Clinical Applications of Standardized Patients (SPs) Kaohsiung Medical University May 8, 2007

Lynn Seng, MSEd University of Pennsylvania School of Medicine (“Penn Med”) Philadelphia, PA USA Director, Special Educational Projects, Director, Standardized Patient Program,

What & Who Are SPs?

What are Standardized Patients (SPs)? People who are trained to pretend to be patients for the purposes of educating and evaluating students.

“ Standardized ” because SPs are trained to act and react in a specific, predictable way, according to the goals of the program; and 2.Cases are often portrayed by more than one SP for the same program.

Who are SPs? “Regular” people like your neighbors, shop clerks, dog walkers, etc. Some are actors; many are not. Are all ages, sizes, colors, genders, etc.

SPs are paid professionals $12 - $22 USD per hour $25 - $38 USD for specialized programs (e.g., gynecology physical exams)

SP Characteristics Are able to act Can memorize roles and lists Have excellent retention skills Are reliable Want to help educate students

SPs in Clinical Education

What schools use SPs? Allied Health Clinical Psychology Dental Medical Nursing Pharmacy Physical Therapy Veterinary

How SPs are being used in medical education Help teach clinical, communication, and interpersonal skills Provide practice in a safe environment Introduce professionalism Evaluate skills

7 Reasons for SPs in Medical Education 1. Fewer real patients to use for teaching Hospitalized patients are sicker Hospitalizations are shorter Patients are more empowered

2. Faculty are too costly Faculty required to devote more time to research and clinics Schools unable to compensate departments for faculty time

3. Reliable and consistent educational experiences Faculty design SP programs to match curriculum Every student sees same clinical “patients”

4. Provide a safe environment Physical exam skills Emotional interviews (e.g., Giving Bad News) Diagnosis, treatment, management Cannot harm SPs

5. Schools need better evaluation tools SPs provide reliable measures of students’ skills Schools use SPs to evaluate and improve own curriculum

6. Help students prepare for exams USMLE Step II CS Students develop test-taking skills and confidence

7. SPs provide feedback Immediate Interpersonal skills

Purpose of SP Feedback To increase students’ awareness of their verbal and non-verbal behaviors...

Purpose of SP Feedback... and how their verbal and non-verbal behaviors affect their patient.

Benefits Patient perspective Immediate Verbal, with discussion & clarification Appropriate

Skills Taught with SPs

Clinical Skills Interviewing & History Taking Physical Exam Differential Diagnosis Treatment & Management

Communication Skills Difficult Subject, e.g.,  Colon cancer screening (3 rd most common cancer in Taiwan)  Teen suicide  HIV+/AIDS  Worker fatigue & stress  Sexual assault

Communication Skills Difficult Patient, e.g.,  Teenager: contraception & pregnancy  Non-compliant patient: asthma inhalers  Foreigner: illegal; tourist; cyber-bride  Behavior modification: smoking cessation  Flirt: suggestive, inappropriate  Physician

Professionalism Substance Abuse Teaching, Evaluating Ethics, e.g.,  Gifts  Relationships

Interpersonal Skills Professional Appearance & Behavior Eliciting & Giving Information Listening Empathy Respectfulness

University of Pennsylvania School of Medicine SP Programs

Penn Med SP Programs Medical Students Residents & Fellows Faculty & Community Physicians and...

Penn Med SP Programs Medical School Administration Hospital Ethics Committee Other U of P schools Other Philadelphia schools

Medical Students History & physical exam Diagnosis, treatment, and management Communication Interpersonal Feedback Cultural Competence Introduction to professionalism

SP Contact Hours in 2006 MS1:12 MS2: 33.5 MS3: 10.5 MS4: 8 Total: 64 hours

Residents & Fellows Improving clinical skills Giving and getting feedback Ethical dilemmas Teaching & evaluating students Teamwork

Faculty & Community Physicians Updating clinical skills Improving interpersonal skills Addressing ethical dilemmas Practicing giving bad news Improving feedback to students and residents

Association of Standardized Patient Educators (ASPE) Annual Meetings: June 17-20, 2007 Toronto, Canada June 29-July 2, 2008 San Antonio, Texas

Questions & Answers

Shieh shieh!