Standardized Patient Interaction Research Articles

SBIRT Training in Social Work Education: Evaluating Change Using Standardized Patient Simulation

A grand challenge for social work is addressing widespread public health problems of alcohol misuse. MSW students (n = 83) received Screening, Brief Intervention, and Referral to Treatment (SBIRT) training through didactic sessions, role plays, and pre–post videotaped standardized patient (SP) interactions. SBIRT knowledge, self-reported practice behaviors, and confidence were assessed at pretest, 30 days, and 6 months posttest. Videos were coded to assess intervention-adherent behaviors. General linear mixed models analyzed changes. Participants demonstrated increased adherence to SBIRT behaviors, and knowledge, skills, and confidence increased posttraining. Findings suggest SBIRT training increases students’ capacity to implement evidence-based interventions designed to reduce alcohol misuse.

Supporting the Call to Action: A Review of Nutrition Educational Interventions in the Health Professions Literature and MedEdPORTAL.

Despite calls to improve nutrition education, training for medical students is inadequate. This systematic review provides an overview of published educational interventions for undergraduate-level health professionals and makes recommendations for improving nutrition training. The authors conducted a systematic review of articles (through July 16, 2015) and examined resources in MedEdPORTAL (through September 28, 2015) focused on materials published since January 2004 that describe nutrition educational interventions for undergraduate-level health professionals. The authors extracted data on pedagogical characteristics, content areas covered, study design, and study outcomes. Of 1,616 article citations, 32 met inclusion criteria. Most were designed at a single institution (n = 29) for medical students (n = 24). Of 51 MedEdPORTAL resources, 15 met inclusion criteria. Most were designed at a single institution (n = 12) for medical students (n = 15). Interventions spread across several countries, learner levels, and settings. Content areas covered included basic science nutrition, population health, counseling, and training framed by specific patient populations and organ systems. No clear trends were observed for intended learning outcomes, type of instructor, method of instruction, or duration. The heterogeneity of interventions and the content areas covered highlight the lack of adopted curricular standards for teaching clinical nutrition. Recommendations that educators should consider include interprofessional education approaches, online learning, placing an emphasis on learners' personal health behaviors, and standardized and real patient interactions. Educators should continue to publish curricular materials and prioritize the evaluation and sharing of resources.

Using Virtual Patients to Teach Empathy: A Randomized Controlled Study to Enhance Medical Students' Empathic Communication.

Physician empathy is a complex phenomenon known to improve illness outcomes; however, few tools are available for deliberate practice of empathy. We used a virtual patient (VP) to teach empathic communication to first-year medical students. We then evaluated students' verbal empathy in a standardized patient (SP) interaction. Seventy medical students, randomly assigned to 3 separate study groups, interacted with (1) a control VP portraying depression, (2) a VP with a backstory simulating patient shadowing, or (3) a VP able to give immediate feedback about empathic communication (empathy-feedback VP). Subsequently, the students interviewed an SP portraying a scenario that included opportunities to express empathy. All SP interviews were recorded and transcribed. The study outcomes were (1) the students' verbal response to the empathic opportunities presented by the SP, as coded by reliable assessors using the Empathic Communication Coding System, and (2) the students' responses as coded by the SPs, using a communication checklist. There were no significant differences in student demographics between groups. The students who interacted with the empathy-feedback VP showed higher empathy in the SP interview than did the students in the backstory VP and the control VP groups [mean (SD) empathy scores coded on a 0-6 scale were 2.91 (0.16) vs. 2.20 (0.22) and 2.27 (0.21), respectively). The difference in scores was significant only for the empathy-feedback VP versus the backstory VP group (P = 0.027). The SPs rated the empathy-feedback and the backstory VP groups significantly higher than the control VP group on offering empathic statements (P < 0.0001), appearing warm and caring (P = 0.015), and forming rapport (P = 0.004). Feedback on empathy in a VP interaction increased students' empathy in encounters with SPs, as rated by trained assessors, whereas a simulation of patient shadowing did not. Both VP interventions increased students' empathy as rated by SPs, compared with the control VP group.

