Standardized Patient Training Research Articles

Adapting standardized patient training to improve patients’ understanding and preparedness for health care encounters

ObjectiveTo examine the impact of standardized patient (SP) training on SPs' real-life healthcare encounters and explore whether SP training elements can be adapted to increase actual patients’ understanding, communication and participation in a patient-centered care model. MethodsData were collected from surveys and focus groups with standardized patients and a survey of primary care physicians. Findings were used to create an educational video with pre- and post-viewing surveys of patients’ understanding of engagement strategies and plans to use them in future encounters. ResultsSPs reported medical visits were more productive because of their ability to understand the visit’s framework; crediting their SP training. Patients reported the video will help in planning future medical visits by providing information that increases their understanding of their role in the care process. ConclusionsSPs’ understanding of the visit and its impact on knowledge, skills and affective domains can be transferred to patients in the form of specific strategies that enhance communication and patient participation during medical visits. Practice ImplicationsA brief educational intervention for patients using SPs’ understanding of the medical visit may contribute to enhanced patient participation in future health care encounters and could increase patient engagement in patient-centered models of care.

Standardized patients’ experiences of portraying characters in difficult communication scenarios: Narrative inquiry

Background There are limited studies that explored the preparation and challenges faced by standardized patients (SPs) in portraying characters in difficult communication scenarios, and the strategies used to overcome these challenges. The purpose of this study was to understand the experience of SPs in interpreting difficult communication situations and the learning needs of performing similar scenarios. And it allows the researchers to explore the meaning, beliefs, values, and aspiration associated with their role as SPs. The findings could shade light on the significance of their experiences and provide valuable insights for the development of future SP training programs. Methods The design of this study is framed by a narrative inquiry, using semi-structured guidelines to conduct in-depth interviews with 11 SPs who have participated in the performances of difficult communication situations. Research data were analyzed by Polkinghorne narrative analysis, and Riessman’s four criteria were used to establish rigor. Results Analysis revealed the following five themes: scenarios to real life connections, process of preparing for a performance, methods to detach from character, obtaining unexpected rewards, and needs for performance training. There are two to three subthemes that are subsumed under each theme. Conclusions To strengthen training in difficult communication for healthcare professionals, the use of SPs to interpret challenging difficult communication scenarios will continue to increase. Educators need to ensure that SPs are fully prepared physically and emotionally before, during and after their performance. Offering of continuing education and training in feedback techniques are crucial to extend the tenure of SPs, reduce their frustration, prevent attrition, and ultimately, reduce training costs. In the future, SP training should also include detachment and feedback techniques to alleviate SPs’ stress.

An Exploration of Diversity, Equity, Inclusion, and Antiracism in Standardized Patient Simulations

A trending topic in pharmacy education is the importance of educating and exposing student pharmacists to topics of diversity, equity, inclusion, and antiracism (DEIA). Incorporation of diverse patient populations is one emerging learning opportunity for students in the DEIA space. This commentary presents the findings of seven pharmacy programs reporting similarities and differences in standardized patient (SP) recruitment and training, and their use in DEIA simulation learning activities. Common barriers of DEIA-centric SP activities in pharmacy programs were also identified and included recruitment of diverse SPs, lack of faculty knowledge for implementation of DEIA-focused simulations, and emotional protection of SPs involved. While no best practices or standardized processes exist, the authors provide suggestions for addressing barriers, and make a call to action for further research to determine best practices related to recruitment, training, and utilization of diverse SPs in simulation activities in pharmacy education.

Does Patient Compliance Influence Wearable Cardioverter Defibrillator Effectiveness? A Single-Center Experience.

