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Britz V, Sterz J, Koch Y, Schreckenbach T, Stefanescu MC, Zinßer U, Verboket RD, Sommer K, Ruesseler M. Impact of simulated patient-based communication training vs. real patient-based communication training on empathetic behaviour in undergraduate students - a prospective evaluation study. BMC MEDICAL EDUCATION 2024; 24:870. [PMID: 39134984 PMCID: PMC11318334 DOI: 10.1186/s12909-024-05801-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 07/19/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Empathy is a key competency and is essential for doctor-patient relationships. Studies have proven a continuous reduction of empathy in medical students during their study period. The use of SPs is positively evaluated for competency acquisition and real patient communication training has positive effects on empathy empowerment. Therefore, the present study focusses on the impact of simulated patient (SP) vs real patient (RP) communication training on empathetic behaviour in undergraduate medical students. METHODS The prospective evaluation took place during a 210-minute skills lab unit on medical communication for 3rd year medical students. Study participants were allocated in advance to one of three groups: one group trained with an SP (SP-group) and was informed about the fact that it was an SP; another group trained with an SP but assumed to encounter an RP (incognito patient group (IP-group)); the last group trained with an RP and was correctly informed about it (real patient group (RP-group). Self-assessed empathy was measured by using Jefferson Scale of Physician Empathy (JSPE) and Interpersonal Reactivity Index (IRI), as these are the most commonly used instruments for assessing empathy. Study participants were evaluated on empathetic behaviour by their group-associated patient using the Consultation and Relational Empathy (CARE) scale. RESULTS 146 students participated. There was no significant difference in self-assessed empathy between groups for JSPE and IRI. External assessment via CARE showed a statistically significant difference between SP-group and IP-group , as well as between SP-group and RP-group. There was no significant difference between IP-group and RP-group. This means that students training with real patients (or who believed them to be real) did receive significantly lower performance ratings on their empathy. CONCLUSION The results demonstrate a significant lower external empathy rating for students who had trained with a real patient or if they were in the belief of having encountered a real patient; this may be due to inhibitions and a lack of routine. Therefore, we recommend implementing SPs in the early study period with the gradual integration of RPs in the student's further course of study.
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Affiliation(s)
- Vanessa Britz
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt/Main, Germany.
| | - Jasmina Sterz
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt/Main, Germany
- Goethe-University Frankfurt, University Hospital, Department of Trauma Hand and Reconstructive Surgery, Frankfurt/Main, Germany
| | - Yannik Koch
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt/Main, Germany
| | - Teresa Schreckenbach
- Goethe University Frankfurt, University Hospital Frankfurt, Department of General, Visceral, Transplantation and Thoracic Surgery, Frankfurt/Main, Germany
| | - Maria-Christina Stefanescu
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt/Main, Germany
- Johannes Gutenberg University, Medical Center Mainz, Department of Pediatric Surgery, Mainz, Germany
| | - Uwe Zinßer
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt/Main, Germany
| | - Rene Danilo Verboket
- Goethe-University Frankfurt, University Hospital, Department of Trauma Hand and Reconstructive Surgery, Frankfurt/Main, Germany
| | - Katharina Sommer
- Goethe-University Frankfurt, University Hospital, Department of Trauma Hand and Reconstructive Surgery, Frankfurt/Main, Germany
| | - Miriam Ruesseler
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt/Main, Germany
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Schuster L, Valor-Méndez L, Wacker J, Dannhardt-Thiem V, Schmidt A, Knitza J, Simon D, Manger B, Schett G, Kleyer A. ["Rheuma (be-)greifen"- A multimodal teaching concept to improve rheumatology education for medical students]. Z Rheumatol 2024; 83:186-193. [PMID: 37505294 PMCID: PMC10973034 DOI: 10.1007/s00393-023-01391-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND The German Society for Rheumatology, through its campaign Rheuma2025, aims to improve student teaching in order to ensure patient care for rheumatological patients in the future. OBJECTIVE To assess whether a combination of traditional and innovative educational methods provide both an improvement in the quality of teaching and an increase in the attractiveness of rheumatology as a discipline. MATERIAL AND METHODS Establishment of the teaching concept "Rheuma (be-)greifen" consisting of five modules on patient history taking with acting patients, musculoskeletal ultrasound, arthrocentesis, 3D printing of pathological joints and virtual reality applications based on real patient cases in the curricular teaching of medical students. RESULTS The evaluation of the teaching concept with 93 students of medicine showed a consistently high acceptance of all modules, which were rated as very effective or rather effective. Direct patient-related modules, such as history taking with acting patients, musculoskeletal ultrasound and arthrocentesis, received even higher acceptance than the visualization methods utilizing 3D printing and virtual reality. CONCLUSION Innovative teaching methods can help to improve the acceptance of teaching in the field of rheumatology, especially when combined with classical teaching contents.
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Affiliation(s)
- L Schuster
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland.
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland.
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland.
| | - L Valor-Méndez
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - J Wacker
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - V Dannhardt-Thiem
- Medizinische Fakultät, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - A Schmidt
- Medizinische Fakultät, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - J Knitza
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - D Simon
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - B Manger
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - G Schett
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - A Kleyer
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Deutschland
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
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Marshall H, Weingartner LA, Henry T, Smith J, Wright T, Bohnert CA, Shaw MA, Adamson DT. Assessing Abdominal Examination Skills in a Surgery Clerkship Standardized Patient Encounter for Curriculum Improvement. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241272382. [PMID: 39119065 PMCID: PMC11307356 DOI: 10.1177/23821205241272382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 07/18/2024] [Indexed: 08/10/2024]
Abstract
INTRODUCTION Standardized patient (SP) encounters allow medical students to practice physical examination skills and clinical reasoning. SP cases are used for learning and assessment, but recorded encounters can also be valuable curriculum evaluation tools. We aimed to review SP encounters to improve abdominal examination skills and the broader physical examination curriculum. METHODS We reviewed recorded SP encounters of third-year medical students on surgery clerkship rotation. Students examined a cisgender woman presenting with acute right lower abdominal pain. We observed abdominal examinations to determine which maneuvers were attempted and completed correctly. We then used these outcomes to develop targeted clerkship training for the subsequent student cohort. Our intervention targeted abdominal examination gaps by explaining how to integrate abdominal examination findings with a focused history for surgical patients. We evaluated the intervention's impact on abdominal examination skills with third-year medical students in comparison (2021-2022, n = 119) and intervention (2022-2023, n = 132) groups. RESULTS In both the comparison and intervention groups, nearly all students attempted at least 1 general examination maneuver like auscultation, palpation, percussion, or rebound tenderness. Only 40% of students in the comparison group attempted an advanced maneuver like the Rovsing, Psoas, or Obturator sign. After the intervention, 75% of students in the intervention group attempted an advanced maneuver (χ2(1, 251) = 31.0, p < .001). Cohorts did not gain skills over time through the clerkship. Rebound tenderness was frequently assessed incorrectly by students in both groups, with many avoiding the right lower quadrant entirely. CONCLUSIONS This project highlights how medical students struggle to utilize abdominal examination maneuvers and integrate findings. The results also showed that students did not consistently learn advanced examination skills either before or during clerkship rotation, which may be commonly assumed by clinical faculty. Finally, this work demonstrates how SP encounters can be used to evaluate and improve surgical education curriculum.