Undergraduate education in palliative medicine in Germany: a longitudinal perspective on curricular and infrastructural development.

BackgroundIn 2009, palliative medicine became an integrated and compulsory part of undergraduate training in Germany by legislation. After a transitional period, all medical faculties were required to provide adequate teaching with an according examination and certification procedure. In parallel, we conducted bi-annual surveys on all medical faculties in Germany to examine for potential discrepancies between the implementation process and their intended consequences on teaching time and content.MethodsFour consecutive bi-annual surveys (2006, 2008, 2010, 2012) of all 36 medical faculties in Germany were performed, using purposively for this study developed questionnaires. Likert scales and closed questions were analyzed descriptively.ResultsMedical Faculty response rate increased from 50 % in 2006 to 88.9 % in 2012. Teaching coordinators in palliative medicine primarily had an anesthesiology or internal medicine background. There was a noted increase over time of the involvement of specialized palliative care units (PCUs) as providing the setting for education. The number of faculties that were able to offer a complete 16 weeks of training in palliative medicine during the “final year” rose steadily. In addition, increased patient-centered teaching formats have been implemented over time. The faculties which offered innovative teaching formats with actors as patients (standardized patient interaction) increased, as did the total number of mandatory examinations. The number of faculties that provided compulsory teaching in a condensed manner within a single academic year increased sharply from 3 of 31 responding faculties in 2010 to 19 of 32 responding faculties in 2012.ConclusionsUntil now, teaching conditions and structures in palliative medicine in Germany have proven to be extraordinarily heterogeneous. Although professorships (“Chairs”) in palliative medicine proved to be particularly beneficial and supportive in curricular and structural development, only a minority of faculties provide leading academic positions in palliative medicine.

Changes in Student Performance and Confidence with a Standardized Patient and Standardized Colleague Interprofessional Activity

To assess the impact of a standardized patient and standardized colleague interprofessional activity on student performance and perceived confidence in communicating with patients and physicians. Students in the third professional year were presented with a practice and final activity including a standardized patient interaction, SOAP note preparation, and standardized colleague interaction. Student performance was measured by assessment rubrics on practice and final activities. Students' perceived confidence was measured via presurvey and postsurvey. Students performed significantly better from the practice to the final activity with regard to communicating with patients, SOAP note, and the overall activity with a mean difference (95% CI) of 9.2 (6.9-11.5), 3.6 (1.3-5.8), and 3.9 (2.0-5.7), respectively. There was a positive significant change from presurvey to postsurvey in students' confidence talking to patients and physicians on majority of questions. This study demonstrates that active learning and integrated assessments improve overall student performance. Integration of interprofessional education also has positive effects on students' perceived confidence.

Resident handoff training: initial evaluation of a novel method.

Residencies are required to have a standardized process for transitioning patient care. This study was designed to assess a novel method of training and evaluating handoffs using both a lecture format and standardized patient (SP) interactions. Matched group design was used to randomly assign interns to trained versus control groups, with the trained group receiving formal handoff training before SP encounters. The residents evaluated three ER SPs and read four written scenarios and then transitioned patients to an SP acting as a resident. All handoffs were videotaped and scored by two blind raters using a rating scale developed based on specialist's interviews. Thirty-two interns were included in the study. The trained interns performed significantly better with lower scores on patient handoffs (mean = 10.08, SD = 2.46) than the untrained interns (mean = 16.56, SD = 2.79). There was also a significant effect for case, with the ER SP cases (mean = 12.23, SD = 14.41) resulting in better performance than the written cases in both surgery and pediatrics (mean = 14.41, SD = 4.29). A protocol was designed and implemented for training residents to perform handoffs, with initial results showing that the curriculum is effective.