The study was designed to assess patient adherence to wearable cardioverter defibrillator as an indicator of device effectiveness. The patient training is not widely properly standardized. We enrolled 25 patients with a wearable cardioverter defibrillator to prevent sudden cardiac death between June 2020 and August 2022. Among them, 84% were male with a median age of 63.6 years. The indication was an ischemic (44%) and a non-ischemic (56%) disease. The patients were followed-up until the decision to upgrade to an implantable device was taken. We trained the patients according to our suggested protocol. The median wear time was 90 days, and the median daily wear time was 23.5 h, similar throughout sex, age, and indication groups. In total, 24% of the participants underwent cardioverter defibrillator implantation. Between the device-implanted and non-implanted groups, left ventricular ejection fraction and left ventricular indexed end-diastolic volume were significantly different (EF 35.8 ± 12 vs. 46.4 ± 8.5%, p = 0.028, iEDV 108 ± 52 vs. 70.7 ± 21.1 mL/m2, p = 0.024). We did not find any differences in cardiac magnetic resonance data, even though all patients who underwent device implantation had late gadolinium enhancement spots. Our results support standardized patient training to obtain great patient adherence to the instructions to the wearable device and therefore its effectiveness.

Application of role reversal and standardized patient simulation (SPS) in the training of new nurses

PurposeTo explore the effect of role reversal and standardized patient simulation on the training of new nurses.MethodThis study was conducted in a territory hospital in China between August 2021 and August 2022. The selected staff were all newly recruited and trained nurses, with a total of 58 cases. This study is a randomised controlled trial. The selected nurses were randomly divided into two groups. One group of 29 nurses (the control group) received routine training and assessment; the other group (the experimental group) was given role reversal combined with a standardized vertebral patient training examination. The implementation effects of different training and assessment methods were compared and analysed.ResultsBefore the training, the core competence scores of nurses in the two groups were lower, and there was no significant data difference (P > 0.05). After training, the core competence scores of nurses were improved, and the score of nurses in the experimental group was 165.49 ± 22.34. The difference was statistically significant when compared with the score of nurses in the control group (P < 0.05), indicating that nurses in the experimental group had better abilities. At the same time, the satisfaction of the two groups of nurses with the training was 96.55% (experimental group) and 75.86% (control group), and the difference in data was significant (P < 0.05). The satisfaction of the experimental group of nurses was higher, and the training effect was better.ConclusionIn the training of new nurses, the combined application of role interchange and standardized patient training and assessment methods has significant effects, which can improve the core competency of nurses and improve the training satisfaction of nurses, which is significant.

Abstract Number ‐ 275: Novel 3D Virtual Reality Simulator Use in Stroke Code Simulation

Introduction Stroke code simulations have gained popularity as an educational model for neurology resident and fellow training in the diagnosis and management of hyperacute stroke. Previous simulations have used live patients or standardized patients as surrogates for learners to interact with in the simulated codes. While these provide high fidelity, there can be significant costs associated with the training and deployment of standardized patients, as well as potential for inconsistencies from encounter to encounter. A novel 3D virtual reality based simulator (Dancing Eyes LLC, Skaneateles, NY) aims to reduce the costs of running stroke code simulations while maintaining high fidelity and encounter consistency. It can also have the additional benefit of being utilized at the convenience of the trainee’s schedule, reducing logistical hurdles for scheduling and organizing simulations. Methods Neurology residents (who have previously experienced live simulation stroke codes with standardized patients) will undergo simulation encounters using the 3D virtual reality‐based simulator. We will enroll 20–25 residents at post graduate year levels (PGY) 2–4. Following the simulated encounter, a debriefing session is conducted for learners to review the case, share their experience, and provide additional feedback. A post‐simulation survey will be comnducted that solicits trainee experience with the VR simulator in defined domains such as comfort, ease of use, fidelity, and overall educational experience and value. Results The VR simulator has been designed to be worn over the face and can be adjusted for trainee comfort. The simulator integrates imaging, labs, the ability to use a virtual NIH‐stroke‐scale booklet, and other neurologic examination tools by virtually grabbing them or selecting them from a panel user interface. The simulated VR patient registers the trainee’s voice and shows the speech that was detected. It then attempts to answer the question or perform the issued command based on variables that have been pre‐programmed for the specific encounter/simulation. Trainees are able to perform a full NIH stroke scale assessment on the simulated patient. We aim to report the results of our study in time for the SVIN Annual Meeting/update deadline prior to the meeting. Conclusions Figure 1 shows a trainee using the VR simulator in a simulated stroke code encounter, as well as a rendering of the simulated patient. The VR simulator aims to serve as a high‐fidelity, low‐cost, convenient and consistent training modality for stroke code simulation and enhance trainees ability and comfort with diagnosis and management of hyperacute stroke.

