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Lights, Camera, Action…The Effective Use of Standardized Patients
in Health Professions Education
Maria Wamsley, MDSharon Youmans, Pharm.D., MPH
Creative Commons LicenseAttribution-NonCommercial-Share Alike 3.0 Unported
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See http://creativecommons.org/licenses/by-nc-sa/3.0/ for full license.
Workshop Objectives
By the end of the workshop…• Discuss the rationale for the use of standardized
patients (SPs) in health professions education.• Describe the use of (SPs) in health professions
education for learner skill assessment.• Explain the process for developing an standardized
patient (SP) case.• Create an outline for a SP case for formative (teaching)
or summative (assessment) purposes.
Workshop Agenda
• Introductions• Overview of SP use• Process of writing SP case• Developing case outline (breakout)• Next steps• Wrap-up
Workshop Agenda
• Introductions• Overview of SP use• Process of writing SP case• Developing case outline (breakout)• Next steps• Wrap-up
Millers Pyramid of Assessment
Does
Shows
Knows How
Knows
Direct observation, unannounced standardized patients
Simulation, Standardized patients
MCQs
Case presentations, essays
Miller G. Acad Med 1990
OSCE• Series of timed stations• Each station focused on a
different task• 8-10 stations to achieve
reliability• Checklist of specific behaviors• Ex: U.S. Medical Licensing
Exam, Canadian Pharmacy Licensing Exam
Reznick RK Acad Med 1993
Reliability Estimate of OSCE
1 hour 2 hours 3 hours 4 hours0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
van der Vleuten CPM and Schuwirth L. Med Educ 2005.
SP Assessments
• 80% of all medical schools use SPs to assess learners
• 30% of all pharmacy schools • ACGME recommends SPs to
assess resident competencies– Interviewing– Communication skills– Counseling
Brownell Teach Learn Med 1994Sturpe, AJPE 2010
Using SPs for Teaching Purposes
• Practicing communication skills– Breaking bad news– Handling challenging patient
interaction– Addressing unprofessional
behavior of colleagues• Interprofessional
standardized patient exercise• Global health simulation
Global Health Simulation
Goal: Prepare trainees to face the ethical challenges of global health fieldwork
Format: Simulation based curriculum comprising 5 scenarios that focus on ethically challenging scenarios in resource-poor settings.
Scenario
You are assisting an HIV outreach team in rural Malawi. The team visits remote villages to do rapid HIV tests on pregnant women. It is known that the majority of pregnant women in these areas do not receive prenatal care or HIV treatment. Women who test positive are offered treatment for free, but the patient must go to the nearest clinic (5 hours walk) monthly to get check ups and their HIV medications. Women are assured that test results and treatment will be kept confidential. You arrive to discuss positive HIV test results with Blessings, who is in her third-trimester of her pregnancy.
Hybrid (Patient-Focused) Simulations
• Combines SPs with inanimate models
• Used in procedural or surgical skills teaching
• Adds the patient perspective to the simulation
Ex: SP plays a pregnant woman but a plastic pelvis/mannequin simulates the actual birthing processNestel D and Kneebone R. Acad Med 2010.
Multiple Mini Interviews (MMI)
• Interview format to assess applicant skills– Ethics– Communication– Professionalism– Interpersonal relationships– Ability to collaborate
• Series of short stations
Beyond Standardized Patients
• Standardized caregivers• Standardized colleagues• Standardized students
Workshop Agenda
• Introductions• Overview of SP use• Process of writing SP case• Developing case outline (breakout)• Next steps• Wrap-up
What makes a case?
TEST RESULTS
INTERSTATION EXERCISE
STUDENT INSTRUCTIONS
FEEDBACK INSTRUCTIONS
GUIDE TO THE CHECKLIST
CHECKLIST
TRAINING MATERIALS
SP DEMOGRAPHICS
CASE OBJECTIVES
17
Elements of a SP Case
• Decide if case for teaching (formative) or assessment (summative).
• Choose the objectives of the case.
• What is the level of the learner? (e.g. 1st year, 4th year, resident)
• What is the context? (e.g. circumstances, background, setting)
Elements of a SP Case
• Develop checklist– Checklist: YES or No answers– Checklist: Global ratings– Number of checklist items–Which one is better?
Cunnington, Adv Health Sci Edu, 1997Ostergarrd, Med Teach, 2003
UCSF SOP MMI
Scenario:You are a volunteer at a local free health clinic for people who cannot otherwise afford healthcare. Pat is new to the clinic and has been asked to fill out a basic information sheet to keep on file at the clinic. You have been asked by the staff to greet Pat and review this basic information. (Pat is waiting inside the room.)
Vera Lyons case• Assess medical students’ skill in
communicating with an interprofessional colleague (nurse)
• Assess medical students’ ability to evaluate and manage a hospitalized patient with an acute complaint
Vera Lyons
• A 55 year old woman hospitalized with cellulitis who develops new chest pain
• Nurse is unable to reach Vera’s physicians; student on the team enters the room and is charged with evaluating the chest pain, coming up with a diagnostic and treatment plan, communicating with patient and nurse
Elements of a SP Case
• Who completes the checklist?– Faculty?– SP?
• How do learners receive feedback?
Workshop Agenda
• Introductions• Overview of SP use• Process of writing SP case• Developing case outline (breakout)• Next steps• Wrap-up
• Essential to good inter-rater reliability• Allows multiple actors to understand
your criteria for them to… Reveal or withhold specific information Give the learner credit for an item when
there are multiple ways to ask the patient for the information
Guide to the Checklist
25
Example:Do you smoke?
• YES: Student must ask: IF you smoke, HOW MUCH you smoke and HOW LONG have you smoked to get credit for this answer
• Your response: “Yes.” “Two packs a day.” “30 years.”
Guide to the Checklist
26
• Assess clinical reasoning• Assess ability to integrate history and PE findings
• Can use: SOAP note Questions related to the case Simulations Heart sounds Lung x-ray
Inter-station exercise
27
Next steps…Case
review by experts
Revisions
SP training
Revisions
Pilot case
Revisions
The Future?
Additional Resources
Hodges B, Hanson M, McNaughton BA, Regehr G. Creating, Monitoring, and Improving a Psychiatry OSCE. A Guide for Faculty, Academic Psychiatry, 26:3, Fall 2002
Coaching standardized patients : for use in the assessment of clinical competence (sample training materials, Checklist Guide, Feedback Instructions)Peggy Wallace, Ph.D., (UCSD) Imprint New York : Springer Pub., c2007 UCSF Call # RT71 .W35 2007
Association of Standardized Patient [email protected]
MedEdPortal https://www.mededportal.org/
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