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Affiliation(s)
- Hannah Marshall
- Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, KY, USA
| | - Laura A. Weingartner
- Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, KY, USA
| | - Taylen Henry
- Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, KY, USA
| | - Jensen Smith
- Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, KY, USA
| | - Tiffany Wright
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Carrie A. Bohnert
- Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, KY, USA
| | - M. Ann Shaw
- Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, KY, USA
| | - Dylan T. Adamson
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
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Nawathe PA, Herrington A. Enhancing healthcare communication education: Standardised patient programmes. Indian J Anaesth 2024; 68:65-70. [PMID: 38406333 PMCID: PMC10893806 DOI: 10.4103/ija.ija_1201_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 12/25/2023] [Accepted: 12/26/2023] [Indexed: 02/27/2024] Open
Abstract
This article delves into standardised patients' (SP) roles in healthcare education, using role-play and in-person methodology for realistic scenario simulation and learner technical and non-technical skill enhancement. Key to the success of the SP programme are phases like recruitment, onboarding, training and continuous quality improvement, cultivating a qualified pool of engaged SPs. Sustained SP engagement involves strategies such as tailored training sessions, quizzes, just-in-time videos and anaesthesia-specific self-assessment tools. The benefits of sessions led by SPs lie in their flexibility, providing anaesthesia learners with a controlled, experiential learning environment, where they can safely learn from mistakes. Addressing challenges in launching SP programmes for training, the article underscores clear objectives, strategic resource allocation, curriculum integration and specialised SP training. Implementing technology, quality assurance and ongoing evaluations are vital for dynamic SP programmes. The article advocates holistic SP programme implementation and optimisation, with continuous improvement for acquiring skills by anaesthesia professionals.
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Affiliation(s)
- Pooja A. Nawathe
- Department of Pediatrics, Cardiology and Biomedical Sciences, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Alaina Herrington
- Director of Simulation and Clinical Affairs, Mississippi State University, Meridian, Mississippi, USA
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Guldner G, Wells J, Ayutyanont N, Iyengar R, Sprenger S, Siegel JT, Kashyap R. COVID-19 related disruptions to medical education and perceived clinical capability of new resident physicians: a nationwide study of over 1200 first-year residents. MEDICAL EDUCATION ONLINE 2023; 28:2143307. [PMID: 36369921 PMCID: PMC9665094 DOI: 10.1080/10872981.2022.2143307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic transformed the final year of undergraduate medical education for thousands of medical students across the globe. Out of concern for spreading SARS-CoV-2 and conserving personal protective equipment, many students experienced declines in bedside clinical exposures. The perceived competency of this class within the context of the pandemic is unclear. We designed and distributed a survey to measure the degree to which recent medical school graduates from the USA felt clinically prepared on 13 core clinical skills. Of the 1283 graduates who matched at HCA Healthcare facilities, 90% (1156) completed the survey. In this national survey, most participants felt they were competent in their clinical skills. However, approximately one out of four soon-to-be residents felt they were clinically below where they should be with regard to calling consultations, performing procedures, and performing pelvic and rectal exams. One in five felt they were below where they should be with regard to safely transitioning care. These perceived deficits in important skill sets suggest the need for evaluation and revised educational approaches in these areas, especially when traditional in-person practical skills teaching and practice are disrupted.
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Affiliation(s)
- Gregory Guldner
- Graduate Medical Education, HCA Healthcare, Brentwood, TN, USA
| | - Jessica Wells
- Graduate Medical Education, HCA Healthcare, Brentwood, TN, USA
| | | | - Rahul Iyengar
- Southern Hills Medical Center, TriStar Division, HCA Healthcare, Nashville, TN, USA
| | - Steven Sprenger
- Tristar Centennial Medical Center, HCA Healthcare, Nashville, TN, USA
| | - Jason T. Siegel
- Department of Behavioral and Organizational Science, Claremont Graduate University, Claremont, CA, USA
| | - Rahul Kashyap
- Tristar Centennial Medical Center, HCA Healthcare, Nashville, TN, USA
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Cai W, You M, Li J, Li Q, Wang D, Wang H. Application of "immersive contextualization based-learning teaching" mode in the orthopaedic musculoskeletal disorder module of clinical medicine education. BMC MEDICAL EDUCATION 2023; 23:906. [PMID: 38031076 PMCID: PMC10687819 DOI: 10.1186/s12909-023-04831-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To evaluate the effect and influence of the "immersive contextualization-based learning" teaching mode (ICBLT) in the orthopaedic musculoskeletal disorder module of clinical medicine education. METHODS Undergraduate students in five consecutive semesters of clinical medicine in West China Hospital, Sichuan University were enrolled in this study. During the teaching process in each semester, a cross-over design was applied, and students were randomly divided into two classes (Class A and Class B) to receive the designated experimental courses with different routes. After they took the final exams, the scores of the selected chapters (sports injury chapter and osteoarthritis chapter) were extracted to conduct Tests of Between-Subjects Effects. Q-Q plot was drawn to test whether the distribution of the scores follows normal distribution. The part of the feedback questionnaires to assess these two teaching modes were also extracted for comparison. RESULTS A total of 441 students were enrolled in this study, among which, Class A teaching route was implemented to 222 students and Class B to the rest 219. The results of Tests of Between-Subjects Effects showed that ICBLT mode could lead to better scores compared to the Lecturing-based learning teaching (LBLT) mode (p < 0.0001). In terms of mastery of practical skills, help to deepen the memory of knowledge and satisfaction with the teaching mode, the ICBLT mode showed better results (p < 0.0001). CONCLUSION ICBLT mode had better potential in helping mastery of practical skills and deepening the memory of knowledge.
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Affiliation(s)
- Wufeng Cai
- Department of Orthopedics, West China Hospital, Orthopedic Research Institute, Sichuan University, Chengdu, China
- Department of Engineering, University of Exeter, Exeter, England
| | - Mingke You
- Department of Orthopedics, West China Hospital, Orthopedic Research Institute, Sichuan University, Chengdu, China
| | - Jian Li
- Department of Orthopedics, West China Hospital, Orthopedic Research Institute, Sichuan University, Chengdu, China.
| | - Qi Li
- Department of Orthopedics, West China Hospital, Orthopedic Research Institute, Sichuan University, Chengdu, China
| | - Duan Wang
- Department of Orthopedics, West China Hospital, Orthopedic Research Institute, Sichuan University, Chengdu, China.
| | - Haoyang Wang
- Department of Orthopedics, West China Hospital, Orthopedic Research Institute, Sichuan University, Chengdu, China.
