactions improve dental student confidence following procedural errors.

Exploring The Impact of Acceptance and Commitment Based Cultural Humility Training on Standardized Patient Interactions: Revisiting the Measurement Process.

Recent findings in health sciences and medical education highlight the importance of training healthcare professionals to interact with their patients in a culturally humble manner (Nadal et al., in Journal of Counseling and Development 92: 57-66, 2014; Pascoe & Smart Richman, in Psychological Bulletin 135: 531, 2009; Sirois & Burg, in Behavior Modification 27: 83-102, 2003; Williams & Mohammed, in Journal of Behavioral Medicine 32: 20-47, 2009). An important piece in the progression of our ability to address training challenges is the assessment of cultural humility. As an extension of previous research (Lombardero et al., in Journal of Clinical Psychology in Medical Settings, 30: 261-273, 2023), this study implemented an evidence-based cultural humility intervention (based onAcceptance and Commitment Training) to improve medical students' interactions with standardized patients (SPs) which was assessed via direct behavioral observation. Specifically, the observational measurement system was focused on culturally humble responses to patients reporting microaggressions to the medical professional. A pre-post comparison of the results demonstrated statistically significant improvements pertaining to participants' culturally humble responses to SPs' reports of microaggressions for one of the measurement scales used (i.e., ARISE), but not the other (i.e., Responsiveness to Racial Challenges Scale). Further analyses, on the bottom quartile of performers, were conducted to assess a possible ceiling effect of the scale that did not demonstrate significant change. These results and implications for future research will be discussed.

An Interactive Online Interprofessional Opioid Education Training Using Standardized Patients.

Opioid pain management is complex and requires a collaborative approach. To prepare health professions students to care for patients who have chronic pain, we developed an interprofessional education (IPE) session for delivery using a virtual platform that featured a standardized patient (SP) interaction. The SP case highlighted a patient on opioids for chronic low back pain resulting from a car accident. Despite no improvement in pain or function, the patient continued taking opioids and developed behaviors that could represent opioid misuse. During the synchronous, online session, interprofessional teams of students interviewed an SP and collaborated to develop a holistic care plan to address the patient's pain and potential opioid misuse. The session evaluation included pre- and postsession surveys. Over 750 students from medicine, pharmacy, nursing, and social work programs participated in the virtual IPE sessions during a single year. Students rated the session positively. Matched survey responses suggested improved confidence in knowledge and skills, and learning through Zoom was rated favorably. We successfully implemented a synchronous online IPE session involving SP interactions that allowed students to practice team-based care of a patient with chronic pain who was taking opioids. Based on the success of this IPE session, including the success of the online delivery model, future IPE sessions will continue virtually.

The Role of Videotaped Clinical Skills Aggregated Peer Evaluations in the Enhancement of Evaluation Skills of Individual Medical School Faculty Members.

The conventional methodology for appraising medical students has some limitations like inherent subjectivity, unstructured nature, and bias.Implementing the Objective Structured Clinical Examination (OSCE) can mitigate these shortcomings.However, the OSCE presents challenges, including substantial financial costs and time-intensive processes, particularly when assessing a large cohort of students.Consequently,an alternative assessment was needed to keep the advantages of OSCE and mask its limitations, especially in resource-constrained settings.In addition, many scholars have expressed concern over medical students' and interns' inadequate interviewing and physical examination competencies in recent years. Due to easy availability, videotaping is a convenient method for objectively observing students for aggregate review by faculty in order to ascertain what exactly faculty are assessing during medical student evaluations.This technique allows for aggregate faculty group improvement inthe ability of educators to assess students' technical proficiency, data collection capabilities,standardized patient interaction demeanor, and strategies for fostering standardized patient comfort.Nonetheless, aggregate evaluation of videotape recordings for faculty assessment development or reliance on verbal feedback from medical students about faculty's ability to assess student skill is a matter of debate. Due to increased subspecialization, the subspecialist or specialist examiners face difficulties in assessing students' skills in specific and/or generalized domains.Despite these challenges, assessing the ability of faculty members' observation and subsequent evaluation of medical trainees remains a vital aspect of assessment throughout various specialties.This paper presents the concept of faculty members individually observing and rating premade recordings of standardized students performing clinical skills for evaluation so that when the individual faculty members' ratings are aggregated and summarized collectively for evaluation by the faculty members as a group, both the group and the individual faculty members will gain a greater understanding of what are appropriate ratings versus outlier ratings.

