Lights, Camera, Action… The Effective Use of Standardized Patients in Health Professions Education Maria Wamsley, MD Sharon Youmans, Pharm.D., MPH

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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 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 1994 Sturpe, 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 process Nestel 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? 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. 1 st year, 4 th 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, 1997 Ostergarrd, 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 RevisionsPilot caseRevisions

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.W Association of Standardized Patient Educators MedEdPortal / 30