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Flanagan OL, Cummings KM. Standardized Patients in Medical Education: A Review of the Literature. Cureus 2023; 15:e42027. [PMID: 37593270 PMCID: PMC10431693 DOI: 10.7759/cureus.42027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/19/2023] Open
Abstract
The concept of standardized patients (SPs) was first introduced in the 1960s by Dr. Howard Barrows of the University of Southern California and has been applied in medical school education since that time. This practice has allowed medical students to practice skills on live persons who are teachers rather than on real patients, who may be endangered by their emerging skills. Previous studies supported the use of SPs but did not measure whether they improved clinical competence or students' confidence in their skills. This literature review evaluated whether current medical education literature supports or refutes the use of SPs compared to other modalities such as simulated patients (SiPs) and virtual reality (VR) in the improvement of student confidence, clinical performance, and interpersonal communication skills. The research questions posed for this review were as follows: do medical students in their first two years of education who have practiced skills using SPs have more self-confidence in their ability to perform skills on real patients than those students who did not use SPs, do medical students in their third and fourth years of medical school have higher clinical competency with sensitive patient examinations after using SPs in their first two years of medical education than those students who did not use SPs, and do medical students who have used SPs for discussing sensitive issues have better interpersonal skills when they encounter real patients in the clinical setting than those who have not used SPs? The methodology for this descriptive, systematic review of the literature was organized using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart to describe how articles were collected and synthesized to evaluate the variables under study. The results of this study revealed that students learned the most when SPs were used because they were able to teach students the skills that they needed in a safe learning environment. Medical students performing sensitive patient examinations with SPs learned not only how to perform the examinations but also how to improve their communication with patients. Students and residents reported increased confidence and clinical competence when performing new skills with SPs rather than with peer practice, virtual reality, or real patients in a clinical setting. Although the utilization of SPs has been studied in multiple ways and found to be a powerful tool in the education of undergraduate medical students and interns, there is still much study to be done to address the human needs of real patients. Gaps in this literature included small sample sizes, a lack of standardized assessment tools, and the need to include a multidisciplinary approach that addresses cultural awareness and appreciation. The authors found limited studies analyzing the effect the coronavirus disease 2019 (COVID-19) pandemic had on the use of SPs in medical school education. Continued scientific inquiry in post-pandemic medical education is an essential component for dissemination as most schools have reintroduced the use of SPs, which strengthens the concept that their use is superior to the other simulation methods used when SPs were not available.
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Affiliation(s)
- Octavia L Flanagan
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine (LECOM), Elmira, USA
| | - Kristina M Cummings
- Department of Family Medicine, Lake Erie College of Osteopathic Medicine (LECOM), Elmira, USA
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Soltero E, Villalobos CD, Englar RE, Graham Brett T. Evaluating Communication Training at AVMA COE-Accredited Institutions and the Need to Consider Diversity within Simulated Client Pools. JOURNAL OF VETERINARY MEDICAL EDUCATION 2023; 50:192-204. [PMID: 35312469 DOI: 10.3138/jvme-2021-0146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The push for competency-based veterinary medical education by accrediting bodies has led to the inclusion of non-technical skills within curricula. Communication, self-awareness, and cultural humility are considered essential for post-graduate success. To facilitate skills development, veterinary educators have incorporated a variety of modalities including lecture, group discussions, virtual and peer-assisted learning, role play, video review of consultations, and simulated clients (SCs). The overarching goal is developing students into self-reflective practitioners through exposure to clinical scenarios that enhance and embody diversity. Decision making about case management is subject to stereotypes, bias, and assumptions. Racial and ethnic disparities reported in health care can adversely impact patient outcomes. This study was conducted to evaluate communication training and diversity among SC pools within veterinary colleges. A questionnaire was electronically disseminated to assistant/associate deans and/or directors of curriculum/education at 54 American Veterinary Medical Association Council on Education-accredited or provisionally accredited colleges of veterinary medicine. Twenty-one institutions are represented within the data set. Participating institutions summarized their communication curricula: 18 (85.71%) used SCs. Over 55% of these did not track SC demographic data or social identities; among institutions that did track, SCs were primarily monolingual English-speaking (77%), non-disabled (94.2%), white (90.4%), non-Hispanic/Latinx (98.6%) women (57%) over age 56 (64%). Sixteen institutions agreed with the statement "I do not feel that our SC pool is adequately diverse." Respondents shared that lack of time and capacity for recruitment were barriers to diversifying SC pools and proposed strategies to improve outreach.
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Affiliation(s)
- Elizabeth Soltero
- University of Arizona College of Veterinary Medicine, 1580 E Hanley Blvd., Oro Valley, AZ 85737 USA
| | - César D Villalobos
- Office of Diversity and Inclusion, University of Arizona College of Veterinary Medicine, 1580 E Hanley Blvd., Oro Valley, AZ 85737 USA
| | - Ryane E Englar
- Associate Professor of Practice, University of Arizona College of Veterinary Medicine, 1580 E Hanley Blvd., Oro Valley, AZ 85737 USA
| | - Teresa Graham Brett
- Diversity, and Inclusion, and Assistant Professor of Veterinary Medicine, University of Arizona College of Veterinary Medicine, 1580 E Hanley Blvd., Oro Valley, AZ 85737 USA
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Siemerkus J, Petrescu AS, Köchli L, Stephan KE, Schmidt H. Using standardized patients for undergraduate clinical skills training in an introductory course to psychiatry. BMC MEDICAL EDUCATION 2023; 23:159. [PMID: 36922802 PMCID: PMC10016160 DOI: 10.1186/s12909-023-04107-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The goal of this study was to assess the value and acceptance of Standardized or Simulated Patients (SPs) for training clinically inexperienced undergraduate medical students in psychiatric history taking, psychopathological assessment, and communication with psychiatric patients. METHODS As part of a newly developed introductory course to psychiatry, pairs of 3rd year medical students conducted psychiatric assessments of SPs, including history and psychopathological state, under the supervision of a clinical lecturer. Prior to the assessment, students attended introductory lectures to communication in psychiatry and psychopathology but were clinically inexperienced. After the interview, the students' summary of their findings was discussed with other students and the lecturer. Students, lecturers, and actors were invited to a survey after the course. Questions for the students included self-reports about perceived learning success and authenticity of the interviews. RESULTS 41 students, 6 actors and 8 lecturers completed the survey (response rates of 48%, 50%, and 100%, respectively). The survey results indicated that, despite their lack of clinical experience, students learned how to conduct a psychiatric interview, communicate in a non-judgmental and empathetic manner, take a psychiatric history and perform a psychopathological examination. SPs were perceived as authentic. The survey results suggested that this setting allowed for an enjoyable, non-distressful and motivating learning experience within a restricted time frame of just two afternoons. CONCLUSION The results indicated that the SP approach presented is useful for teaching clinical skills in psychiatry to students with limited previous clinical experience and knowledge of psychiatry. We argue that SPs can be used to teach practical psychiatric skills already during an early phase of the curriculum. Limitations of our study include a limited sample size, a temporal gap between the course and the survey, reliance on self-reports, and lack of comparison to alternative interventions.