Peer Role-Play in a College of Korean Medicine to Improve Senior Students’ Competencies in Patient Care and Communication: A Case Analysis and Proposal for a Model

Objectives: Peer role-play (PRP) has been used in health care training simulations because standardized patient training requires considerable time and expense. This study described the implementation of clinical simulation using PRP and examined the effect.Methods: Final year students from a single college of Korean medicine engaged in PRP as part of clinical skills practice. Education tools from clinical practice guidelines were used to structure the PRP. Communication competency was assessed with the Korean Version of the Self-Efficacy Questionnaire (KSE-12). Whether this training helped to achieve graduate outcomes was evaluated on a five-point scale.Results: Fifty-nine students (53.2%) participated in the survey. Among 12 items on the KSE-12, the score for "How certain are you that you are able to successfully listen attentively to the patient?" was the highest. Further, PRP was found to be helpful for self-directed learning, establishment of one's professional identity, and the ability to communicate and manage patients. Three themes ("Benefits of role-play", "The importance of positive feedback", "Limitations and problems of role-play"), 15 categories, and 16 central meanings were derived by categorizing learners' subjective opinions about PRP.Conclusions: Study findings indicate that PRP may contribute to improving communication skills and establishing a professional identity for future Korean medicine doctors. We suggest using PRP in clinical education in colleges of Korean Medicine.

표준화환자를 활용한 정신간호학실습 시뮬레이션 프로그램 적용 효과

Objectives This study was conducted to verify the effect of applying a psychonursing simulation program using standardized patients to nursing students.&#x0D; Methods This is a single-group pre- and post-experimental design study conducted on 49 third-year nursing students. The research procedure consisted of the formation of a psychiatric nursing practice simulation team, program development, standardized patient selection and training, program application and effectiveness verification.&#x0D; Results Learner self-efficacy(t=4.81, p&lt;.001), learning satisfaction(t=3.95, p&lt;.001), and transfer motivation(t=5.44, p&lt; .001) were significantly improved compared to before the implementation of the program, and there was a quantitative correlation between learner self-efficacy, learning satisfaction, transfer motivation, and self-efficacy in communication.&#x0D; Conclusions Since simulation education using standardized patients was useful in mental nursing practice education, it is expected to help improve the quality of mental nursing practice and clinical practice education.

Who Can Be the Standardized Patient in Disaster Medical Full-Scale Exercise, Freshman, or Professional?

Disasters cannot be predicted, so being well-prepared is important before a disaster strike. Good preparation needs constant practice and improvement, and full-scale exercise can provide both. The standardized patients (SPs) in a full-scale exercise to simulate patients are vital because they can provide realistic effects to exercise participants. However, there was no literature about who is capable of being an SP. We investigated the relationship between the SPs' current occupation and previous experience with their fidelity and participants' performance. Three identically designed full-scale exercises were conducted for three different emergency medical teams (EMTs) with the scenario of post-earthquake mass casualty incidents. Forty SPs were used in each exercise. Exercise objective and detail scenario were told to the SPs before exercise, and mock wound makeup was applied to the SPs. Each SP's occupation and previous experience were recorded before exercise. The SP's previous experience was defined as previous exercise experience and previous disaster medicine education. The SPs' fidelity (SPF) was rated using a 5-point Likert scale (1 = poor and 5 = excellent). The participants' performance (PP) was also rated using a 5-point Likert scale (1 = poor and 5 = excellent) according to the accuracy of each SP's triage result and management. The SPF and the PP were evaluated by clinicians with disaster medicine specialties using the same standard. The relationship between the SPs' occupation and the SPF along with occupation, and the PP were analyzed by analysis of variance (ANOVA). The data of the SPF and the PP in the SP groups divided by previous experience were analyzed by the Student's t -test. The SPs' occupations were medical student, nurse, physician, and members of EMT. There was no significant difference in the SPF and the PP between occupations ( p = 0.382 and 0.416, respectively). Both the experienced and the inexperienced SP groups show no significant difference in the SPF ( p = 0.339). Significantly better PP was noted in the inexperienced SP group ( p < 0.001). The SPs' background does not influence the performance of either SPs or exercise participants. We proposed that the success of using freshmen as SPs in full-scale exercise depends on the pre-exercise design and the SP instruction and training.

