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

2. Lynn Seng, MSEd University of Pennsylvania School of Medicine (“Penn Med”) Philadelphia, PA USA Director, Special Educational Projects, 1984-2006 Director, Standardized Patient Program, 1996-2006

3. What & Who Are SPs?

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

5. “ Standardized ” because... 1. 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.

6. 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.

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

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

9. SPs in Clinical Education

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

11. 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

12. 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

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

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

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

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

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

18. 7. SPs provide feedback Immediate Interpersonal skills

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

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

21. Benefits Patient perspective Immediate Verbal, with discussion & clarification Appropriate

22. Skills Taught with SPs

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

24. 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

25. 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

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

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

28. University of Pennsylvania School of Medicine SP Programs

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

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

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

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

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

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

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

36. Questions & Answers

37. Shieh shieh! lynnseng.global@gmail.com