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Affiliation(s)
- Jakob Siemerkus
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland.
| | - Ana-Stela Petrescu
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Laura Köchli
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Klaas Enno Stephan
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
- Max Planck Institute for Metabolism Research, Cologne, Germany
| | - Helen Schmidt
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
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Zhang C. A Literature Study of Medical Simulations for Non-Technical Skills Training in Emergency Medicine: Twenty Years of Progress, an Integrated Research Framework, and Future Research Avenues. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4487. [PMID: 36901496 PMCID: PMC10002261 DOI: 10.3390/ijerph20054487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Medical simulations have led to extensive developments in emergency medicine. Apart from the growing number of applications and research efforts in patient safety, few studies have focused on modalities, research methods, and professions via a synthesis of simulation studies with a focus on non-technical skills training. Intersections between medical simulation, non-technical skills training, and emergency medicine merit a synthesis of progress over the first two decades of the 21st century. Drawing on research from the Web of Science Core Collection's Science Citation Index Expanded and Social Science Citation Index editions, results showed that medical simulations were found to be effective, practical, and highly motivating. More importantly, simulation-based education should be a teaching approach, and many simulations are utilised to substitute high-risk, rare, and complex circumstances in technical or situational simulations. (1) Publications were grouped by specific categories of non-technical skills, teamwork, communication, diagnosis, resuscitation, airway management, anaesthesia, simulation, and medical education. (2) Although mixed-method and quantitative approaches were prominent during the time period, further exploration of qualitative data would greatly contribute to the interpretation of experience. (3) High-fidelity dummy was the most suitable instrument, but the tendency of simulators without explicitly stating the vendor selection calls for a standardised training process. The literature study concludes with a ring model as the integrated framework of presently known best practices and a broad range of underexplored research areas to be investigated in detail.
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Affiliation(s)
- Cevin Zhang
- School of Media and Design, Beijing Technology and Business University, Sunlight South Road 1, Beijing 102488, China
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Finnegan R, Flanagan O, Cantillon P, McGlacken-Byrne S. The hidden benefits of patient encounters. CLINICAL TEACHER 2023; 20:e13544. [PMID: 36199232 PMCID: PMC10092410 DOI: 10.1111/tct.13544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 09/12/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Whilst it is widely acknowledged that health care professionals (HCPs) learn from patient encounters, research exploring what HCPs learn from their meetings with patients is relatively sparse, particularly in the context of postgraduate training. Moreover, there are few research studies that examine the contribution of patient encounters to HCP education from both HCP and patient perspectives. This study set out to explore HCPs learning from patient encounters from both HCP and patient perspectives. METHODS Qualitative descriptive design was used to conduct this study. Using purposive sampling, we recruited participants from three different groups in a single department of paediatrics in a teaching hospital. Data was collected through interviews, which were transcribed and analysed for key themes. FINDINGS Patients felt that they played a central role in clinical education and highlighted their ability to educate postgraduate HCPs about their lived experiences of disease. HCPs highlighted the unique insight into a chronic illness gained from patient accounts, essential to developing patient and family orientated approaches to care. HCPs reported that they developed professionally, learning to adapt their negotiation and educational strategies. CONCLUSIONS This study highlights the importance of patient encounters as critical contributors to HCPs understanding of the lived experiences of patients with chronic disease, and offers insights into how parents view their contribution to clinical education. Much of this learning is embedded and implicit, which suggests that HCP trainees need to develop better in the moment awareness of what they are learning from their meetings with patients and their families.
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Affiliation(s)
- Rebecca Finnegan
- School of Medicine, NUI Galway, Galway, Ireland.,Discipline of Paediatrics, Galway University Hospital, Galway, Ireland
| | - Orla Flanagan
- Discipline of Paediatrics, Galway University Hospital, Galway, Ireland
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12
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Dutt H, Dean A, Kamal RS, Allan AL. Importance of Incorporating the Perspectives of People with Cancer into Oncology Education: A Scoping Review. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231219394. [PMID: 38116493 PMCID: PMC10729629 DOI: 10.1177/23821205231219394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023]
Abstract
Background With the shift towards person-centered care (PCC) in oncology, there is a need for parallel evolution of oncology education programs to prepare the next generation of health professionals to deliver effective PCC. These programs should be designed utilizing perspectives from individuals who have lived experience with cancer to ensure that changes to education curricula translate to improved PCC in the clinic. Objectives Our goal was to identify existing literature describing such programs as well as identify gaps for further development. Methods Keywords were agreed upon and searched across Ovid Medline, Ovid Embase, ERIC, Google Scholar, and MedEdPORTAL databases. Duplicates were removed, unique articles were screened for relevance by title and abstract, and a full text review of each article was completed for validation. Included articles describe methods for involving people with cancer in developing and/or delivering oncology-focused education programs. Results In total, 15 articles describing 12 unique oncology education programs from 7 different countries were identified, reviewed, and summarized. These programs involved learners undertaking undergraduate medical education, postgraduate medical education, continuing medical education, or training as nurses or radiation therapists. Current literature indicates that classroom-based sessions, experiential or simulated learning modalities, and/or asynchronous online modules can all feasibly be created with the integration of perspectives/narratives of people with cancer. Furthermore, involving people with cancer directly in the design and/or delivery of these education programs may contribute to improved patient experiences. Conclusions Including the perspectives of people with cancer directly in oncology curriculum development and delivery can improve established pedagogical approaches and enhance learner confidence and competency in delivering PCC. We provide recommendations for stepwise implementation of patient perspectives into oncology education, with the hope that future programs will better prepare and motivate learners to provide PCC aimed at improving cancer care, quality of life, and disease outcomes.