The Role of Standardized Patient Programs in Promoting Equity, Diversity, and Inclusion: A Narrative Review.

Integrating equity, diversity, and inclusion (EDI) in curricula for training health professionals is a frequent institutional goal. The use of standardized (or simulated) patient programs (SPPs) to support EDI in health sciences training is not well described. Here the authors present a theoretical model based on a synthesis of the literature for using SPPs in EDI training, along with a narrative review of the available literature. The authors searched PubMed, Scopus, Science Direct, and Google Scholar databases for studies published between January 2000 and October 2019 describing the use of SPPs to support EDI in health sciences education. Studies were included if they described standardized patient (SP) education involving EDI and reported empiric data about its design, delivery, or effectiveness. The authors conducted a narrative review and provided a synthesis of the available literature, identifying key themes. Out of 117 studies identified, 17 met the inclusion criteria. Most studies (53%; n = 9) focused on cultural competence; many focused on communication with diverse patients (29%; n = 5) or health inequity (18%; n = 3). Studies employed portrayal of diversity (71%; n = 12) or learning objectives supported by diversity (29%; n = 5) as approaches to EDI relevant to SP training. Three primary themes emerged: improving cultural competence, effective communication with diverse patients, and highlighting health inequalities. This review outlines approaches to EDI-based SPPs, with the perspectives and priorities of institutional approaches in mind. SP education around specific EDI issues is reported; however, programmatic approaches to EDI by SPPs are lacking. More research is needed to provide further evidence for the challenges, effectiveness, and outcomes of developing and implementing EDI-based SPPs in health sciences education.

Quality in Standardized Patient Training and Delivery: Retrospective Documentary Analysis of Trainer and Instructor Feedback.

BackgroundAn important aspect of developing and maintaining a high-quality standardized patient (SP) program is incorporating quality assurance processes. Trainer and instructor feedbacks are considered critical in achieving these goals. The aim of this study is to determine programmatic and systematic issues in the scope of quality assurance and improvement through trainer and instructor feedback on SP performance. We also presented a logic model based on a synthesis of the current literature to ensure the development and maintenance of a quality management culture in the SP program.MethodsA retrospective analysis of SP scoring was conducted, and written feedback forms completed by trainers and instructors in a large Canadian university’s SP program were collected. The previous six years (2014-2020) of SP feedback forms in the scope of quality assurance were reviewed and analyzed. Descriptive statistics were utilized to analyze the ratings. Thematic analysis was conducted on the data gathered from the written feedback.ResultsA total of 138 feedback forms were reviewed and analyzed in the study. The mean ratings given by the trainers for feedback and professionalism were 4.27 ± 1.29 and 4.77 ± 0.8, respectively. The mean ratings given by the instructors for knowledge of case information, appropriate responses, and affect were 4.84 ± 0.64, 4.86 ± 0.35, and 4.71 ± 0.76, respectively (from a range of 1 to 5). Four key themes emerged from the written feedback: nonverbal behaviors in simulation activity or feedback sessions, providing feedback from the patient perspective, consistency between role portrayal and scenario, and adapting easily to changing situations.ConclusionsComponent scoring on SP performance did not discriminate individual issues, but the qualitative comments identified certain specific issues. Further research is needed to establish standards of continuous quality improvement (CQI) within an SP program.