Integration of Sex and Gender Minority Standardized Patients into a Workshop on Gender-Inclusive Patient Care: Exploring Medical Student Perspectives.

Sexual and gender minority (SGM) communities experience significant health disparities. Although coverage of health issues specific to these communities has increased in the undergraduate medical curriculum, there is still opportunity for improved teaching about sexual diversity and inclusive care. The goal of this study was to assess students' perceptions of and satisfaction with a half-day workshop focused on sexual history taking and transgender health. The second-year clinical skills course at the Florida International University Herbert Wertheim College of Medicine includes a sexual history workshop that starts with a 1-hour lecture on sexual history taking. This is followed by a faculty-facilitated small group session during which students interview an SGM patient and debrief about this experience. In 2020, for the first time, the standardized patients were members of the SGM community, and the session was on Zoom. Students completed an optional, anonymous postsession survey assessing the workshop. Students overwhelmingly believed that the integration of SGM standardized patients into the session helped improve their knowledge, attitudes, and skills related to providing care for this population. They noted that the standardized patient interaction and debriefing were the most beneficial parts of the session. Given the positive feedback, future iterations of this session will continue to use the SGM community as standardized patients. In addition, student competency related to SGM patient care will be assessed through observed structured clinical examinations.

Measurement of primary care providers' suicide prevention skills following didactic education.

Almost half of individuals who die by suicide have had contact with primary care (PC) services within 1month of their death. PC providers must be able to assess and manage patients' suicidal ideation, intent, and behaviors. When didactic training is provided to providers, it is assumed that their requisite skills are well developed. The current study assessed observed skills following high-quality online didactics. Medical residents and nurse practitioner (NP) trainees (n=127) participated in online didactic training as part of their education program, followed by a standardized patient interaction conducted to assess demonstrated suicide prevention skills (i.e., assessment of risk factors, protective factors, suicidal ideation and behavior, safety planning). Participants demonstrated only about 50% of the possible total skills in most domains and were least competent in assessing potential risk for suicide. Regression analyses showed that residents were rated significantly higher than NPs on observed skills. Personal experience with suicide was not associated with any observed skills. Baseline knowledge scores were positively associated with some skills while elapsed days since completion of didactics were negatively associated with skills. Didactics were insufficient for building suicide-specific assessment skills among physicians and nurses in advanced training.

Assessment of professionalism and ethics among final year part I undergraduate students of Kurnool Medical College, Kurnool, Andhra Pradesh

Background: Professionalism is a core competency of physicians. Erstwhile Medical Council of India envisioned competency-based medical education with Attitude, Ethics and Communication module as its forerunner. Objectives: The aim of this study was to objectively assess professionalism and ethics (P&E) by introducing multiple choice questions (MCQs) and Professionalism Mini-Evaluation Exercise (PMEX) as P&E assessment tools for MBBS students, by sensitizing the faculty and students. Materials and Methods: A mixed-method study was conducted during June to December 2019, among final MBBS part I undergraduate students, posted in the Department of Community Medicine, Kurnool Medical College, Kurnool. After obtaining IEC clearance and written informed consent from the study participants, a 3-day workshop on P&E was conducted with interactive teaching session on day 2, pretest on day 1, and posttest on day 3, in the form of five standardized patient interactions in OSCE stations rated using PMEX tool and five response stations for MCQs. Descriptive and inferential statistical analysis was done in IBM SPSS version 21.0 to see difference in pre- and posttest scores. Qualitative analysis using manual thematic coding was done to assess the perception of faculty and students. Results: A statistically significant difference in means was observed in pretest and posttest scores using PMEX tool (t test = −22.12, P value = 0.0001). 75% of students considered MCQs and PMEX as a feasible tool, out of a total of 29 study participants. Conclusion: MCQs and PMEX are effective tools to assess P&E among medical undergraduate students.

A Comparison of Doctor of Physical Therapy Students' Self-Reported Empathy With Standardized Patients Perceptions of Empathy During a Simulated Telehealth Encounter.