Brief Educational Intervention to Improve Medical Student Competence in Managing Patients Exposed to Secondhand Smoke

ABSTRACT. Background: Secondhand smoke (SHS) exposure may lead to the development of various diseases and conditions. One way to reduce SHS exposure is to screen for it within each primary care examination so that appropriate counseling can be directed to affected individuals. There has been little attention to improving medical education about SHS exposure and screening. The goal of this study was to develop an SHS-related educational intervention for medical students, with the purpose of improving knowledge regarding consequences of SHS exposure, and increasing intent to screen patients for exposure. Methods: Medical students (N = 405) were given a measure assessing their knowledge of SHS exposure and intent to screen. Two groups of students served as controls (i.e., a posttest-only group and a pre/posttest group), and one group participated in the SHS education intervention. A factorial analysis with repeated measures and chi-square analyses were used to assess the differences between the groups to determine the impact of the SHS education intervention (ie, online lectures and a standardized patient interaction) on knowledge and intent to screen. Results: Results of pretesting demonstrated that medical students had little knowledge of SHS exposure, averaging scores between 63% and 69% on the examination. One control group was reassessed a year later with no educational intervention. They did not demonstrate a significant change in their pre- to posttest scores, although the vast majority (∼95%) reported intending to screen future patients. Students who participated in the SHS educational intervention significantly improved their scores from pre- to posttest (P <.001), and 100% also reported intending to screen future patients. Conclusions: This study suggests that brief education regarding the consequences of SHS exposure may improve medical students’ knowledge and increase intent to screen. Future research should assess the long-term impact of educational programs on improved clinical care.

Assessing Professionalism and Ethics Knowledge and Skills: Preferences of Psychiatry Residents

Professionalism is one of the fundamental expectations and a core competency in residency education. Although programs use a variety of evaluative methods, little is known about residents' views of and preferences regarding various methods of assessment. The authors surveyed residents at seven psychiatry residency programs in the United States regarding their attitudes on professionalism, ethics preparation, and evaluation in psychiatry residency training. This report describes their views on methods of assessing professionalism. Residents strongly agreed that clinical supervision is an appropriate assessment method. Moreover, they rated clinical supervision more highly than oral examinations, short-answer questions, essays, and standardized patient interactions. Residents also strongly favored direct faculty observation of residents' interactions with actual patients and clinical team members. This study suggests that both direct faculty supervision and other clinically-based assessments are methods accepted by psychiatry residents. Future research on the validity and effectiveness of these modes of assessment is needed.

End of Life Decisions: Using Lectures, Small Groups and Standardized Patients to Develop Communication Skills

Study Background: Teaching communication skills to medical students is necessary and challenging. Our aim was to enhance student confidence in and ability to communicate with patients and families, particularly in difficult and complex medical situations. Methods: Interactive didactics given to 146 third year medical students at the University of Colorado School of Medicine provided content and context for developing advanced communication skills. Students practiced these skills during standardized patient (SP) interactions involving 1) breaking bad news and 2) a family meeting to address goals of care. The course was assessed using: 1) student self-assessment, 2) SP assessment of student’s performance, and 3) results of the medical school graduation questionnaire. Results: Students felt better prepared to deliver bad news (93.9% either agreed or strongly agreed with this statement), manage family meetings (95.3% agreed or strongly agreed) and communicate with patients and families (95.3% agreed or strongly agreed). More than 80% of students consistently demonstrated key skills during SP encounters including: eliciting understanding, responding to emotion, and avoiding false reassurances. Four percent and 3% of students who completed this curriculum reported that they received inadequate palliative or end of life care instruction compared with 22% and 19% of all students nationally (respectively). Conclusion: A multimodal medical student curriculum in advanced communication skills is feasible and effectively teaches these skills.

