Trained Standardized Patients Research Articles

Acute Neurological Emergencies: Using Neurology-Trained Standardized Patients To Promote Active Learning in a Case-Based Simulation Curriculum for Neurology Clerkship Students (P9-2.004)

<h3>Objective:</h3> To describe the impact of using live, neurology-trained standardized patients (SPs) in a case-based simulation curriculum for clerkship students. <h3>Background:</h3> Simulation in neurology is limited by the inadequacy of manikins to portray neurologic exam findings. We designed a simulation curriculum using live, neurology-trained resident SPs residents for clerkship students to (1) practice taking a neurologic history, (2) perform a neurologic exam, and (3) recognize and triage neurological emergencies. <h3>Design/Methods:</h3> Two scenarios were developed: (1) evaluation of dizziness and management of acute stroke and (2) treatment of new-onset seizure. Monthly sessions involved 4–5 students. Residents SPs mimicked expected exam findings. Pre- and post-session surveys evaluated students’ self-rated knowledge, clinical skills, and confidence in gathering a history, performing a neurological exam, presenting a case, and recognizing, working up, and managing strokes and seizures. Students also rated the overall session quality and provided feedback about the experience. Paired t-tests were performed for quantitative items. <h3>Results:</h3> 54 students participated. Post-session, students reported significantly higher self-confidence in all neurological knowledge domains and clinical skills (p&lt;0.003 for all). Over 90% of students agreed sessions met the learning objectives, the course was valuable, and the simulation was a safe learning environment and would improve their clinical performance. 94% would recommend the session to others. Over 80% agreed the simulation was realistic, well-organized, and an effective way to practice teamwork and clinical skills. In open responses, students reported they appreciated evaluating neurologic emergencies, performing the exam with a trained SP, and making treatment decisions. Students wanted more cases and time; they suggested smaller groups. <h3>Conclusions:</h3> A simulation curriculum with neurology residents portraying the patient increased students’ knowledge, clinical skills, and self-confidence in recognizing and managing acute neurological emergencies. Resident SPs were cited as the most effective educational component. Future research should evaluate the sustainability of benefits gained and assess clinical skills objectively. <b>Disclosure:</b> Dr. Gheihman has nothing to disclose. Dr. Harrold has nothing to disclose. The institution of Dr. Howard has received research support from Genentech. The institution of Dr. Howard has received research support from Novartis. Dr. Howard has received personal compensation in the range of $50,000-$99,999 for serving as a Clinical Fellow with National Multiple Sclerosis Society. Dr. Albin has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Continuum: Life Long Learning in Neurology. Dr. Albin has received research support from American Academy of Neurology. Dr. Albin has received publishing royalties from a publication relating to health care. Dr. Albin has received personal compensation in the range of $500-$4,999 for serving as a Instructor with Resuscitation Leadership Academy. Dr. Kaplan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis . Dr. Kaplan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono .

Perceptions of motivational interviewing in genetic counseling practice and training.

Motivational interviewing (MI) is a counseling approach that allows a provider to engage in a dialog with patients to evoke motivation for health behavior change or decision-making. MI is a relatively recent addition to the curricula of genetic counseling programs, and recent research has demonstrated its utility in genetic counseling practice. However, the perspectives of genetic counselors trained in MI have yet to be studied with the intent of illuminating how it is applied in practice or what should be emphasized in training. This qualitative study interviewed fifteen genetic counselors from various practice areas who have had training in MI. The interviews focused on how MI is being used in practice, and the strengths and weaknesses of their MI training. Five themes were identified through inductive qualitative analysis: (a) utility of MI in genetic counseling practice, (b) value of MI in genetic counseling training, (c) barriers to implementing MI in genetic counseling practice, (d) barriers to training genetic counselors in MI, and (e) timing of MI training. The perspectives discovered from this study can help inform genetic counseling educators who wish to include MI in their curriculum. In addition for those programs that already include MI, these results serve as a guide for the development of training role-plays and/or standardized patient encounter scenarios.

Interprofessional Simulation as an Educational Tool to Assess Cultural Competence Among Health Professions Students.