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Affiliation(s)
- Hanna Dutt
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
- Interdisciplinary Medical Sciences Program, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Arleigh Dean
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
- Interdisciplinary Medical Sciences Program, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Rayyan Syed Kamal
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
- Interdisciplinary Medical Sciences Program, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Alison L. Allan
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
- Department of Anatomy & Cell Biology, and Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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13
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Torres K, Evans P, Mamcarz I, Radczuk N, Torres A. A manikin or human simulator-development of a tool for measuring students' perception. PeerJ 2022; 10:e14214. [PMID: 36530415 PMCID: PMC9753758 DOI: 10.7717/peerj.14214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 09/19/2022] [Indexed: 12/14/2022] Open
Abstract
Background Education with the use of medical simulation may involve the use of two modalities: manikins or standardized patients (SPs) to meet specific learning objectives. We have collected students' opinions about the two modalities which can be helpful in planning and evaluating the curriculum process. Although reviews or comparisons of student opinions appear in the literature, it is difficult to find a scale that would be based on a comparison of specific effects that can be obtained in the educational process. In order to fill this gap, an attempt was made to construct a questionnaire. Methods An experimental version of a questionnaire measuring the final-year students' (273) opinions about the effectiveness of both simulation techniques has been designed on the basis of semi-structured interviews. They were conducted with 14 final-year students excluded from the subsequently analyzed cohort. The scale has been completed, tested and validated. Results The authors developed a 33-statement questionnaire which contain two scales: teaching medicine with the manikins and with the SPs. Two factors were identified for each scale: Doctor-patient relationship and practical aspects. The scales can be used complementary or separately, as the article reports independent statistics for each scale. The Cronbach's alpha coefficient for the manikin scale is 0.721 and for the SP scale is 0.758. Conclusions The questionnaire may be applied to medical students to identify their opinions about using manikins and SPs in teaching. It may have an important impact for planning curriculum and implementing particular modalities in accordance with the intended learning objectives.
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Affiliation(s)
- Kamil Torres
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, Lubelskie, Poland
| | - Phillip Evans
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, Lubelskie, Poland
| | - Izabela Mamcarz
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, Lubelskie, Poland
| | - Natalia Radczuk
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, Lubelskie, Poland
| | - Anna Torres
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, Lubelskie, Poland
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14
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Fluet A, Essakow J, Ju M. Standardized Patients' Perspectives on Bias in Student Encounters. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:S29-S34. [PMID: 35947468 DOI: 10.1097/acm.0000000000004925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Standardized patient (SP) encounters are widely used in health professional education to evaluate trainees' clinical skills. Prior literature suggests that bias can influence the evaluations of student learners in SP-student encounters. Understanding how SPs perceive bias in their work and how they view their role in mitigating or perpetuating bias in simulation is an important first step in addressing bias in the SP-student encounter. METHOD Researchers designed a qualitative interview study and conducted 16 semistructured interviews with SPs at the University of California, San Francisco Kanbar Simulation Center from July through September of 2020. Participants were selected using purposive sampling. The interviews were transcribed and analyzed by researchers using inductive thematic analysis. Researchers met iteratively to reconcile codes and identify themes. RESULTS SPs identified bias occurring in multiple directions: SP-to-student, student-to-SP, student-to-character, and SP-to-character. SPs were hesitant to label their own biases and instead used words such as "comfort" or "preference." SPs reported little bias from students, because students were being evaluated and therefore behaving carefully. Additionally, SPs perceived bias in the implementation of health care simulation, which manifests as underrepresentation of certain groups amongst actors and character descriptions. Most SPs felt that they should play a role in mitigating bias in SP-student encounters, including addressing bias that occurs, challenging stereotypes, teaching about cultural differences, and/or being conscious of bias in their assessments of learners. CONCLUSIONS In the SP-student encounter, bias can occur on many levels and between many individuals, including between the SP and the character they are portraying. Identifying the areas in which bias can exist can help simulation educators mitigate bias.
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Affiliation(s)
- Angelina Fluet
- A. Fluet is a medical student, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Jenna Essakow
- J. Essakow is a clinical fellow, Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Mindy Ju
- M. Ju is assistant clinical professor, Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of California, San Francisco, and associate education director, University of California, San Francisco Kanbar Center for Simulation, San Francisco, California
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15
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Herrmann-Werner A, Erschens R, Fries M, Wehner H, Zipfel S, Festl-Wietek T. The effects of diverse fidelity scenarios on stress in medical students when taking patients' medical histories: A longitudinal study. Stress Health 2022. [PMID: 36288563 DOI: 10.1002/smi.3206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022]
Abstract
Taking patients' medical history correctly is the basis of diagnosis and therapy. Medical students as a vulnerable group may perceive patient-physician interactions as stressful. This study examines stress among medical students in different degrees of fidelity when taking a patient's medical history. In this longitudinal study, students' stress levels were assessed during scenarios with different degrees of fidelity (role-play, simulated patient encounters and real patient encounters) using standardised questionnaires (State-Trait Anxiety Inventory and a distress scale) and the physiological measurement of heart rate variability. The stress level of participating medical students (N = 128) was expected to significantly increase during scenarios of increasing fidelity (Mroleplay = 2.08 ± 0.92; SPEs: Msimulatedpatient = 2.68 ± 1.08; RPEs: Mrealpatient = 3.35 ± 1.08; p < 0.001). Whereas physiological stress was significantly higher with real patients (N = 106), psychological stress was not affected by the fidelity of the scenarios (N = 85). Medical students experienced stress when taking patients' medical history. Medical students might be unaware of their perceived stress based on the results. Thus, they should know how to cope with stress in such situations.
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Affiliation(s)
- Anne Herrmann-Werner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tuebingen, Internal Medicine, Tuebingen, Germany.,TIME-Tuebingen Insitute for Medical Education, University of Tuebingen, Tuebingen, Germany
| | - Rebecca Erschens
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tuebingen, Internal Medicine, Tuebingen, Germany
| | - Maximilian Fries
- Department of Neurology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hannah Wehner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tuebingen, Internal Medicine, Tuebingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tuebingen, Internal Medicine, Tuebingen, Germany.,Deanery of Students' Affairs, Faculty of Medicine Eberhard-Karls University Tuebingen, Tuebingen, Germany
| | - Teresa Festl-Wietek
- TIME-Tuebingen Insitute for Medical Education, University of Tuebingen, Tuebingen, Germany
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16
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Britz V, Koch Y, Schreckenbach T, Stefanescu MC, Zinßer U, Sterz J, Ruesseler M. Influence of using simulated or real patients on undergraduate medical students acquiring competencies in medical conversations in surgery: A prospective, controlled study. Front Surg 2022; 9:986826. [PMID: 36171816 PMCID: PMC9510648 DOI: 10.3389/fsurg.2022.986826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Communication with patients and their relatives as well as with colleagues and students is an essential part of every physician's daily work. An established method for teaching communication skills is using simulated patients (SPs). However, teaching with SPs is often subjectively perceived by medical students as less instructive than teaching with real patients (RPs). Studies that analyze the influence of SPs compared to RPs for acquiring competencies are lacking. The aim of the present study was therefore to investigate the impact of SPs on long-term learning success for communication skills compared to RPs. Material and Methods Study participants were undergraduate third-year medical students who attended a communication unit and were randomized into three groups. The first group trained the role-play part with a SP (SP-group). The second group trained with a SP but thought that the patient was a RP because the students and the tutors were told that they were a RP by the principal investigator (incognito patient group [IP-group]). The third group and their tutors trained with a RP and were told that the patient was a RP (real patient group [RP-group]). Five to 12 weeks after completing the training, the study participants completed a curricular summative objective standardized clinical examination. Results There were 146 students who participated in the study. There were no significant differences between the three study groups at the informed consent stations and for those conducting anamnesis interviews. Conclusion Communication skills training with SPs appears to be equivalent to training with RPs in terms of competency development in communication-based assessments in surgery. Therefore, SPs should be used in these curricula, especially at an early stage, to enable the students to practice adequate communication skills.