Empathy is an important factor in developing a positive patient–provider relationship. It has been shown to lead to improved patient outcomes, well-being, and satisfaction. This study examines the relationship between first-year physical therapy students’ self-reported empathy levels and a patient's perceptions of caregiver empathy during a standardized patient interview via telehealth. Forty-five students completed a self-reported empathy survey before the standardized patient encounter using telehealth. Following the experience, standardized patients rated the perceived empathy demonstrated by the students during that patient–provider encounter using 2 validated measures. The mean student self-reported empathy using the Jefferson Scale of Empathy-Health Care Provider Student (JSE-HPS) version was 123.93 (range 95-135 SD 7.328). The standardized Jefferson Scale of Patient Perception of Provider Empathy (JSPPPE) scores showed a mean of 23.8 (range 11-32 SD 3.951) and a mean of 3.16 (range 1-5 SD.85) on the Global Rating of Empathy (GRE). There was no significant correlation found between the JSE-HPS and the JSPPPE, r = −.47, P = .760, or the GRE r = −.166, P = .276. The artificial nature of a standardized patient interaction using the telehealth format for this encounter may have contributed to the students’ inability to communicate empathy to the patient and may explain this discrepancy.

127 Caution and Context: COVID-19 as the Educational Focus for Inter-Professional Learning

Traditionally our university-affiliated Office of IPE delivers a 3-phase (exposure, immersion, competence) inter-professional education (IPE) curriculum which is a graduation requirement for students. On 13 March 2020, on-site classes were suspended due to the first confirmed case of COVID-19 in the state. Faculty rapidly implemented alternative methods of instruction to complete coursework for the spring semester utilizing COVID-19 as the educational focus and hosting these learning events on the virtual platform.The aim of the study was to lean into the educational opportunities provided by the global pandemic to continue to provide high-quality IP education including simulation, crafting these educational events to meet the pandemic needs of our community.During the COVID-19 pandemic, healthcare students and faculty stepped forward with a desire to serve during this health crisis. Several public health support programmes were provided by the academic health centre and IP educational activities were crafted around these. Such programmes included: a 1–800 COVID-19 hotline providing rapid access to health screening to assist the community in understanding when and where they should access the healthcare system for testing or care; a Contact Tracing Call Center to identify those with exposure and risk and counsel next steps; and provision of public health information regarding the virus and the vaccine. IP Faculty developed a series of IP simulations to provide students with the knowledge and skills necessary to serve in these public health support areas. These simulations were all structured utilizing an initial brief (detailing Interprofessional Education Collaborative (IPEC) domains and Patient- and Family-Centered Care principles), followed by scenario-specific education such as IP team review of screening algorithm and decision tree for hotline and call centre work, with subsequent standardized patient (SP) interaction, and finally IP debriefing. Five simulations involving 190 students occurred. Evaluation metrics collected included pre-/post-Interprofessional Collaborative Competencies Attainment Survey (ICCAS), evaluation of learning objectives, SP interaction and simulation methodology via Likert scale, and identification of themes from qualitative response items.Inter-professional simulation training activity via an online platform supported student learning for COVID-19 disease information, screening algorithm and decision tree tools and telemedicine delivery. The rapidly implemented virtual training prepares students to graduate whilst also supporting the state during this public health crisis. This work provides a template by which curricula can pivot to meet the needs of all key stakeholders during a time of global crisis.

In Response.

In Response.

Self-Confidence and Perceptions of Athletic Training Students Following Simulated Experiences: A Mixed-Methods Pilot Study

Purpose: Athletic training clinical education provides students with a variety of real-life patient encounters under the supervision of a credentialed athletic trainer. However, clinical education experiences may not allow for all students to practice more invasive or less common skills such as rectal thermometry. The purpose of this study was two-fold: 1) determine the effect of a series of low to high-fidelity simulated rectal thermometry experiences on athletic training students’ self-confidence scores; and 2) through a phenomenological qualitative approach, explore athletic training students’ perceptions following the simulated rectal thermometry experiences. Method: This study used a quasi-experimental, mixed methods, one-group repeated measures design. Participants were nine first year professional Master of Athletic Training students who completed four simulated experiences on the skill of rectal thermometry. The outcome measures were The Athletic Trainer’s Self-Confidence Scale (ATSCS) and qualitative semi-structured open-ended interviews. Results: Friedman’s ANOVA revealed a statistically significant improvement from the participant’s baseline ATSCS scores to the last post-test scores. We identified three major themes following qualitative interviews: 1) Perception changes before and after participation; 2) Benefits of a series of four simulations; 3) Explanations for the improvements in confidence and competence. Conclusions: A series of simulated learning activities using high-fidelity and standardized patient interactions can help improve athletic training students’ self-confidence. Though future research is needed, athletic training education programs should consider implementing simulated experiences to equip athletic training students to transition to practice.