Obesity Educational Interventions in U.S. Medical Schools: A Systematic Review and Identified Gaps

Background: Obesity is the second leading cause of preventable death in the United States. However, physicians feel poorly trained to address the obesity epidemic. This article examines effective training methods for overweight and obesity intervention in undergraduate medical education. Using indexing terms related to overweight, obesity, and medical student education, we conducted a literature searched PubMed PsycINFO, Cochrane, and ERIC for relevant articles in English. References from articles identified were also reviewed to located additional articles. Summary: We included all studies that incorporated process or outcome evaluations of obesity educational interventions for U.S. medical students. Of an initial 168 citations, 40 abstracts were retrieved; 11 studies were found to be pertinent to medical student obesity education, but only 5 included intervention and evaluation elements. Quality criteria for inclusion consisted of explicit evaluation of the educational methods used. Data extraction identified participants (e.g., year of medical students), interventions, evaluations, and results. These 5 studies successfully used a variety of teaching methods including hands on training, didactic lectures, role–playing, and standardized patient interaction to increase medical students’ knowledge, attitudes, and skills regarding overweight and obesity intervention. Two studies addressed medical student bias toward overweight and obese patients. No studies addressed health disparities in the epidemiology and bias of obesity. Conclusions: Despite the commonly cited “obesity epidemic,” there are very few published studies that report the effectiveness of medical school obesity educational programs. Gaps still exist within undergraduate medical education including specific training that addresses obesity and long-term studies showing that such training is retained.

Pharmacy Course on Women's and Men's Health

To design and implement an integrated course dedicated to women's and men's health. A women's and men's health module that integrated the basic and clinical sciences was developed and implemented as part of the core undergraduate pharmacy curriculum. Instruction included classroom lectures, large- and small-group case discussion, self-directed learning assignments, and case-based simulations with standardized patients, all of which focused on conditions impacting women's and men's health. Assessment of student learning included multiple-choice and written examinations using case vignettes when possible, evaluation of documentation of patient care process with standardized patient interactions, and group case assignments. Students appreciated the scope of topics, the active-learning opportunities, and use of simulated patients, as well as teaching by experts in the area. A mandatory course in women's and men's health was well received by students and ensured that these important issues were addressed in the undergraduate pharmacy curriculum.

Slicing it thin: New methods for brief sampling analysis using RIAS-coded medical dialogue

Objective To explore the relationship between one-minute slices and full-session interaction and the predictive validity of the slices to ratings of affect and rapport. Methods Third-year medical students ( n = 253) were videotaped during an OSCE. All interaction was coded using the Roter Interaction Analysis System (RIAS) and samples were drawn at minutes 1, 5, and 9 and extracted from the coded database. The slices were related in multivariate analysis to full-session interaction, corrected for slice content, and correlated with affect ratings of participants and independently rated judgments of rapport. Results One-minute slices explained 33% of full-session variance in student interaction and 30% of variance in standardized patient interaction. Slices were significantly correlated with affective ratings of participants and independent judgments of rapport in a similar pattern as full-session interaction analysis. Conclusions One-minute slices of interaction can provide a meaningful degree of insight into OSCE session communication with both concurrent and predictive validity to ratings of session affect and rapport. Practice implications Evidence of concurrent and predictive validity further supports use of this approach as a research tool that provides an efficient means of analyzing processes of care, examining variation in communication throughout a visit and predicting visit outcomes.

Integration of Standardized Patients in Clinical Simulation Education of Temple University Undergraduate Nursing Students

Undergraduate nursing students typically enjoy a rich variety of learning experiences provided in laboratories, classrooms, and in community and clinical settings. The diversity of learning models continues to expand with the evolution of information and health technologies. However, there is a clinical learning tool, frequently used in medical education, that most undergraduate nursing students in the United States have not had the benefit of experiencing. U.S. medical students routinely benefit from learning through the use of standardized patient interactions (SPI).