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Affiliation(s)
- Vanessa Britz
- Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University Frankfurt/Main, Frankfurt, Germany
| | - Yannic Koch
- Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University Frankfurt/Main, Frankfurt, Germany
| | - Teresa Schreckenbach
- Department of General, Visceral, Transplantation and Thoracic Surgery, Goethe University Frankfurt/Main, University Hospital Frankfurt, Frankfurt, Germany
| | - Maria Christina Stefanescu
- Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University Frankfurt/Main, Frankfurt, Germany
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Uwe Zinßer
- Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University Frankfurt/Main, Frankfurt, Germany
| | - Jasmina Sterz
- Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University Frankfurt/Main, Frankfurt, Germany
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- Correspondence: Jasmina Sterz
| | - Miriam Ruesseler
- Medical Faculty, Frankfurt Interdisciplinary Simulation Center FIneST, Goethe University Frankfurt/Main, Frankfurt, Germany
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17
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Banks-McGovern C, Gormley GJ, Wilson D, Kearney GP. Conscious engagement within patients' and simulated participants' personal space: medical students' perspective. ADVANCES IN SIMULATION (LONDON, ENGLAND) 2022; 7:27. [PMID: 36064452 PMCID: PMC9444077 DOI: 10.1186/s41077-022-00224-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND #MeToo prompted a shift in acceptable societal norms, sparking global recognition of the complexities of entering another's personal space. Physical examinations are an integral part of medicine yet have the capacity to encroach upon patient's personal space, whether in simulated or clinical environments. Examinations may be misconstrued as inappropriate advances, with negative effects for both patient and doctor. Medical educators must consider how they teach students to approach this complex task. This study aimed to gain insight into the lived experiences of medical students when working within patient's personal space. This builds on previous research from the perspective of simulated participants. METHOD A hermeneutic phenomenology approach was used to explore lived experiences of working within patient's personal space. Data was collected from seven medical students through semi-structured interviews and thematically analysed using template analysis. RESULTS The analysis yielded four main themes: (1) transitioning into a privileged position; (2) negative role modelling: emphasising the physical; (3) consent: a dynamic and fragile state; and (4) a simple act or a complex performance? DISCUSSION This study provides a unique insight into the lived experiences of medical students when working within a patient's personal space. The physical examination is a complex process; the experiences of medical students can shape learning on crossing boundaries. Medical educators need to reflect this complexity in teaching, mirroring societal interest around the boundaries of consent. Students need a pedagogical space to develop these interpersonal skills, to prevent early adoption of the clinical gaze, and to create more consciously engaged doctors for the future.
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Affiliation(s)
- Chara Banks-McGovern
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland.
| | - Gerard J Gormley
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland.,Clinical Skills Education Centre, Queen's University Belfast, Belfast, Northern Ireland
| | - Diane Wilson
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland.,Clinical Skills Education Centre, Queen's University Belfast, Belfast, Northern Ireland
| | - Grainne P Kearney
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland
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18
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Adnan AI. Effectiveness of Communication Skills Training in Medical Students Using Simulated Patients or Volunteer Outpatients. Cureus 2022; 14:e26717. [PMID: 35967150 PMCID: PMC9362856 DOI: 10.7759/cureus.26717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 12/02/2022] Open
Abstract
Communication skills are the vital basis for patient-doctor interactions in undergraduate medical education. With excellent patient-physician interaction and communication, patients will likely build better rapport and trust with the physician. This allows all the necessary information to be divulged with the reassurance of confidentiality and devise appropriate investigations and treatment plans that patients would be more inclined to follow. The most common and effective ways of teaching communication skills to medical students are by using simulated patients and volunteer outpatients. However, which types of patients to use for better development of practical communication skills training. Establishing the demonstrable difference between using two kinds of patients would refine the training scheme for students. This would produce doctors that have practical communication skills and enhance their care to assist patients on their road to recovery or palliative care.
This review compares and establishes the effectiveness of medical students’ communication skills training using simulated patients and volunteer outpatients about the adult learning theories. This research is carried out following a critical review of internationally reputed guidelines from the World Health Organisation (WHO) and the General Medical Council (GMC). Several search terms were used on various online databases such as Medline (Ovid), PubMed, and Academic Medicine. A thorough selection process was applied using the inclusion and exclusion criteria to narrow the search. Four studies related to this review’s aim were collected and critically analyzed. The methods of obtaining the studies were structured using the PRISMA guidelines.
The studies showed that one study favored volunteer outpatients while the other preferred having simulated patients. Another study showed that students considered both types of patients essential for communication skills training. All the studies presented the strengths and weaknesses of both simulated and volunteer outpatients. Discussion of the validity of all analyses was based on the CASP criteria. Study design, sample selection, and biases were scrutinized for each study. Various adult learning theories were used to correlate the effects of the communication skills training. In conclusion, simulated patients are more useful for pre-clinical years, intimate examination, and giving instructions about the physical examination. Whereas volunteer outpatients are put to better use in clinical years to incorporate more medical aspects such as obtaining a differential diagnosis, management of illness, and procedural techniques. Introducing different types of patients based on their study progression and topic of discussion could be adapted.