Expanding the Traditional History and Physical Examination to Address Chronic Diseases and Social Needs: A Multisite Randomized Control Trial of 4 Medical Schools

This study gathers validity evidence of an expanded History and Physical examination (H&P 360) to address chronic diseases through incorporation of biopsychosocial elements that are lacking in traditional H&P assessments via a multisite randomized controlled trial among medical students. Third- and fourth-year medical students (n = 159) at 4 schools participated in an Objective Structured Clinical Examination designed with 2 cases for chronic disease. Students were randomized into the treatment group, which involved brief written instructions on how to use the H&P 360 followed by a standardized patient (SP) interaction, or the control group, which used the traditional H&P in an SP interaction without additional instructions. Validity evidence was gathered for content (alignment with an empirically derived expanded history list), response process (feedback from raters and learners on the process), internal structure (reliability and item-level psychometrics), relations to other variables (comparison between treatment and control groups), and consequences (survey results from learners on experience). H&P 360 items were blueprinted by faculty experts. SP observation checklist grading was consistent, and postassessment debrief confirmed favorable educational experience among learners. The reliability of the H&P 360 was .76. Overall mean scores on the H&P 360 content (mean = 15.96, standard deviation [SD] = 3.66) were significantly higher compared with the traditional H&P (mean = 10.99, SD = 2.69, Cohen's d = 1.17, P < .001). Medical students using the H&P 360 collected significantly more biopsychosocial information compared with students using the traditional H&P, providing empirical support for teaching and assessing biopsychosocial information. The assessment demonstrated strong validity evidence supporting the use of the H&P 360 assessment in medical schools.

University of Michigan Medical School.

University of Michigan Medical School.

Addressing the Rapidly Increasing Need for Telemedicine Education for Future Physicians.

As the COVID-19 pandemic affected the ability to conduct in-person sessions to teach clinical skills, our medical school developed a curriculum to introduce first-year medical students to telemedicine visits, while also reinforcing their history-taking and clinical reasoning skills. All first-year medical students at Florida Atlantic University went through three sessions on telemedicine that began with a lecture, followed by a standardized patient interaction, then a small group meeting with clinical faculty. We assessed the sessions using survey questions on a 5-point Likert scale and additional narrative feedback. We also assessed students on a telemedicine objective structured clinical examination (OSCE) at the end of the semester and compared results to the previous year's same case done in person. Students overall found the sessions helpful for refining their history-taking skills and that the knowledge gained would be helpful in their future practices. They felt the online platform was a useful way to interact with patients, but had frustrations with technical difficulties. They also expressed a greater appreciation for the ability to perform an in-person physical examination. Students performed similarly on the OSCE station in person compared to virtual visits (mean score 93% vs 93.75%). Introducing telemedicine during a first-year medical school clinical skills course provides students with opportunities to refine their clinical skills while introducing a skill that will be commonplace in the postpandemic environment. This curriculum could be adopted not only during a time of necessary distance learning, but also continued as in-person education resumes.

Texas Tech University Health Sciences Center School of Medicine, Lubbock.

Texas Tech University Health Sciences Center School of Medicine, Lubbock.

Attitudes to psychiatry and to mental illness among nursing students: Adaptation and use of two validated instruments in preclinical education.