Medical student gender and issues of confidence

Objective To review the literature on gender differences and issues of self-confidence in medical students and to present original research on observers’ perceptions of medical student confidence. Methods One hundred forty-one 3rd year medical students at Indiana University School of Medicine were videotaped during their objective structured clinical examination (OSCE). Trained coders rated how confident the student appeared and coded a variety of nonverbal behaviors at the beginning, middle, and end of the interaction. Analysis focused on gender differences in coders’ ratings of perceived confidence. Results Female medical students were viewed as significantly less confident than male medical students ( F(1,133) = 4.45, p < 0.05), especially at the beginning of the interaction. Conclusion Past research indicates that despite performing equally to their male peers, female medical students consistently report decreased self-confidence and increased anxiety, particularly over issues related to their competence. In a standardized patient interaction examination situation, female medical students also appeared significantly less confident than male medical students to independent observers. Practice implications Medical educators should focus on issues of female students’ confidence, increasing faculty sensitivity, and publicly recognizing and discussing perceptions of confidence.

An evaluation of tobacco treatment specialist counseling performance using standardized patient interviews

In the United States, tobacco treatment specialists are professionals from a variety of backgrounds trained to deliver moderate to intensive evidence-based tobacco treatment in a variety of settings across the country. This paper reports the results of a study that examined the extent to which specialists participating in a larger study adhered to clinical practice guidelines for tobacco dependence using standardized patient assessments. A total of 64 tobacco treatment specialists completed a survey and two audiotaped standardized patient interviews. Overall, 41% and 31% of tobacco treatment specialists demonstrated 80% or more of session content and interviewing skills assessed, respectively, when required to demonstrate the skill in both standardized patient interactions. These rates increased to 85% and 56%, respectively, when using the less stringent criteria of demonstrating the skill in at least one of the two standardized patient interactions. Tobacco treatment specialists who had attended a greater number of types of tobacco treatment training exhibited both greater coverage of session content (p<.06) and greater interviewing skills (p<.02). Those who had achieved certification as a tobacco treatment specialist exhibited greater coverage of session content (p<.02), and those perceiving more positive support from their agency for their services exhibited greater interviewing skills (p=.02). Although the tobacco treatment specialists evaluated appear to have the necessary skills to deliver guideline-based intervention, they demonstrated only moderate adherence to the guidelines when expected to do so consistently across multiple assessments. Findings suggest specific components of tobacco treatment and interviewing skills that would benefit from strengthening through training and support.

Changes in Clinician Ability to Assess Risk and Help Patients Determine the Need for Hiv Testing

An estimated one of four people with HIV in the United States do not know they have the infection. The Centers for Disease Control and Prevention encourages HIV testing in clinical settings, but there is evidence that this is not done on a regular basis. The purposes of this study were to (a) compare two less traditional teaching methods with a classroom method to determine whether the less traditional methods resulted in greater improvement of clinician knowledge, skill, and willingness to perform HIV risk assessment as the basis for recommending HIV testing; and (b) find out whether there were significant differences in convenience, cost, learner preference, or learner acceptance that would make one method more desirable than the others. Findings from participants in the standardized patient interaction with facilitator feedback (FB) and the case-based self-study module (SSM) were not different from those of participants in the interactive classroom education method (CL). Generally, there were positive changes in knowledge, attitudes, and behaviors over time. Participants preferred standardized patient interaction (FB) and interactive classes (CL) to self-study modules (SSM).

Lecture versus standardized patient interaction in the surgical clerkship: a randomized prospective cross-over study