«СТАНДАРТТАЛҒАН НАУҚАС» – ЖОО -да КЛИНИКАЛЫҚ ИНТЕРАКТИВТІ ӘДІС

The paper discusses the Standardized Patient Data provided in the available literature. In particular, the issues of direct standardized patient training were raised. Students and teachers discussed the methods of conducting classes with patients. Special attention is paid to assessing the level of education of students. The publication is prepared mainly on the basis of the authors' experience of applying a standardized patient to education.

18 SP Training for Transgender Healthcare Stations: What SPS and Program Directors Need to Know

Recent interest in the United States addressing Lesbian, Gay, Bisexual, Transgender (LGBT) healthcare issues, particularly obstacles faced by transgender individuals, has resulted in newly developed programming addressing these concerns. Training students and faculty on nuances of LGBT patients, with a specific focus on transgender patients, is critical if outcomes for this population are to improve. Data show 23% of survey respondents avoided seeing a doctor when needed, fearing mistreatment as a transgender person The aims of the study were to increase empathy and awareness of LGBT healthcare needs and to improve communication and patient/practitioner relationships through experiential learning with live transgender standardized patients.The programmes developed address fundamentals for healthcare professionals about serving LGBT patients: inclusivity, rapport, effective communication without creating anxiety or offense, language to avoid, and other practical knowledge including various surgeries and gender-affirming care available to transgender individuals. Initial panel discussions with members of the LGBT community have proved very effective in covering realities faced by transgender patients. Implementation of Teaching OSCEs (Objective Structured Clinical Exams) utilizing transgender individuals applies gained knowledge from lectures and discussions. It is critical for learners to experience working with an actual transgender standardized patient to effectively simulate encounters. Only a person from a marginalized community can accurately portray unique experiences affecting that particular community. Advanced medical training has also been developed including training for forensic examiners.These programmes include an LGBT didactic presentation, followed by a moderated panel (conducted virtually or in-person) of transgender individuals from varied backgrounds to share personal experiences receiving healthcare. Trainees are encouraged to ask panellists questions regarding concerns on proper communication, inquire about experiences in receiving gender-affirming care and discuss how to improve healthcare for transgender patients. Subsequently, trainees have the opportunity to participate in scenarios scripted and led by transgender standardized patients (SPs) or Trans Teaching Associates (TTAs). These scenarios can be conducted virtually, focussing on interview/history taking and communication skills, which makes global reach possible. In-person hands-on OSCEs can further assist trainees by providing opportunities to visualize trans anatomy. Learner feedback on improved understanding and empathy has been overwhelmingly positive, proving the necessity of providing training for learners in the care and treatment of transgender patients.

The effectiveness of the Construction of the Oral Examination Script Training Module for Nurse Practitioner