The concept of collaborative practice within health professions is viewed as "best practice." Poor collaboration can adversely affect patient safety. Interprofessional (IP) teamwork skills can be developed and nurtured through the health professionals' education; however, many barriers exist, which deter this from occurring. A lack of cultural diversity exposure within the healthcare setting can result in treatment disparities and place the patient at risk. One healthcare area that has gained considerable interest is the practitioners' understanding of multiculturalism and how cultural competence subsequently influences health disparities. This study examined the application of culturally complex clinical simulation scenarios that intentionally integrated IP teamwork and hypothesized that participants' understanding of cultural competence would improve. Participants were junior-level nursing, bachelor-level social work, graduate-level occupational therapy, and PharmD students (N = 180) who participated in an IP simulation exercise composed of culturally complex clinical scenarios performed by trained standardized patients designed to demonstrate underrepresented populations with diverse religious/spiritual, sexual orientation, racial/ethnic, socioeconomic, psychosocial, and geographic characteristics. Survey tools included an adapted Multicultural Awareness, Knowledge, and Skills Survey (MAKSS) and the Cultural Awareness Assessment Tool (CAAT). Descriptive statistical analyses were conducted to describe the sample population with the use of inferential statistics to analyze the MAKSS and CAAT scores using a statistical significance level of 0.05. Data were analyzed using SPSS v25 using paired t tests to compare pretest-posttest results. Results showed that there was a statistically significant increase in MAKSS and CAAT scores from presimulation to postsimulation. The findings also suggest that participation in this type of exercise may have increased self-assessment of cultural awareness and multicultural awareness, knowledge, and skills among health professions students. This study described the planning and execution of a large multiple scenario simulation event that involved 180 students spanning 5 healthcare disciplines. Findings demonstrated that the IP simulation event improved the students' self-assessment of multicultural awareness, knowledge, and skills as well as their own cultural awareness. The exploration of cultural competence and humility should be a priority for simulation-based learning.

Feasibility of Using Standardized Patients as Examiners in an Objective Structured Clinical Examination (OSCE) of Medical Students

Purpose: An OSCE (Objective Structured Clinical Examination) is an assessment of medical school graduates' skills through multiple timed stations in which the graduates are assessed by one or more examiners. Due to the design of the OSCE, the demand for physician examiners is intense. The objective of this study is to confirm the feasibility of training standardized patients (SP) as OSCE examiners to alleviate the burden on physicians. Methods: Sixty SPs and 30 medical school graduates participated in a five-station OSCE at a medical center in Eastern Taiwan. Thirteen physicians participated as examiners, assessing the graduates' performance during the OSCE. All scenarios contained a content-specific checklist, with no patient note test. Every graduate was simultaneously scored by a physician examiner and an SP examiner using the same checklist. We used a paired t-test to evaluate the score difference between physician and SP examiners. Results: The SP examiners scored graduates higher than physician examiners in all scenarios except the history-taking station. Three scenarios testing patient condition explanations and physical examination revealed a statistically significant difference between SP and physician examiners. The other two scenarios, history taking and doctor-patient communication, showed no significant difference. Conclusions: Our study suggests that SPs could be trained as examiners if OSCE stations contain checklist items recommending generic concepts and not requiring medical knowledge or clinical experience of SPs. Using SPs as examiners would partially alleviate the demand for physician examiners. Further studies are needed to assess whether additional training for SP examiners can improve unbiased evaluations.

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.

Albert Einstein College of Medicine.

Albert Einstein College of Medicine.

Subtle skills: Using objective structured clinical examinations to assess gastroenterology fellow performance in system based practice milestones.

BACKGROUNDSystem based practice (SBP) milestones require trainees to effectively navigate the larger health care system for optimal patient care. In gastroenterology training programs, the assessment of SBP is difficult due to high volume, high acuity inpatient care, as well as inconsistent direct supervision. Nevertheless, structured assessment is required for training programs. We hypothesized that objective structured clinical examination (OSCE) would be an effective tool for assessment of SBP.AIMTo develop a novel method for SBP milestone assessment of gastroenterology fellows using the OSCE.METHODSFor this observational study, we created 4 OSCE stations: Counseling an impaired colleague, handoff after overnight call, a feeding tube placement discussion, and giving feedback to a medical student on a progress note. Twenty-six first year fellows from 7 programs participated. All fellows encountered identical case presentations. Checklists were completed by trained standardized patients who interacted with each fellow participant. A report with individual and composite scores was generated and forwarded to program directors to utilize in formative assessment. Fellows also received immediate feedback from a faculty observer and completed a post-session program evaluation survey.RESULTSSurvey response rate was 100%. The average composite score across SBP milestones for all cases were 6.22 (SBP1), 4.34 (SBP2), 3.35 (SBP3), and 6.42 (SBP4) out of 9. The lowest composite score was in SBP 3, which asks fellows to advocate for cost effective care. This highest score was in patient care 2, which asks fellows to develop comprehensive management plans. Discrepancies were identified between the fellows’ perceived performance in their self-assessments and Standardized Patient checklist evaluations for each case. Eighty-seven percent of fellows agreed that OSCEs are an important component of their clinical training, and 83% stated that the cases were similar to actual clinical encounters. All participating fellows stated that the immediate feedback was “very useful.” One hundred percent of the fellows stated they would incorporate OSCE learning into their clinical practice.CONCLUSIONOSCEs may be used for standardized evaluation of SBP milestones. Trainees scored lower on SBP milestones than other more concrete milestones. Training programs should consider OSCEs for assessment of SBP.