Background Medical schools increasingly are incorporating the standardized patient (SP) interaction as a teaching and testing modality to prepare students for United States Medical Licensing Examination Step 2 Clinical Skills. Although SP interactions provide a safe environment in which to practice clinical skills, little is known about medical students’ perceptions of the instructional SP interaction in comparison with the classic didactic lecture. We hypothesized that students would enjoy and value an instructional SP interaction more than a didactic lecture, and that this perception would be enhanced if the lecture immediately preceded the instructional SP interaction. Methods Students on the junior surgery clerkship from January to December 2004 were randomized into 2 groups. Group A (n = 71) received an hour-long didactic lecture about peripheral vascular disease followed by a 20-minute instructional SP interaction in which the SP portrayed a patient with lower-extremity claudication. Group B (n = 72) received the SP interaction first, followed by the lecture. All students received an identical quiz about peripheral vascular disease after the second educational encounter, whether the SP interaction or the lecture. Student perceptions were surveyed by written questionnaire before and after the session by using a 5-point Likert scale, with 5 being the most favorable rating. Data (perceptions, performances on the quiz and the SP interaction, clerkship grades) were compared using the Student t test or the Mann-Whitney rank sums test. Results Although all students on average enjoyed and valued the lecture more than the SP interaction ( P <.001), group A students enjoyed the SP interaction more than group B (3.3 ± .9 vs. 2.8 ± 1.0, P = .008), and they perceived the SP interaction as having more value to their overall education (3.3 ± 1.0 vs. 2.8 ± 1.0, P = .004). Group A students performed statistically better on the physical examination (66% ± 19% vs. 40% ± 16%, P <.001) and communication portions (90% ± 11% vs. 79% ± 12%, P <.001) of the SP checklist than group B, but not on the history portion. Student confidence in their own history and physical examination skills increased similarly for both groups. Conclusions The classic lecture format not only is enjoyed and valued as a learning tool more by our surgical clerkship students than the instructional SP interaction, but having a lecture just before an SP interaction increased perceived enjoyment and value of the SP interaction and enhanced performance on the SP checklist. These data suggest that educators can improve student perceptions and attitudes surrounding the instructional SP interaction by using strategically timed lectures.

Standardized Patients and Multidisciplinary Classroom Instruction for Physical Therapist Students to Improve Interviewing Skills and Attitudes About Diabetes

Background and Purpose. The purpose of this study was to enable physical therapist educators to evaluate the impact of multidisciplinary classroom instruction and a standardized patient interaction on physical therapist students' attitudes towards diabetes, and their confidence and skills in performing a physical examination and communicating with simulated patients. Method/Model Description and Evaluation. All aspects of the module were conducted cooperatively by faculty from physical therapist, nursing, physician assistant, and pharmacy education programs. Instruction covered patient interviewing, physical examination skills, diabetes risk factors, management, and complications, as well as a standardized patient interaction. Study subjects were 29 first-semester Master of Physical Therapy (MPT) students. Pre- and post-module surveys were completed by all subjects. Both surveys included the Diabetes Attitude Scale, 3rd version (DAS-3), and a set of self-perception statements. The postmodule survey included 8 evaluative statements about the education module. Outcomes. Four of the five DAS-3 subscales (need for specialized diabetes training, seriousness of type 2 diabetes, value of tight glucose control, psychosocial impact of diabetes, and patient autonomy) and statements about 5 of the 7 learning objectives showed a statistically significant change from baseline. Student satisfaction with this educational module was very good. Generally, students scored themselves lower than did the patients in regard to their interactions. Discussion and Conclusions. Multidisciplinary diabetes-focused instruction and a standardized patient interaction improved the attitudes about diabetes in these students. This type of education module was well received by students and helped build student confidence, knowledge, and skills related to diabetes, patient interviewing, and physical exam.

Didactic lecture versus instructional standardized patient interaction in the surgical clerkship

