Dealing with difficult sexual questions during consultations: a new training program

Frequency of Difficult Patient Encounters in a Japanese University Hospital and Community Hospitals: A Cross-sectional Study

Objective Difficult patient encounters (DPEs) are defined as encounters with patients causing strong negative feelings in physicians. In primary care settings, DPEs account for approximately 15% of visits among outpatients. To our knowledge, this is the first epidemiological study of DPEs in Japan. Methods We conducted a survey of 8 physicians (5.0±2 years of clinical experience) who examined first-visit patients ≥15 years old with clinical symptoms at the Department of General Medicine in Chiba University Hospital and 4 community hospitals over a 2-month period since December 2015. Materials We evaluated 10-Item Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10) scores (DPE ≥31 points; non-DPE ≤30 points) and patient age, sex, and presence of psychological or social problems. Results The valid response rate was 98.9% (94/95) and 98.4% (189/192) in the university and community hospitals, respectively. The percentage of DPEs was 39.8% (37/93) and 15.0% (26/173) in the university and community hospitals, respectively; the percentage of DPEs was significantly higher at the university hospital than at the community hospitals (p<0.001). The proportion of patients with psychosocial problems was significantly higher in the DPE group than in the non-DPE group (93.7% vs. 40.4%, p<0.001). Conclusion Our findings were similar to those reported in primary care settings in other countries in community hospital outpatient and general internal medicine departments, where patients are mostly non-referrals, although the values were higher in university hospital general medicine departments, where patients were mostly referrals. Patients involved in DPEs have a high rate of psychological and social problems.

The association of standardized patient educators (ASPE) gynecological teaching associate (GTA) and male urogenital teaching associate (MUTA) standards of best practice

Gynecological Teaching Associates (GTAs) and Male Urogenital Teaching Associates (MUTAs) instruct healthcare professional learners to perform accurate and respectful breast, speculum, bimanual vaginal, rectal, urogenital, and prostate examinations. During such sessions, the GTA/MUTA uses their own body to instruct while providing real-time feedback. While GTAs/MUTAs fall under the broader umbrella of Standardized Patient methodology, the specificity of their role indicates need for establishment of Standards of Best Practice (SOBP) for GTA/MUTA programs. On behalf of the Association of Standardized Patient Educators (ASPE), the Delphi process was utilized to reach international consensus identifying the Practices that comprise the ASPE GTA/MUTA SOBP. The original ASPE SOBP was used as the foundation for the iterative series of three surveys. Results were presented at the ASPE 2019 conference for additional feedback. Fifteen participants from four countries completed the Delphi process. Four of the original ASPE SOBP Domains were validated for GTA/MUTA programs: Safe Work Environment, Instructional Session Development, Training GTAs/MUTAs, and Program Management. Principles and Practices were shaped, and in some instances created, to best fit the distinct needs of GTA/MUTA programs. The ASPE GTA/MUTA SOBP apply to programs that engage GTAs/MUTAs in formative instructional sessions with learners. Programs that incorporate GTAs/MUTAs in simulation roles or in summative assessment are encouraged to reference the ASPE SOBP in conjunction with this document. The SOBP are aspirational and should be used to shape Practices within the program's local context. The ASPE GTA/MUTA SOBP will continue to evolve as our knowledge-base and practice develop.

Usefulness of a short training seminar on how to handle difficult patients in simulated education

OBJECTIVE

To evaluate a short-time simulation training seminar on how to handle difficult patients using professional simulated patients (SPs) such as actors.

PARTICIPANTS

Sixty-three second-year residents at Chiba University Hospital between 2015 and 2017 who only attended the seminar once.

INTERVENTION

The participants were divided into small groups, each of which was assigned a supervisory doctor as facilitator. Those who were playing the doctor's role enacted a medical interview with an SP. After the interview, the facilitator, the SP, and the observing residents participated in a debriefing while watching a recorded video of the interview.

OUTCOME MEASURES

Pre- and post-seminar questionnaires using a 7-point Likert scale (from 1: strongly disagree to 7: strongly agree) were used to examine the differences in "confidence in ability to handle difficult patients" and "learning motivation to handle difficult patients". The two items examined by both pre- and post-seminar questionnaires, were analyzed by a paired t-test. The residents were also surveyed on their satisfaction with the seminar, acquisition of new knowledge, and impressions and comments (free-text answers).

RESULTS

The findings of the questionnaire showed a significant post-seminar increase in confidence (3.1±1.6 to 4.0±1.5 [p<0.01]) and learning motivation (5.3±1.8 to 5.8±1.5 [p<0.01]) as well as high levels of satisfaction (5.8±1.1) with the seminar and acquisition of knowledge (5.7±1.3). Some residents further reported that the seminar led to self-review and was valuable for their future clinical practice.

CONCLUSION

Our seminar on how to handle difficult patients was perceived as effective, as evaluated by the questionnaire, despite the short duration of the session. Factors potentially contributing to this effectiveness include the use of actors as SPs and the post-interview debriefing with feedback from the SP, colleagues, and facilitator.

To the Point: The expanding role of simulation in obstetrics and gynecology medical student education

This article, from the "To the Point" series prepared by the Association of Professors of Gynecology and Obstetrics (APGO) Undergraduate Medical Education Committee (UMEC), provides educators with an overview of the use of simulation in undergraduate medical education in the field of obstetrics and gynecology. Simulation plays an important role in the education of medical students. Students are increasingly serving as clinical observers and providing less direct patient care. Simulation can help standardize education and ensure quality and comparability across an enlarging educational environment. This article summarizes the expanding role of simulation in undergraduate medical education in obstetrics and gynecology and its effect on important learner outcomes such as confidence, knowledge, skills, workplace behaviors, and translation to patient care.

Achieving 360° student feedback using SPaCE

BACKGROUND

The use of simulated patients (SPs) in undergraduate medical curricula is now an accepted norm. SPs play an important role in the delivery of feedback to medical students. In Dundee, SPs are used in clinical skills teaching sessions from year 1 onwards. Currently SPs provide open feedback to students during communication skills sessions. Rather than giving balanced feedback, SPs can sometimes focus on the negative aspects of a student's performance.

METHOD

This research study developed a closed-feedback tool to be used by SPs to provide constructive feedback to final-year medical students after they have undertaken the Final Year Ward Simulation Exercise (FYWSE). The Simulated Patient Candidate Evaluation (SPaCE) tool was evaluated using a convenience sample of SPs who rated the applicability of the tool by reviewing three previous FYWSE videos.

RESULTS

The SPs were able to engage with the SPaCE tool, agreeing that it helped them to identify differences between student's performances. Correlations were shown between the SP's assessment and the marks awarded by the assessment panel.

DISCUSSION

The SPaCE tool is a structured, standardised feedback tool that SPs can complete easily and quickly. The SpaCE tool encourages SPs to provide feedback from specific interactions they have had with students during the FYWSE. In the SP's opinion, good interaction and good interpersonal skills are the determinants of good performance.