STANDART HASTA İLE EĞİTİMİN PROFESYONEL DEĞERLERE ETKİSİ

<div><!--block-->Objective: This study aims to investigate the changes in professional values through a structured training program and standardized patient practices.&nbsp;<br><br>Method: The study was conducted with 346 3rd year medical students during the 2016-2017 academic year. Attitudes towards professionalism were assessed by using the “Professionalism” scale developed by The Penn State College of Medicine. The scale was applied to all of the students before the training (pretest) and after the training was completed (post-test).&nbsp;<br><br>Results: The mean scores of the pre-test and post-test, respectively, were 17.5±1.8-18.1±1.9 for accountability; 16.34±2.117.0±1.6 for enrichment; 12.5±1.3-13.0±2.1 for equity; 19.6±1.720.7±1.5 for honor and integrity; 8.4±1.2-13.5±2.1 for altruism; 11.9±1.2-13.4±1.1 for duty; and 5.51±0.6-5.92±0.9 for respect (p&lt;0.05). When the mean scores of the students were compared based on gender, the scores of the female students were found to be higher than those of the male students in all sub dimensions (p&lt;0.05).&nbsp;<br><br>Conclusion: Professional values are important concepts which are complex, difficult-to-measure and affected by multiple factors. An increase was observed in the professionalism scores of the students after the standard patient education practice. This increase was found to be significantly higher among the female students than among the male students.</div>

The role of standardized patient assessment forms in medical communication skills education

Communication skills training is a routine practice in medical education designed to instruct and evaluate future physicians in matters of patient-provider interaction. Based on the United States Medical Licensing Examination Step 2 Clinical Skills (CS), medical schools across the United States hire and train standardized patients (SPs) to act as patients in and evaluators of simulated interactions with medical students (MSs). Using discourse analysis, I examine how a computerized assessment form creates a particularized version of communication skills with implications for future practice. The 39-item checklist is completed by SPs following a simulated interaction designed to prepare third-year MSs for the Step 2 CS. Specifically, I analyze how the form is structured to make recognizable specific communication skills tasks, who should complete said tasks, and what varying degrees of communication skills competency are within the realm of task completion. By analyzing the form, I consider the agency of texts in medical education, the implications of technologizing communication as an institutional skill, and the limitations of enlisting SPs to evaluate communication skills competency under the guise of a patient perspective.

Interprofessional Healthcare Student Training in the Care of Sexual Assault Patients Utilizing Standardized Patient Methodology.

The medical assessment of sexual assault (SA) is challenging because SA patients are often hesitant to disclose their medical needs, which puts them at further physical and psychological risk, and because of provider unease in conducting SA examinations. This challenge is compounded by a lack of provider training. The study goals were to develop an interprofessional simulation event that would foster SA interview skills, foster effective communication with SA patients, and increase learner confidence in assessing SA patients. Participants were senior-year school of medicine (n = 165) and advanced practice registered nursing (n = 30) students (N = 195) who were enrolled in a mandatory Military Sexual Assault Assessment and Treatment course, along with data provided by trained standardized patients (SPs, n = 16) who participated in the simulation event and in assessments of learners. Measures included the Sexual Assault Interview Skills Checklist, the Essential Elements of Communication, and the Confidence in SA Assessment scale. Data were analyzed using analysis of variance and t tests at the P < 0.05 threshold. Postsimulation Sexual Assault Interview Skills Checklist and Essential Elements of Communication scores demonstrated an acceptable level of competence according to both students and SPs. Confidence in SA assessment rose significantly from presimulation to postsimulation. Before simulation, medical students were significantly lower than nursing students, but the simulation event closed the confidence in SA assessment gap. This interprofessional simulation event resulted in SA interview competence, communication skills competence, and improved confidence scores. Combined, these findings support the efficacy of simulation to train emerging healthcare providers to properly assess SA.