&lt;p&gt;專科護理師（簡稱專師）（Nurse practitioner, NP）是本國唯一具有國家證照之進階護理師，與醫師共同提供病人醫療及執行護理照護業務，須通過筆試及口試才能領取執業執照。專師執行病人照顧須展現的臨床推理能力較無法以紙筆測驗評量，故甄審口試採用客觀結構式臨床考試（Objective structured clinical examination,OSCE）以彌補筆試無法評值出的臨床實作能力。OSCE的口試劇本稱之「活考題」，需由標準化病人（Standardized patient, SP）扮演情境角色，真人演出若缺乏一致性可能影響考生的表現，過去每年約有2-3件考生反應SP演出問題的申訴案件。標準化病人訓練師（Standardized patienttrainer,SPT）是訓練SP表演教案的重要角色，過去大多由資深NP或曾擔任SP的資深救護技術員（Emergency medical technician, EMT）擔任口試劇本訓練的SPT，依舉辦單位設計的流程訓練SP，未有前置之SPT訓練課程。有鑑於SP演出涉及 考生的口試成績表現，演出品質的把關相形重要，本文目的為探討應用劇本訓練模組課程進行SPT訓練後，SPT對課程的學習滿意度及考生申覆案件之改善結果。採用「標準化病人師資訓練課程學習滿意度問卷」，包括「課程教材」、「課室訓練課程」，及「劇本實作訓練」三個構面，以李克氏5分法（1分為「非常不滿意」，5分為「非常滿意」） 進行學習成效評值；申覆SP演出件數由舉辦單位提供。參與訓練的SPT共計21位，資深NP 6位，資深EMT 15位。學習滿意度分析發現口試演出結束後總平均分數高於劇本訓練完成後，其中「劇本實作訓練」達統計顯著差異（p&lt; .05），顯示SPT對訓練模組課程的肯定外，109年甄審口試後首次無考生提出SP演出申覆案件。研究發現訓練模組課程能培育出勝任專師甄審口試劇本訓練的SPT。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Nurse practitioners (NP) are the only advanced nurse practitioners with a national license in Taiwan.NPs work with physicians to provide medical treatment and perform nursing care services. NPs must pass written and oral exams to obtain practicing license. The required clinical reasoning ability is difficult to evaluate by using written tests. Therefore, the objective structured clinical examination (OSCE) is chosen to examine practical and clinical ability of future NPs. OSCE scripts are called &amp;ldquo;living exam questions&amp;rdquo; and require standardized patients (SP) to play the role in the determined context. Lack of consistency in SPs&amp;rsquo; live-action affects the performance of candidates. In the past, candidates&amp;rsquo; appeal due to SP performance was about 2 to 3 times per year. Standardized Patient Trainer (SPT) plays a vital role in SP training. In the past, senior NPs or senior emergency medical technicians (EMT), served as the SPT in oral script training, depending on the organizer. There is no pre-SPT training course in the designed process. The quality of SPs&amp;rsquo; performance is important because it affects the candidates&amp;rsquo;performance in the oral exam. Thus, the purpose of this study is to investigate the improvements of SPT&amp;rsquo;s learning satisfaction and candidates&amp;rsquo; appeal rate after SPTs training program adopting the script training module course. A total of 21 SPTs participated in the training program, including 6 senior NPs and 15 senior EMTs. The study adopted the &amp;ldquo;Learning satisfaction questionnaire of standardized patient trainer training course, (LSQSPTTC), &amp;ldquo;including three domains of &amp;ldquo;curriculum materials,&amp;rdquo;&amp;ldquo;lesson training,&amp;rdquo; and &amp;ldquo;script practice training.&amp;rdquo; Also, use the Likert 5-point scale (1-very dissatisfied and 5-very satisfied) to evaluate the learning effectiveness. Furthermore, the number of incidents of candidates&amp;rsquo; appeal due to SP performance was provided by the examination organizer. The learning satisfaction after the oral exams is higher than the completion of the script training. The domain of &amp;ldquo;script practice training&amp;rdquo; had a statistically significant difference (p &lt; 0.05), indicating that SPTs satisfied with the training module courses. Furthermore, there is no appeal incident due to SP performance in the 109th Republic of China for the first time. The results support that the training module courses can effectively prepare SPTs to be competent for SP scripts training dedicated to NP screening exams.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

The Effect of Standardized Patient use in Teaching Preoperative Care Practices on Students' Knowledge, Skills, and Anxiety in Clinical Practice

Background This study aimed to examine the effect of standardized patient use in teaching preoperative preparation on the knowledge, skills, anxiety, and stress levels of students in clinical practice. Method A total of 53 students were included in the single blind randomized controlled trial. After theoretical training was given to the control and intervention groups, skills training was carried out using the role-playing method. The intervention group also participated in standardized patient training. Three weeks after, all students attended clinical training. Results It was observed that the total post-test knowledge score increased significantly in both groups and the skill scores were higher in clinical practice. However, no significant difference was found between the groups. The anxiety level in clinical practice was found to be significantly lower in both groups and that there was no difference between the stress levels by both groups in clinical practice. Conclusion The use of high-fidelity standardized patients applied in addition to the role-playing method in teaching preoperative preparation has a similar effect to the role-playing method in increasing students' knowledge and skills and reducing their anxiety.