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19
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Cuevas-Nunez MC, Pulido MT, Harpe S, Stein AB, Lempicki K. Assessment of communication and physical exam skills: A comparison of students, faculty and standardized patients. J Dent Educ 2022; 86:853-862. [PMID: 35181888 DOI: 10.1002/jdd.12892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 12/02/2021] [Accepted: 01/04/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE/OBJECTIVES The objective of this retrospective study was twofold: it aimed to investigate dental students' communication and physical exam self-assessment skills by comparing students' self-evaluations with those completed by faculty and standardized patients (SPs). Second, it aimed to compare faculty and SPs assessment of students' communication skills. METHODS At the end of their first year of training, students (n = 127), participated in one SP encounter about an initial dental consultation. Students completed self-assessment before receiving feedback from faculty (n = 19) and SPs (n = 19). The data source included evaluation forms submitted by students, faculty and SPs. The Wilcoxon signed rank test was used to compare the overall scores between groups. Agreement between evaluations items were analyzed with McNemar's test (p < 0.05). RESULTS Overall, there were no statistically significant differences in how students and faculty graded for either communication (p = 0.6724) or physical exam (p = 0.1921) skills. However, both students and faculty provided less favorable marks than SPs for communication skills with a statistically significant difference in the overall grading between both students and SPs (p = 0.0146) and between faculty and SPs (p = 0.0045). CONCLUSIONS While there was disagreement between students and faculty versus SPs, they weren't meaningful differences in scores and the dissimilarities mainly consisted of ratings of explanation skills. We suggest that, when applicable, dental student's self-evaluations may represent an alternative to faculty assessments of communication and physical exam skills. Nonetheless, we recommend that SPs be included in the assessment of communication skills to provide students with comprehensive feedback that more realistically represents the natural patient-provider relationship.
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Affiliation(s)
| | - M Teresa Pulido
- College of Dental Medicine, Midwestern University, Glendale, Arizona, USA
| | - Spencer Harpe
- Pharmacy Practice, Midwestern University, Downers Grove, Illinois, USA
| | - Amy B Stein
- BioClinical Statistics, Research Sponsored Programs, Midwestern University, Glendale, Arizona, USA
| | - Kelly Lempicki
- Simulation Center, Midwestern University, Downers Grove, Illinois, USA
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20
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Thyson T, Schallenburger M, Scherg A, Leister A, Schwartz J, Neukirchen M. Communication in the face of death and dying - how does the encounter with death influence the patient management competence of medical students? An outcome-evaluation. BMC MEDICAL EDUCATION 2022; 22:25. [PMID: 35012542 PMCID: PMC8744229 DOI: 10.1186/s12909-021-03060-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND INFORMATION As part of an elective course, the Interdisciplinary Centre for Palliative Medicine at Duesseldorf University Hospital offers medical students the opportunity to personally meet and talk to a seriously ill patient on one or more occasions. The future physicians are provided with an opportunity to broaden their professional competence, i.e. their knowledge and skills in patient-centred communication at the end of life, and enhance their personal competence, for example in how to professionally handle their own emotions. A topical e-learning module helps the students to prepare for the meetings, and writing a reflection paper forms the basis for the concluding reflection seminar. OBJECTIVES The study's objective is a global and outcome-based evaluation of the elective blended-learning course that provides real-world patient interaction. The outcome-based evaluation or outcome assessment aims to objectively evaluate changes identified in knowledge, skills and attitude among the participants of the elective-course. Furthermore, the evaluation aims to answer the question of whether changes especially in attitude (social skills and self-competence) should be expected after the students have met with severely ill or dying patients. METHOD On two questionnaires specifically developed for this survey the students were able to provide a global rating of the elective course and describe their learning gains in palliative care. The students' learning gains were measured by means of 14 items reflecting the specific educational objectives of the offered elective course. Using the German school grading system as a rating scale, the students assessed their learning progress by retrospectively evaluating their skills before and after completion of the elective course (Comparative Self-Assessment, CSA). RESULTS In the time from April 2018 till March 2020, 62 students participated in the evaluation. Overall, learning progress among students could be observed across all areas of competence, and in 50% of all retrospective self-assessment items the learning gains were ≥ 50%. The highest learning gain (63.6%) was observed in the students' ability to meet a severely ill patient without fear. The lowest learning gain was observed when students had to confront and accept their own mortality. CONCLUSIONS The offered elective course supports students in achieving social and self-competence development goals. According to the obtained results, contact with real-world patients helps mould the students' attitude.
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Affiliation(s)
- T Thyson
- Interdisciplinary Centre of Palliative Care, University Hospital, Heinrich Heine University, Duesseldorf, Germany.
- University Hospital Duesseldorf, Interdisciplinary Centre for Palliative Medicine, Moorenstr. 5, 40225, Duesseldorf, Germany.
| | - M Schallenburger
- Interdisciplinary Centre of Palliative Care, University Hospital, Heinrich Heine University, Duesseldorf, Germany.
- University Hospital Duesseldorf, Interdisciplinary Centre for Palliative Medicine, Moorenstr. 5, 40225, Duesseldorf, Germany.
| | - A Scherg
- Interdisciplinary Centre of Palliative Care, University Hospital, Heinrich Heine University, Duesseldorf, Germany
| | - A Leister
- Interdisciplinary Centre of Palliative Care, University Hospital, Heinrich Heine University, Duesseldorf, Germany
| | - J Schwartz
- Interdisciplinary Centre of Palliative Care, University Hospital, Heinrich Heine University, Duesseldorf, Germany
| | - M Neukirchen
- Interdisciplinary Centre of Palliative Care, University Hospital, Heinrich Heine University, Duesseldorf, Germany
- Department of Anaesthesiology, University Hospital, Heinrich Heine University, Duesseldorf, Germany
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21
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Takeuchi YL, Bonvin R, Ambresin AE. 'Demystifying' the encounter with adolescent patients: a qualitative study on medical students' experiences and perspectives during training with adolescent simulated patients. MEDICAL EDUCATION ONLINE 2021; 26:1979445. [PMID: 34553674 PMCID: PMC8462882 DOI: 10.1080/10872981.2021.1979445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
Training with adolescent simulated patients (ASP) is increasingly recognized as an effective form of teaching interviewing skills with adolescent patients. Beyond the acknowledged effectiveness and satisfaction of training with ASP, little is known on medical students' actual experience and specific learning needs related to simulated encounters with ASP, as well as factors influencing their learning experience.The aim of this study was an in-depth exploration of medical students' perspectives about training with ASP.Using a qualitative design with grounded theory methods, we conducted in-field observation of training sessions with ASP and individual interviews with eighteen fourth-year medical students participating in training.When provided with an actual experience in a simulated setting, students go through a process of anticipating then modulating the challenge of the encounter with an adolescent patient. This challenge is influenced and modulated within 3 main dimensions: preconceptions about adolescents, level of experience with adolescent patients and professional distance. This process is also influenced by how students perceive and cope with the educational setting.Training with ASP, as a first concrete experience of an adolescent consultation, is an opportunity to address important aspects of students' attitudes towards adolescent patients such as students' preconceptions, personal experiences and feelings that could influence the doctor-patient relationship later on. Training should focus on ways to reflect upon and handle such attitudes and the emotional resonance experienced by medical students.