Medication History Lab and Assessment using the Medication Mysteries Infinite Case Tool.

Teaching medication history taking or medication reconciliation to students requires practice for students to achieve competency. Practice makes students more confident with the process, but multiple practice opportunities require multiple cases, and creating these new cases can be a tedious and time-consuming process. The Medication Mysteries Infinite Case Tool was designed to produce random patient cases using game-like features to allow students to practice medication history taking and medication reconciliation without the need to use and train standardized patients. The tool was created using a random draw card-based system to determine patient personality attributes, drugs they are taking, and confusions they have about their drug-taking behavior. This tool is used in a lab dedicated for the purpose of practicing medication history taking with students being assessed via simulation with standardized patients. This tool is currently used at the University of Florida College of Pharmacy as part of a training program for first-year pharmacy students. Since 2011, seven classes of first- and second-year pharmacy students have participated in this lab. Each year's class contained an average of 280 students divided into lab groups of 18-24 students. In our initial offering of the lab and assessment, 200 students on three campuses completed the individual assessments following the laboratory session. Fifty-eight percent achieved excellence, and 39% achieved competence on the individual assessment. Only 3% were assessed as being deficient on their performance and were required to repeat the assessment. Overall, 86.8% agreed or strongly agreed that the MMICT was an excellent way to experience how to reconcile medication. Students enjoy the practice and become proficient with the skills they learn through this process as evidenced by increased self-efficacy and achieved competence on a standardized assessment. The tool and the research associated with the outcome were awarded with the 2012 American Association of Colleges of Pharmacy Innovations in Teaching Award.

Reducing Medical Errors: Using Observed Standardized Clinical Examinations to Assess Fellows' Performance in System-Based Practice Milestones

Medical training has increasingly focused on standardization to improve communication and reduce medical errors. In gastroenterology training programs, the need for clear interpersonal communication is heightened by the high acuity of patients and the frequent use of a home call system. We sought to assess important yet largely unevaluated skill sets based on system-based practice milestones outlined by Accreditation Council for Graduate Medical Education requirements using an Observed Standardized Clinical Examination (OSCE). We created the following cases: recognizing and counseling an impaired colleague, overnight hand-off, a percutaneous endoscopic gastrostomy placement discussion, and feedback on a progress note with a medical student. Fellows from 3 institutions in New York City participated. Behavioral anchored checklists were completed by trained standardized patients (SPs). Fellows received verbal feedback from a faculty observer after each case and completed a questionnaire evaluating their experience after the OSCE. We had 9 fellows participate. Discrepancies were identified between the fellows’ perceived performance in their self-assessments and SP evaluations. In the percutaneous endoscopic gastrostomy case, only 11% of fellows engaged the family member in shared decision making and no fellows assessed the SP’s basic understanding of risks. Conversely, 86% of the fellows believed they were well prepared for the case and 78% believed they did well achieving the case objectives. None of the fellows fully assessed depression, suicidal ideation, or alcohol use in the impaired colleague case. Only 33% screened for depression and collaborated on identifying next steps. Eighty-six percent of these fellows believed that they would be able to identify substance abuse and depression in a colleague before the OSCE, and 100% agreed after the OSCE. In the hand-off case, 55% of fellows fully explained hospital course; 44% collaborated to identify next steps in the plan. Only 44% of the fellows were rated as completely professional during the encounter. In the note feedback encounter, 44% of fellows asked effective questions to engage the learner. The SP rated 22% of the fellows as very effective at giving feedback, and 100% of fellows reported feeling comfortable giving feedback before the OSCE. Our results highlight the discrepancies between perceived performance of fellows and their actual success in achieving milestones in system-based practices. Fellows were more successful in meeting objectives in the more familiar scenarios, that is, in giving handoff and in giving feedback on note writing, although there was still much room for improvement. In less-familiar scenarios, the fellows did not perform as well. Training programs should consider using OSCEs or other educational programs geared toward system-based practice milestones to improve their fellows' performance in a secure setting before they encounter such scenarios with real patients or colleagues.