Training and Validation of Incognito Standardized Patients for Assessing Oncology Fellows’ Performance Regarding Breaking Bad News

Background: Standardized patient (SP) has been applied to measure learner’s communication challenges such as breaking bad news (BBN). When utilizing SP-based assessment, 2 steps should be considered in SP training; assessing SPs portrayal as the real patient (authenticity) and how SPs checklist fill out reproducibility. Objectives: In this study, we described the process of training authentic and consistent SPs for evaluating oncology fellows’ performance regarding BBN in Iran. Methods: In this cross-sectional study, 8 eligible SPs took part in a 3-day educational meeting. Four different scenarios were developed regarding cancer patients along with corresponding checklists representing common presentations of illness. The accuracy of SPs portrayal was evaluated by experts, using a previously validated rating scale during observation of their role-playing. The reproducibility of SPs’ portraits was measured, using a test-retest approach. The inter-rater agreement of the SPs’ ability to fill out the BBN scale was measured by comparing the correlation between the SPs, who completed the scale, and oncologist faculty members’ judgments, which is considered a gold standard. Results: The findings of this study indicated that the cut-off score for the SPs’ portrayal validity was 95%. The reliability of SPs portrayal was acceptable (r = 0.89). The inter-rater agreement between SPs and experts in filling the BBN scale (k = 0.82), as well as, the consistency of filling the BBN scale between SP groups were highly acceptable (k = 0.86). Conclusions: The present study has demonstrated that if SP is trained appropriately, they shave a high degree of reliability and validity to assess oncology fellows’ performance regarding BBN skills.

Implementation and evaluation of a virtual objective structured clinical examination for pharmacy students

AbstractIntroductionThe University of California, San Francisco (UCSF) School of Pharmacy employs Objective Structured Clinical Examinations (OSCEs) to assess students' skills. The Coronavirus disease 2019 (COVID‐19) pandemic made in‐person OSCEs infeasible. This article describes the implementation and evaluation of a two‐station virtual OSCE (vOSCE) for first‐year pharmacy students.MethodsA summative vOSCE was conducted in June 2020 using Zoom and ExamSoft. Faculty and residents served as standardized patients (SPs) and evaluated student performance. Students and SPs were surveyed on their perceptions post‐vOSCE. A mixed methods analysis was conducted, incorporating thematic analysis of survey responses and quantitative analyses of student performance on the virtual vs in‐person OSCE.ResultsNinety‐six (75%) students and 17 SPs (94.4%) completed the survey. Students and SPs (69% vs 88%, P = .10) felt that vOSCEs were acceptable alternatives for demonstrating knowledge, communication, and telehealth skills. SPs felt that in‐person OSCEs were more effective to assess communication skills and ability to conduct in‐person encounters (P &lt; .05). Qualitative comments from students and SPs corroborated these differences, emphasizing limitations of vOSCEs for demonstrating nonverbal skills, and additional considerations regarding exam administration and assessment. Students who failed an OSCE generally had lower median communication scores (P &lt; .01). Technological difficulties, before OSCE performance, and before telehealth experience were not associated with passing the vOSCE (P &gt; 0.05).DiscussionThe virtual environment did not seem to negatively impact student performance. However, students and SPs felt vOSCEs may be less effective to demonstrate and assess nonverbal communication. To address these limitations, future implementation of vOSCEs may include providing students with instruction on nonverbal telehealth skills and SP training on virtual assessment of nonverbal communication skills.

Avoiding Fumbles: Online Patient Handoff Training.