Background Medical schools increasingly employ the standardized patient interaction (SPI) as a teaching and testing modality to prepare students for USMLE Step 2 Clinical Skills (Step 2 CS). However, little is known about the perceptions medical students have toward SPIs. We hypothesized that the SPI would increase the self-confidence of surgery students in their history and physical examination (H&P) skills as compared with the classic lecture format and that students would perceive the SPI as a valuable learning tool. Methods Students (n = 126) on the junior surgery clerkship were randomized into two groups. Group A (n = 61) received a didactic lecture on acute appendicitis. Group B (n = 65) participated in an SPI in which the portrayed patient had acute appendicitis. Student perceptions were surveyed by written questionnaire pre- and postencounter using a 5-point Likert scale, with 5 being the most favorable rating. Data (perceptions, performances on the SPI, clerkship grades) were compared using a Student t test followed by the Mann-Whitney rank sums test. Results Group A “enjoyed” the lecture format more than group B “enjoyed” the SPI format (3.4 ± 0.1 versus 2.6 ± 0.1, P <.001) and perceived the lecture as having more value to their overall education (3.5 ± 0.1 versus 2.6 ± 0.1, P <.001) than the SPI group. Surprisingly, student self-confidence in their H&P skills increased after the didactic lecture (from 3.6 ± 0.1 to 4.1 ± 0.1, P = .001) but not after the SPI (from 3.6 ± 0.1 to 3.8 ± 0.1, P = not significant). Conclusions The didactic lecture format was not only enjoyed and valued more than the SPI, but our surgery students also perceived it as superior to the SPI in building confidence in history and physical examination skills. These findings suggest that surgical educators should develop ways to improve students’ perceptions and attitudes surrounding the surgical SPI.

Reflection on the Teaching of Ethics in Physical Therapist Education: Integrating Cases, Theory, and Learning

Background and Purpose. Engaging in the scholarship of teaching and learning (SoTL) in our classrooms is an important professional role and responsibility for physical therapist educators. In physical therapist education, there is an increased emphasis on the moral and ethical development of students, yet we know little about which learning tools work best. The purpose of this case study was to explore student learning in the teaching of ethics in physical therapist education. Case Description. Evidence for this case comes from the experiences of 3 classes of physical therapist students taking the ethics course from 2003 to 2005. Data sources for the case include data gathered from the following: (1) student debriefing/self-reflection responses following 2 videotaped standardized patient (SP) interactions centered on ethical problems; (2) student peer and self-assessments; (3) student pre- and post-test scores on a self-efficacy survey tool; and (4) instructor reflections on student learning. Outcomes and Discussion. Standardized patient interactions centered on ethical issues provided structured, authentic learning experiences and opportunities for students to grapple with uncertainty in the context of performance. Student performance did vary as those students who were extremely confident in the SP interaction also demonstrated less critical self-reflection on performance. All students demonstrated significant increases between pre and posttest scores on a self-efficacy ethics survey. This case study suggests the following about ethics education in the health professions: (1) one of the most important goals of ethics education may be facilitating development of students' reflective capacity as a critical element in their professional formation, and (2) learning experiences that have clinical authenticity may well be an important element of pedagogical content knowledge. Key Words: Ethics, Moral education, Reflection, Scholarship of teaching and learning. INTRODUCTION A few years ago, I was on a plane returning from the East coast, dreading the thought of having to read and comment on the student papers in my briefcase. These papers were student responses to reflection questions done directly following a standardized patient (SP) interaction. As I began to read the student papers, I realized that something was very different about them. I found myself totally captured by the students' responses and had no problem writing copious comments on their In fact, the man sitting next to me said, You know, you should be reading a book, not grading papers. I replied, Usually that is the case, but I had students do a new assignment and these papers are incredible - I never knew what students were thinking before. Although I have spent the last 20 years priding myself on my role of advocate for promoting methods of facilitating reflection in my students, this became a critical incident for me. I will never forget that moment of my own personal insight as I realized, perhaps for the first time, I had a deeper insight into what students were actually thinking. Over the last 3 years, I have engaged in a process of inquiry focused on student and instructor learning in the teaching of ethics in physical therapy. This inquiry process has been driven by collaborative conversations with a Carnegie Scholar on our campus about pedagogy in higher education, as well as my own desire to learn more about my teaching and enhance student learning. This paper is a case study representing a collaborative reflective analysis of the teaching of ethics. The first author (GJ) provides the case materials from the teaching of an ethics course and, together with the second author, a Carnegie Scholar (AR), provides a critical analysis of the case. Early in my teaching career in physical therapist education, I taught lecture and laboratory courses in the musculoskeletal area that had direct clinical application and perceived relevance to students. …