Stigma towards psychiatry and people with serious mental illness (SMI) is prevalent among healthcare providers and can adversely affect patient care. Internalized stigma among nurses can affect personal self-care and limit help-seeking behaviours. Stigma around mental health nursing can adversely affect recruitment into this already underserved field. This is the first report on the adaptation and use in a nursing student sample of two widely used stigma-related instruments that have been normed among medical students. The attitudes to psychiatry (ATP-30) and the attitudes to mental illness (AMI) instruments proved sensitive to change and can be useful in tracking specific anti-stigma curricular interventions. Interactive and participatory student activities in courses such as ours (that include simulation with standardized patients, clinical placements and patient interaction) need to be complemented by exposure to individuals with lived experience with mental illness in order to address stigmatized views of SMI. Nursing educators and fellow nurses willing to share their own experiences with mental illness-including diagnosis, health-seeking, treatment and recovery-may prove especially powerful and germane during nursing school. Even a strong academic curriculum is not sufficient to change stigmatized perceptions about mental illness, psychiatric care and mental health nursing as a profession. Comparison and potential synergy between ATP-30, AMI and OMS-HC (Opening Minds Scale for Health Care Providers) could prove fruitful in identifying a more comprehensive approach to stigma assessment over time. The addition of validated instruments, such as the Self-Compassion Scale-Short Form (SCS-SF) and the Self-Stigma of Seeking Help (SSOSH), which tap into internalized stigma and into health-seeking behaviours and intervening barriers could prove particularly useful in evaluating innovative interventions for stigma-decreasing initiatives in nursing education. Interactive and participatory didactic offerings need to be complemented by exposure to individuals with lived experience with mental illness and ideally to nursing educators and practicing nurses willing to share their histories of diagnosis, help-seeking, treatment and recovery. Introduction Stigma towards psychiatry and to people with serious mental illness (SMI) is prevalent among healthcare providers and can adversely affect patient care. Such stigmatized views can adversely affect recruitment into the already underserved field of mental health nursing. Aim/question We adapted two stigma-related instruments in a sample of nursing students and examined change in scores after participation in an eight-week preclinical psychiatry curriculum. Our goal was to identify stigma-malleable opportunities that would inform refinements in future iterations of a preclinical psychiatry curriculum in nursing. Method We made minor adaptations to the attitudes to psychiatry (ATP-30) and the attitudes to mental illness (AMI) instruments. We invited first-year nursing students to complete assessments at two time points: before and after completion of an eight-week core course in preclinical psychiatry. Results Seventy-one students completed the assessment at both time points. ATP-30 and three of its eight subscale scores improved by course's endpoint. By contrast, AMI scores did not change. Compared with medical student published norms, nursing students in our sample had higher (less stigmatized) average scores. Discussion The ATP-30 and the AMI can be easily adapted to a nursing student population and may prove useful in tracking specific anti-stigma educational interventions. Implications for practice A general psychiatry course during nursing school is, it and of itself, unlikely to change biased views about SMI and should be enhanced with exposure to, and interaction with individuals with lived experiences of mental illness, ideally by nurse educators and practicing nurses.

The impact of standardized patient interactions on nursing students’ preventive interventions for pressure ulcers

AimThis study was performed as a quasi-experimental study using a standardized patient simulation program in order to explore the effects of education on the performance and knowledge of undergraduate nursing students with respect to pressure ulcer prevention. MethodsThe study sample consisted of 38 students who completed the study. After the theoretical education portion, the students first knowledge and performance scores were evaluated with the standardized patient program. Demonstration education with the standardized patient and a second standardized patient practice were then performed. Afterwards, a debriefing session was held under the supervision of the researcher. After three months, the second knowledge and performance score evaluation was performed with the standardized patient. Knowledge and performance scores were compared after theoretical training and three months after simulation training. ResultsThe mean score of 38 students were 43.68 ± 9.06 and 75.92 ± 16.84 on the pre- and post-tests, respectively. Preliminary points were significantly lower than post-test points (p < 0.001). The median performance score was 7.89 (min–max: 0–73.68) in the first simulation and 86.84 (min–max: 63.16–100.00) in the second simulation. There was a statistically significant change between the two performance scores (p < 0.001). ConclusionIn this study, it was determined that the level of knowledge and performance persisted in the evaluations after comprehensive training using standardized patient simulations. This study confirmed standardized patient practice as an efficient learning modality for nursing students in the long-term.