The COVID-19 pandemic required rapid curriculum adaptation to online delivery. Given the importance of accurate clinical patient handoffs, we adapted simulation-based medical student training in clinical patient handoffs. We scored the accuracy of the information students presented. We also elicited student feedback to determine their perceptions of the event and their evaluations of the effectiveness of the training. Twenty-six third-year medical students participated online via Zoom. Students participated in groups of three or four students. They sequentially encountered a standardized patient. Clinical information and physical exam findings were handed off from student to student until the encounter was complete. The student group then debriefed with faculty. Students were evaluated based on the proportion of clinical information handed off to the following student. Students also evaluated the training session. The first student handoff included 73.4% of the available information. In subsequent handoffs, the percentage fell to 43%. All students said they felt the training was helpful in practicing patient handoffs and interactions with colleagues. Negative student comments focused on perceived deficiencies in session planning and standardized patient training. This rapidly developed simulation session demonstrated that clinical training in patient handoffs can be adapted to an online environment. In order to ensure success, faculty should carefully consider logistical adjustments required to transition from a patient contact setting to an online environment. Meticulous preparation and attention to detail will ensure that training is successful.

The Electronic Health Record Objective Structured Clinical Examination Station: Assessing Student Competency in Patient Notes and Patient Interaction.

IntroductionThe ability to utilize the electronic health record (EHR) without compromising the doctor-patient relationship (DPR) is an essential skill of all physicians and trainees, yet little time is spent on educating or assessing learners on needed techniques. To address this gap, we developed a conventional OSCE station coupled with a simulated patient chart within the Epic program in order to assess our students' skills utilizing the EHR during a patient encounter.MethodsOf third-year medical students, 119 were given full access to the patient's simulated chart 24 hours in advance of their OSCE to review clinical data. During an in-person OSCE with a standardized patient (SP), students performed a focused history and physical, using the EHR to verify allergies and medications. Students completed an electronic patient note graded by faculty. SPs evaluated the students on communication and interpersonal skills with specific rubric elements. Faculty graded the students' notes to evaluate their expression of clinical reasoning in the assessment and plan.ResultsTraining SPs and faculty to assess students on EHR skills was feasible. After implementation of a comprehensive curriculum focused on EHR and DPR, there was a significant difference on EHR-related communication skills (M = 76.4, SD = 17.6) versus (M = 37, SD = 28.9) before curriculum enhancement t (117.9) = −12.4, p <.001.DiscussionThe EHR OSCE station provided a standardized method of assessing students' EHR skills during a patient encounter. Challenges still exist in the technological requirements to develop and deliver cases in today's EHR platform.

Characterizing standardized patients and genetic counseling graduate education.

Standardized patients (SPs) are laypersons trained to portray patients, family members, and others in a consistent, measurable manner to teach and assess healthcare students, and to provide practice for emotionally and medically challenging cases. SP methodology has been studied with practicing genetic counselors; however, there is minimal empirical evidence characterizing its use in genetic counseling (GC) education. The Accreditation Council for Genetic Counseling (ACGC) Standards of Accreditation for Graduate Programs in Genetic Counseling include SP sessions as one way to achieve up to 20% of the 50 participatory cases required for graduation. The purpose of the current project was to determine the scope, frequency, and timing of SP methodology in ACGC-accredited programs to establish baseline usage, which happened prior to the SARS-CoV-2 pandemic. A 40-item investigator-created survey was developed to document the scope and frequency of SP use among programs. The survey was distributed through the Association of Genetic Counseling Program Directors' (AGCPD) listserv to 43 accredited and 6 programs under development. Surveys were analyzed from 25 accredited programs (response rate=58%). Seventeen of these programs report inclusion of SP methodology in the curricula (68%), of which 13 report working with an established SP program. SPs are used predominantly for role-plays (70.6%), individualized instruction and remediation (29.4%), and for other reasons such as lecture demonstration, final examinations, practicing skills, and assessing students' goals. Sixteen of the participating programs use SPs to give GC students experience disclosing positive test results. Other details vary among the GC programs including the use of trained SPs, volunteer or paid SPs, actors with and without SP training, or GC students acting as patients. This study demonstrates that GC program SP experiences differ, but are largely viewed as valuable by the programs. Many GC programs report using SP encounters to create multiple opportunities for students to practice and refine clinical skills similar to SPs in medical school.