Using a standardized patient walk-through to improve implementation of clinical trials

Simulated Patients Are Predominantly Used to Teach and Evaluate Athletic Training Students' Skills: A 10-Year Follow-Up

Context:

Health care education needs to include methods of teaching and evaluation that are realistic and mimic patient care.

Objective:

To follow up on previous research regarding the methods athletic training educators use to evaluate and teach athletic training students' clinical skills during clinical experiences and in the classroom/laboratory.

Design:

Cross-sectional.

Setting:

Public and private institutions.

Patients or Other Participants:

Program directors of all accredited professional athletic training programs as of November 2015 (N = 372) were asked to participate; a total of 90 participated.

Data Collection and Analysis:

The electronic survey consisted of 6 demographic questions, 6 questions regarding methods used to teach and evaluate clinical skills, and 6 items regarding barriers, educational content areas, and practice settings for real-time patient encounters. The Cronbach α determined internal consistency, α = 0.784. Descriptive statistics were computed for all items. An analysis of variance and independent t tests analyzed differences among institutions/programs with different demographic characteristics with regard to methods, barriers, educational content areas, and settings used for teaching and evaluating skills. The α level was set at .05.

Results:

Simulated patients and real-time evaluations were the most prevalent methods of teaching and evaluating clinical skills in the classroom/laboratory and during clinical experiences, respectively. Students' lack of self-confidence (4.10 ± 0.835) was the most common barrier during clinical experiences. The clinical examination and diagnosis (4.54 ± 0.656) and acute care of injury and illness (4.39 ± 0.775) content areas ranked highest for sufficient opportunities for real-time skill evaluation. One-way analysis of variances revealed no significant differences related to institutional/program demographics regarding opportunities for or barriers to teaching and evaluating skills.

Conclusions:

Ten years after our previous research, athletic training students' skills are still primarily taught and evaluated via simulated patients, with a slight increase in real-time patient encounters. Professional programs should continue using simulations and consider real-time encounters to provide additional patient care experiences.

Evaluation of medical record quality and communication skills among pediatric interns after standardized parent training history-taking in China

OBJECTIVE

The effect of using standardized parent training history-taking on the quality of medical records and communication skills among pediatric interns was determined.

METHODS

Fifth-year interns who were undertaking a pediatric clinical practice rotation were randomized to intervention and control groups. All of the pediatric interns received history-taking training by lecture and bedside teaching. The pediatric interns in the intervention group also received standardized parent history-taking training. The following two outcome measures were used: the scores of medical records, which were written by the pediatric interns after history-taking from real parents of pediatric patients; and the communication assessment tool (CAT) assessed by real parents.

RESULTS

The general information, history of present illness (HPI), past medical history, personal history, family history, diagnosis, diagnostic analysis, and differential diagnosis scores in the intervention group were significantly higher than the control group (p < 0.05). Assessment of the CAT indicated that the real parents were more satisfied with the pediatric interns in the intervention group.

CONCLUSIONS

Standardized parent training history-taking is effective in improving the quality of medical records by pediatric interns. Standardized parent training history-taking is a superior teaching tool for clinical reasoning ability, as well as communication skills in clinical pediatric practice.

Using standardized patients to train telephone counselors for a clinical trial

Background

Standardized Patients (SPs) are actors trained to portray health care patients during the training and assessment of health care providers. This paper describes the methods and costs associated with using SPs to evaluate the skills of telephone counselors working on a clinical trial that evaluated a telephone smoking cessation program tailored for smokers using Department of Veterans Affairs mental health clinics.

Findings

Conducting the SP exercises required five main steps: (1) Write a SP case description detailing patient demographics, demeanor, clinical symptoms and history, and instructions on how to respond to counseling, (2) Identify, select and train actors to portray the SP cases; (3) Conduct audio-taped counseling encounters between the SPs and counselors, (4) Rate the counselors on their core counseling competencies, (5) Provide feedback to counselors. The SPs and study supervisors reported that the checklist was easy to use when rating the counselors. Counselors reported that the SP encounters were realistic and helpful for practicing their clinical work and for building self-efficacy for working with real patients. The labor costs of developing two SP cases and training two SP actors was approximately $1,475. The per-session labor cost of conducting a 1-hour counseling session between one SP and one counselor was approximately $314.

Conclusions

Using SPs to train telephone counselors working on a clinical trial was feasible and offered training benefits beyond those provided by didactic instruction and role plays. Our research group is now routinely using SPs for the training of incoming telephone counselors.