Abstract: Building a National Simulation Program in Rwanda Through the Use of Partnerships

BackgroundBuilding a simulation program in a low-resource environment can be challenging. With the assistance of international partners, Rwanda has successfully built a sustainable national simulation program. We believe this may be a successful model for other low-resource countries.DescriptionIn 2003, a partnership was formed between Kigali Health Institute (KHI) and VVOB (the Flemish International Corporation in Belgium). Through this partnership former KHI, currently College of Medicine and Health Sciences of the University of Rwanda – ( UR-CMHS) was able to build an initial simulation program including an education plan, outfitting rooms, training standardized patients, purchasing and the setting up of equipment, and training simulation staff and faculty. This partnership was extended until 2010. From 2010 to 2012, a partnership was formed between the Kigali University Teaching Hospital (CHUK) and the Canadian Anesthesiologists Society International Education Foundation. Through this partnership a skills lab was set up at CHUK, for use by medical students, residents, and physicians at CHUK. From 2012-2015, a third simulation partnership was set up with the Human Resources for Health Program whereby an experienced simulation advisor was sent to CMHS for one year. A number of improvements have been accomplished through this partnership.Lessons LearnedThrough the use of deliberate, structured international partnerships, a successful and sustainable simulation program has been set up in Rwanda. We have learned that the partnerships should be designed in a way that ensures sustainable growth and improvement in the simulation program long after partnerships terminate.ConclusionInternational simulation program partnerships, if set up correctly, can assist in building sustainable simulation facilities in low-resource settings.Key words: simulation, clinical education, low resource countries, Rwanda, partnerships

Morning in refugee health: an introduction for medical students

Purpose – Migration is increasing worldwide. health care practitioners must provide care to migrants in a culturally competent manner that is sensitive to cultural, political and economic contexts shaping health and illness. Many studies have provided strong evidence that health providers benefit from training in cross-cultural care. Cultural competence education of medical students during their early learning can begin to address attitudes and responsiveness toward refugees. At Memorial University in Canada, the authors designed “Morning in Refugee Health”, an innovative program in cultural competency training for first year medical students in the Clinical Skills and Ethics course. The purpose of this paper is to discuss these issues. Design/methodology/approach – Here the authors introduce the curriculum and provide the rationale for the specific pedagogical techniques employed, emphasizing the consideration of culture in its relation to political and economic contexts. The authors describe the innovation of training standardized patients (SPs) who are themselves immigrants or refugees. The authors explain how and why the collaboration of community agencies and medical school administration is key to the successful implementation of such a curriculum. Findings – Medical students benefit from early pre-clinical education in refugee health. Specific attention to community context, SP training, small group format, linkages between clinical skills and medical ethics, medical school administrative and community agency support are essential to development and delivery of this curriculum. As a result of the Morning in Refugee Health, students initiated a community medical outreach project for newly arriving refugees. Originality/value – The approach is unique in three ways: integration of training in clinical skills and ethics; training of SPs who are themselves immigrants or refugees; and reflection on the political, economic and cultural contexts shaping health and health care.

Standardized patient in small group teaching: facilitating the small group

Small group teaching is used frequently in medical education to provide an opportunity for performance based instruction in problem-solving, communication, and team work. Principles used to help medical students learn to assess and manage their patients may be integrated into small groups for formative education. This article describes an application of a successful model of human simulation based interaction (standardized patients) to a clinical development program in a problem-based learning environment. Evidence of institutions using this methodology will be included in the discussion assessing the scope and practical application. Description of both faculty facilitator and learner roles in small group experiential learning settings with standardized patients will be provided, as well as a brief discussion of assessment techniques using both formative and summative feedback. This method uses scenarios derived from real case examples that are structured to provide common challenges. It uses trained standardized patients to portray patients and to give live and immediate feedback to learners. Live learner simulations give participants a true experiential learning opportunity in a classroom without risk of harming real patients. A realistic practice scenario allows learners to practice and receive valuable feedback from other learners, faculty and standardized patients. This article will describe one application of this method in medical education to teach students patient-centered communication. Keywords: Active learning; Curriculum, Problem-based; Experiential learning; Patient simulation; Education, Medical, Undergraduate. Revista HUPE, Rio de Janeiro, 2014;13(4):57-61 doi: 10.12957/rhupe.2014.13955

