An Overview and Discussion of the Literature

2010 Publications Involving Standardized Patients

My apologies to Best Buy…

Educational Scholarship

• Clear Goals

• Adequate Preparation

• Appropriate Methods

• Significant Results

• Effective Presentation

• Reflective Critique

Glassick

Objectives

• Provide a guided discussion of the published literature from 2010 involving SPs

• Discuss the unique applications of SPs in teaching, assessment and research

• Guide participants through discussion on the potential application of findings to their own program

• Stimulate ideas for studies involving standardized patients.

Clear goals

Thinking ‘both this…

• Review Medline capabilities

• Decisions on limitations

• Skills in literature search

Adequate Preparation

Methods

Medline search

• MeSH descriptors:–Standardized patient(s)

–Simulated patient(s)

–OSCE

–Objective structured clinical examination

Limited to English language, 2010

Appropriate Methods

Results

• Initial result: – 427 papers– Titles scanned – Irrelevant papers discarded.

• Left with 423 articles • Reviewed all abstracts

Result was 154 articles

Significant Results

Which Journals? N=91

Medical Education

Medicine Osteopathic Med

Nursing Pharmacy

Allied Health Dentistry

Psychology Pastoral Care

Medical Informatics Nutrition

Location of Author

• Australia• Belgium• Brazil• Canada• Chile• France• Germany• India

• Iran• Israel• Italy• Japan• Korea• Malaysia• Netherlands• Nepal

• Pakistan• South Africa• Sweden• Switzerland• Taiwan• UK• USA

Questions to Ponder

• Unique aspect of the use of standardized patients is presented in the article

• Consider ways that the use of findings from current literature can enhance your program

• Do the papers presented offer ideas for further research?

Effective Presentation

Organizing the Chaos

• What do we do?

• Where do we do it?

• When do we do it?

• With whom do we do it?

• Why do we do it?

• How do we do it?

• What can we learn from the experience?

Categories

• Teaching / Assessment

• Communication skills / Feedback

• Logistics

• Impact of the SP experience

• Really Cool Stuff

Teaching vs Assessment

• Primary skills– Interview – Physical examination (neuro, MSK)– Specialized exams (GTA)– Skills (ultrasound)

• Special Concepts– Populations (geriatrics, pt with disability)– Topics (palliative care)– Situations (transitions of care, student to resident)– Delivery: by SP vs other

Academic Medicine

• Brown R, Graham C, Richerson N et al

• Evaluation of Medical Student Performance on Objective Structured Clinical Exams with Standardized Patients with and without Disabilities

Use of Assessment with SPs

• Outcome measures– Comparison of curricula– Comparison of training sites

• Special topics – Demonstration of knowledge– Critical thinking skills– Patient context– Challenging patient situations (say “no”)– Self assessment

Medical Education

• Yudkowsky R, Otaki J, Lowenstien T et al.

• A hypothesis-driven physical examination learning and assessment procedure for medical students: initial validity evidence

Communication Skills

• Motivational interviewing• Behavior change• Palliative care• Elderly with altered mental status• Persons with mental health issues (suicide)• Organ procurement • Bad news delivery• Adherence to medication

Behavioral and Cognitive Psychotherapy

• Hartzler B, Beadnell B, Rosengren D et al

• Deconstructing Proficiency in Motivational Interviewing: Mechanics of Skilful Practitioner Delivery During Brief Simulated Encounters

Communication Skills

• Nonverbal communication

• Patient centered communication

• Professionalism

• Empathy

Patient Education and Counseling

• Thompson B, Teal C, Scott S et al

• Following the clues: Teaching Medical students to explore patient contexts

Annals of Internal Medicine

• Weiner S, Schwartz A, Weaver F et al

• Contextual Errors and Failures in Individualized Patient Care

JAMA

• Schwartz A, Weiner S, Harris I, Binns-Calvey A.

• An Educational Intervention for Contextualizing Patient Care and Medical students’ Abilities to Probe for Contextual Issues in Simulated Patients

Academic Medicine

• Blatt B, LeLacheur S, Galinsky A

• Does Perspective-Taking Increase Patient Satisfaction in Medical Encounters?

Feedback

• Not much in 2010 on – Who should give it– How to give it – When to give it – Why to give it

Logistics

• Description of OSCE experience

• Build an OSCE

• Prepare for an OSCE

• Prepare a hybrid simulation

Logistics

• Validity studies

• Checklist development

• Comparison of scoring methods

• Repeat use of cases

• Post encounter scoring

• The “who” in scoring

• Gender issues

Medical Teacher

• Pell G, Fuller R, Homer M. Roberts T.

• How to Measure the Quality of the OSCE: A review of metrics – AMEE guide no. 49

Just Read This

Medical Education

• Durning S, Artino A, Boulet J, et al

Making Use of Contrasting Participant Views of the Same Encounter

Medical Education

• Hettinga A, Denessen E, Postma C

Checking the Checklist: a content analysis of expert- and evidence-based case-specific checklist items.

Academic Medicine

• Swygert K, Muller E, Scott C, Swanson D

• The Relationship Between USMLE Step 2 CS Patient Note Ratings and Time Spent on the Note: So Examinees Who Spend More Time Write Better Notes?

Impact of SP experience

• Impact of experience on students

• Still not much on the SPs themselves– Can they?

• SP vs faculty

– Should they?• Role play vs SP• SP vs actual patients

– Guides for SPs

Academic Medicine

• Bokken L, Rethans JJ, Jobsis Q et al

Instructiveness of Real Patients and Simulated Patients in Undergraduate Medical Education: A Randomized Experiment

Simulation in Healthcare

• Nestel D, Clark S, Tabak D, et al

Defining Responsibilities of Simulated Patients in Medical Education

International Journal of Psychophysiology

• Hulsman R, Pranger S, Koot S et al

How stressful it doctor-patient communication? Physiological and psychological stress of medical students in simulated history taking and bad-news consultations

Really Cool Stuff

• Faculty Development– Skills as raters– Development of skills – Reentry to practice

American Journal of Gastroenterology

• Alevi D, Baiocco PJ, Chokhavatia S et al.

• Teaching the competencies: using observed structured clinical examinations for faculty development

Academic Medicine

• Kogan J, Hess B, Conforti L, Holmboe E

• What Drives Faculty Ratings of Residents’ Clinical Skills? The Impact of Faculty’s Own Clinical Skills

It’s a depth of field issue….

B

E

C

U

R

I

O

U

S

A

S

K

*

*

R

E

A

D

Reflective Critique

BIBLIOGRAPHY

www.utmb.edu/oed

• Once you open the OED home page, go to “standardized patient “ section.

• Go to subheading “bibliography”