A randomized controlled trial of suicide prevention training for primary care providers: a study protocol

BackgroundSuicide is a national public health crisis and a critical patient safety issue. It is the 10th leading cause of death overall and the second leading cause of death among adolescents and young adults (15–34 years old). Research shows 80% of youth who died by suicide saw their primary care provider within the year of their death. It is imperative that primary care providers develop the knowledge and skills to talk with patients about distress and suicidal thoughts, and to assess and respond in the context of the ongoing patient - primary care provider relationship.MethodsThis study examines the effectiveness of simulation on suicide prevention training for providers-in-training by comparing two conditions: 1) a control group that receives online teaching on suicide prevention in primary care via brief online videos and 2) an experimental group that includes the same online teaching videos plus two standardized patient (SP) interactions (face-to-face and telehealth, presentation randomized). All SP interactions are video-recorded. The primary analysis is a comparison of the two groups’ suicide prevention skills using an SP “test case” at 6-month follow-up.DiscussionThe primary research question examines the impact of practice (through SP simulation) over and above online teaching alone on suicide prevention skills demonstrated at follow-up. We will assess moderators of outcomes, differences among SP simulations (i.e., face-to-face vs. telehealth modalities), and whether the experimental group’s suicide prevention skills improve over the three SP experiences.Trial registrationThe study was registered on Clinical Trials Registry (clinicaltrials.gov) on December 14, 2016. The Trial Registration Number is NCT02996344.

The role of metacognition in teaching clinical reasoning: Theory to practice

The ability to think critically in an uncertain and complex health-care environment is a paramount skill needed for health profession students to transition to clinical practice. Experts and educators in health profession education have unintentionally created confusion regarding operationalizing critical thinking, clinical reasoning, and clinical decision-making. In the purest form, health profession educators are referencing the cognitive abilities of a clinician to transfer thinking skills from an academic to a clinical setting. The problem with teaching clinical reasoning in health professions is that the ability to transfer knowledge and skill to patient care is often inefficient. Metacognitive awareness provides a theoretical and practical construct to make previously unconscious cognitive processes overt. The benefit of integrating and scaffolding pedagogical practices to emphasize explicit student knowledge and regulation of cognition may benefit health profession educators in teaching future clinicians how to handle cognitively complex problems. Making clinical reasoning overt through metacognitive awareness provides health profession educators a framework which helps to teach and assess cognitive strategies associated with clinical reasoning. Metacognitive awareness operationalizes a complex construct to allow a definitive way for health profession educators to instruct the cognitive system, resulting in enhanced clinical reasoning. Learning the components of metacognitive awareness is essential to a solid foundation for students and faculty. As students receive further instruction and feedback on cognitive strategies, the potential exists to improve metacognitive judgments. Case-based learning, simulated and standardized patient interactions, and experiential learning all provide pedagogical tools to promote metacognitive awareness in health profession students. Through serial assessment of metacognitive awareness, health profession educators may also gain valuable insight into how students develop cognitive strategies for future clinical reasoning. The increased ability to plan and evaluate cognitive processes may aid health profession students and educators in attaining more meaningful thinking for complex problem-solving in clinical practice.

Distance Versus On-Site Educational Strategies for Competency-Based Screening, Brief Intervention, and Referral to Treatment Education.

Although the individual and public health consequences of alcohol and drug use are substantial, nursing education programs generally lack content on addiction. The goal of this evaluation was to compare the initial outcomes of on-site versus distance methods for training graduate nurse practitioner students in Screening, Brief Intervention, and Referral to Treatment (SBIRT) for substance use. A nonrandomized two-group pretest-posttest design was used to compare knowledge, attitudes, and skills learning outcomes between on-site (n = 45) and distance (n = 18) family or adult/geriatric Master of Science in Nursing nurse practitioner students receiving SBIRT training. Overall, students increased their knowledge, attitudes, and confidence about screening and intervening with patients who use substances; showed a high level of skills in conducting a brief intervention to motivate patients to reduce their substance use; and were highly satisfied with the education provided. Counseling confidence and gains in knowledge were similar across groups. Compared with distance students, on-site students reported significantly more positive attitudes about their role adequacy, role legitimacy, and role support for intervening with alcohol use and about their role support for intervening with drug use. On-site students had greater training satisfaction, but distance students' skills assessed through standardized patient interactions were significantly better. Both on-site and distance training were effective instructional methods to increase SBIRT knowledge and skills. However, differences in attitudes, training satisfaction, and skills demonstration should be taken into account when designing addiction training using distance technologies.