Medical Student's Perception And Preferences About Peer Physical Examination (PPE)

There is greater emphasis on clinically oriented teaching and early clinical exposure for medical students. There is limitation to practice and perfect the skills on sick patients. Hence, standardized patients are used for practice of clinical skills. However non-availability of trained standardized patients, high cost of employing them poses a challenge to training medical students. The viable alternative is to use the peers for skill training. It can be a potential area of student discomfort or inappropriate behavior by classmates or tutors. Present study assesses the attitude of students towards Peer Physical Examination (PPE). Fifty three third term medical students (23 males and 30 females) were administered a structured and validated questionnaire with 15 questions to assess elements of comfort, professionalism, appropriateness and value of PPE. Students responded to questions using a five-point Likert scale, where 1 = strongly agree, and 5 = strongly disagree.The pattern of response was similar for male and female students. 81.82% were comfortable with PPE for practice of clinical skills. 32.90% were comfortable examining peers of opposite sex. 18.04% felt it was appropriate to perform breast, genital and rectal examinations on peers. 2.17% agreed to volunteer for such examination.Majority of students preferred PPE to standardized patients for practice of clinical skills. PPE was preferred as it provided valuable feedback, better learning experience, and felt examining classmates was comfortable &amp; appropriate. However they felt inappropriate to volunteer or examine breast, inguinal, genital regions of classmate as a part of PPE.

Standardized Patients for Korean Psychiatric Nursing Student Simulations

Changes in the health care system driven by demands for expert health care services have fueled the need for quality psychiatric nursing education that uses simulated learning with standardized patients. Training standardized patients (SPs) with psychiatric disorders is not as simple as training those with other disorders, one challenge being the difficulty of portraying abstract psychiatric symptoms in a “standardized” fashion. This article describes the elements and processes behind training psychiatric SPs for a simulated psychiatric nursing practicum. The backgrounds of SPs, type of scenarios, and training procedures for SPs are described. Essential attributes for an SP include an ability to adopt expected roles, an interest in education, an ability to stay in character, and flexible work availability. Structured training scenarios enhanced the reality of the simulation and standardized role plays.

Analysis of the perceived effectiveness and learning experience of medical communication skills training in interns.

This study aims to explore the perceived effectiveness, benefits, and learning experiences of interns with regard to their participation in a communication skills workshop program, which can have implications for the development and implementation of future communication skills training. One hundred twenty one interns and 12 senior residents and fellows participated in the workshop program as learners and tutors. The participating interns encountered three difficult communication situations, represented by trained standardized patients. During each encounter, each participant had an individual encounter, group discussion, and feedback on his performance. A self-assessment survey, composed of five itemized questions and seven open-ended questions, was administered after the workshop. A mixed methods approach was used to analyze the quantitative and qualitative data. The participants had positive perceptions of the implementation and effects of the workshop, and they responded higher than 4.0 to all itemized questions on their perception of the effectiveness and benefits of the workshop. The analysis of open-ended questions demonstrated specific learning experiences of the participants, such as the hardship of solving ill-structured communication problems and reflection on their current knowledge, skills, attitudes, and practice as physicians. The participants reported that the workshop provided opportunities of improving diverse communication skills and problem-solving skills and identifying further learning needs. The results suggest that communication skills training for interns facilitates their reflection and development of communication skills, as well as their competency of situated problem solving. Consequently, communication skills development should be regarded as an important subject of continuing medical education. Several implications of this study can contribute to the design and development of communication skills-related programs.

The Experience of an Objective, Structured Clinical Examination at Kaohsiung Medical University

The objective, structured clinical examination (OSCE) is a method to assess clinical competency based on objective testing, through direct observation in a formal setting. The Kaohsiung Medical University (KMU) has pioneered OSCEs in Taiwan. In KMU, three groups of examinees---medical students in years 3 and 4, medical students in years 5 and 6, and medical students in year 7---were assessed using different OSCEs. Each OSCE was set up using the following five steps: (1) create cases; (2) decide on the items or clinical skills to be evaluated; (3) train standardized patients; (4) run the OSCE and (5) review videos to improve the curriculum. We expect that KMU will become the premier OSCE center in Taiwan.

Objective structured clinical examinations as an assessment method in residency training: practical considerations.

Objective structured clinical examinations as an assessment method in residency training: practical considerations.