What family support specialists do: examining service delivery

This study describes services provided by family support specialists (FSS), peer advocates in programs for children with serious psychiatric conditions, to delineate differences between recommended components of FSS services and services actually provided. An analysis of qualitative interview and observational data and quantitative survey data from 63 staff at 21 mental health programs in New York identified that FSS and other staff have generally similar ideas about FSS services, and that these perceptions of activities are generally congruent with what FSS actually did. Implications of findings are discussed in the context of developing competencies and quality indicators for FSS.

Family Peer Advocates: A Pilot Study of the Content and Process of Service Provision

Professional family peer advocates are increasingly employed by public mental health systems to deliver family-to-family support that reduces barriers families face in accessing children's mental health care. These services, however, are neither uniformly available nor standardized. This pilot study describes the process, content and context of family-to-family support services. Simulating a parent seeking services, a trained standardized parent participated as a client in meetings with advocates in four programs and collected data through structured observations, a structured survey, and session audiotapes. The "walk-through" process was determined to be feasible and acceptable to family peer advocates as a way of evaluating services. Four family peer advocates provided an average of 25 services during each 2-session simulation with the standardized parent, including the following: information and educational support, instruction and skills development, emotional and affirmational support, instrumental support, and advocacy. Findings also revealed variability in the range of services provided and identified challenges in aspects of service provision, such as boundaries of advocate roles, availability of confidential service environments, and addressing crises and parent concerns about child safety. This paper provides the first in-depth look at services provided by this emerging workforce.

Standardized patient walkthroughs in the National Drug Abuse Treatment Clinical Trials Network: common challenges to protocol implementation

BACKGROUND

Training research staff to implement clinical trials occurring in community-based addiction treatment programs presents unique challenges. Standardized patient walkthroughs of study procedures may enhance training and protocol implementation.

OBJECTIVES

Examine and discuss cross-site and cross-study challenges of participant screening and data collection procedures identified during standardized patient walkthroughs of multi-site clinical trials.

METHOD

Actors portrayed clients and "walked through" study procedures with protocol research staff. The study completed 57 walkthroughs during implementation of 4 clinical trials.

RESULTS

Observers and walkthrough participants identified three areas of concern (consent procedures, screening and assessment processes, and protocol implementation) and made suggestions for resolving the concerns.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Standardized patient walkthroughs capture issues with study procedures previously unidentified with didactic training or unscripted rehearsals. Clinical trials within the National Drug Abuse Treatment Clinical Trials Network are conducted in addiction treatment centers that vary on multiple dimensions. Based on walkthrough observations, the national protocol team and local site leadership modify standardized operating procedures and resolve cross-site problems prior to recruiting study participants. The standardized patient walkthrough improves consistency across study sites and reduces potential site variation in study outcomes.

Use of actors as standardized psychiatric patients

Using actors in simulation provides opportunities for immersive, interactive, and reflective experiences to improve health care professionals' clinical expertise and practice. These experiences facilitate the development of enhanced critical thinking, problem-solving, and communication skills without risks to patients. This article discusses how to integrate actors and students into simulated experiences. Examples are provided using mental health simulations with actors as standardized psychiatric patients.

From research to the real world: buprenorphine in the decade of the Clinical Trials Network

The National Institute on Drug Abuse (NIDA) established the National Drug Abuse Treatment Clinical Trials Network (CTN) in 1999 to bring researchers and treatment providers together to develop a clinically relevant research agenda. Initial CTN efforts addressed the use of buprenorphine, a mu-opioid partial agonist, as treatment for opioid dependence. Strong evidence of buprenorphine's therapeutic efficacy was demonstrated in clinical trials involving several thousand opioid-dependent participants, and in 2002, the Food and Drug Administration approved buprenorphine for the treatment of opioid dependence. With the advent of a sublingual tablet containing both buprenorphine and naloxone to mitigate abuse and diversion (Suboxone), buprenorphine appeared poised to be the first-line treatment for opioid addiction. Notwithstanding its many attributes, certain implementation barriers remained to be addressed in CTN studies, and these efforts have brought a body of knowledge on buprenorphine to frontline clinicians. The purpose of this article is to review CTN-based buprenorphine research and related efforts to overcome challenges to the implementation of buprenorphine therapy in mainstream practice. Furthermore, this article explores current issues and future challenges that may require additional CTN efforts.