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Affiliation(s)
- Yusuke Leo Takeuchi
- Interdisciplinary Division for Adolescent Health, Lausanne University Hospital (Chuv) and University of Lausanne, Switzerland
- Medical Education Unit, Faculty of Biology and Medicine, University of Lausanne, Switzerland
| | - Raphaël Bonvin
- Medical Education Unit, Faculty of Biology and Medicine, University of Lausanne, Switzerland
| | - Anne-Emmanuelle Ambresin
- Interdisciplinary Division for Adolescent Health, Lausanne University Hospital (Chuv) and University of Lausanne, Switzerland
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22
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Shah RT, Thavajothy T. A Reply to: Spiralling Pre-clerkship Concepts into the Clinical Phase: Augmenting Knowledge Transfer Using Innovative Technology-Enhanced Curriculum Activities. MEDICAL SCIENCE EDUCATOR 2021; 31:2133. [PMID: 34956716 PMCID: PMC8651862 DOI: 10.1007/s40670-021-01390-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Riya Tejas Shah
- Faculty of Life Sciences & Medicine, King’s College London, London, UK
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Rieffestahl AM, Risør T, Mogensen HO, Reventlow S, Morcke AM. Ignitions of empathy. Medical students feel touched and shaken by interacting with patients with chronic conditions in communication skills training. PATIENT EDUCATION AND COUNSELING 2021; 104:1668-1673. [PMID: 33376009 DOI: 10.1016/j.pec.2020.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore what and how medical students learn from patients with chronic conditions in the context of communication skills training. METHODS Semi-structured interviews and focus groups with 32 medical students. Interviews were recorded, transcribed, analyzed inductively and organized into four main narrative themes. RESULTS Learning from patients provided medical students opportunities to see the world through the patients' eyes, understand the diversity of patients' needs, and recognize the importance of matching patients' and doctors' perspectives. Consequently, students expressed emotional responses on challenges in interactions with the patients related to performing the role as 'medical expert'. Difficulty empathizing became visible in the students' interaction with patients. CONCLUSION The patients' authentic contributions provided the students with unique opportunities to engage with their own emotions and capacity for empathy. However, for students to benefit from this affective practical training, they need guidance to balance professional and personal aspects in encounters. There is a need to introduce the 'doctor as person' in medical education. PRACTICE IMPLICATIONS Patients with chronic conditions strengthen students' learning of empathy as part of transformative learning. Doing so with patients is a challenging way of learning. Thus, faculty and educators must provide explicit guidance for students to benefit.
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Affiliation(s)
- Anne Marie Rieffestahl
- Copenhagen Academy for Medical Education and Simulation, the Capital Region of Denmark, Denmark; Section of General Practice and the Research Unit for General Practice, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Denmark.
| | - Torsten Risør
- Section of General Practice and the Research Unit for General Practice, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Denmark; Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Norway
| | - Hanne O Mogensen
- Department of Anthropology, Faculty of Social Science, University of Copenhagen, Denmark
| | - Susanne Reventlow
- Section of General Practice and the Research Unit for General Practice, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Denmark
| | - Anne Mette Morcke
- Copenhagen Academy for Medical Education and Simulation, the Capital Region of Denmark, Denmark
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Langewitz W, Pleines Dantas Seixas U, Hunziker S, Becker C, Fischer MR, Benz A, Otto B. Doctor-patient communication during the Corona crisis - web-based interactions and structured feedback from standardized patients at the University of Basel and the LMU Munich. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc81. [PMID: 34056070 PMCID: PMC8136343 DOI: 10.3205/zma001477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/01/2020] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
Background: Due to the pandemic-related restrictions in classroom teaching at the medical faculties of the LMU Munich and the University of Basel, teaching methods with standardized patients (SPs), were shifted to a digital, web-based format at short notice as of April 2020. We report on our experiences with the WebEncounter program, which was used for the first time in German-speaking countries. The program enables one-to-one encounters between SPs and students. Students receive an invitational email with brief instructions and background information on the case. SPs use case-specific criteria that are compliant with the learning objectives for digital evaluation during the encounter. A feedback session takes place immediately following the encounter. The SPs address the didactically relevant sections and can illustrate them with the corresponding video sequences. Finally, the students receive the links to the video recordings of the encounter and the feedback unit by email. Project description: The aim of this pilot study was to analyze the practicability of the program and its acceptance by students and SPs. In addition, we examined whether the operationalization of the learning objectives in the form of assessment items has an impact on the content and thematic development of courses in the area of doctor-patient communication. Methods: To implement the program, patient cases previously tested in communication seminars in Munich and Basel were rewritten and case-specific evaluation criteria were developed. SPs were trained to use the program, to present their patient figure online and to give feedback. The experience of those involved (faculty, SPs and SP trainers, students) in implementing the program was documented at various levels. The frequency and causes of technical problems were described. Student results on the patient cases and on the feedback items were collected quantitatively and, where possible, supplemented by free-text statements. Results: Data from 218/220 students in Basel and 120/127 students in Munich were collected and evaluated. Students were very satisfied with the patient cases, the encounter with the SPs and their feedback: 3.81±0.42. SPs experienced the training as an increase in their competence and the structured feedback as particularly positive. The training effort per SP was between 2.5 and 4 hours. The results show predominantly normally-distributed, case-specific sum scores of the evaluation criteria. The analysis of the individual assessment items refers to learning objectives that students find difficult to achieve (e.g. explicitly structuring the conversation). Problems in the technical implementation (<10 percent of the encounters) were due mainly to the use of insufficient hardware or internet connection problems. The need to define case-specific evaluation criteria triggered a discussion in the group of study directors about learning objectives and their operationalization. Summary: Web-based encounters can be built into the ongoing communication curriculum with reasonable effort. Training the SPs and heeding the technical requirements are of central importance. Practicing the virtual consultation was evaluated very positively by the students - in particular, the immediate feedback in the protected dialogue was appreciated by all involved.
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Affiliation(s)
- Wolf Langewitz
- University Hospital Basel, Medical Communication and Psychosomatic Medicine, Basel, Switzerland
| | | | - Sabina Hunziker
- University Hospital Basel, Medical Communication and Psychosomatic Medicine, Basel, Switzerland
| | - Christoph Becker
- University Hospital Basel, Medical Communication and Psychosomatic Medicine, Basel, Switzerland
| | - Martin R. Fischer
- LMU Munich, University Hospital, Institute for Medical Education, Munich, Germany
| | - Alexander Benz
- Ludwig Maximilian University Munich (LMU), Institute of Medical Psychology, Munich, Germany
| | - Bärbel Otto
- LMU Munich, Institute for Medical Education, University Hospital, Munich, Germany
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Falk EE, Allen KE, DeGroote NP, Wasilewski-Masker K, Brock KE. Feasibility, Acceptability, and Education of Pediatric Oncology Providers Before and After an Embedded Pediatric Palliative Oncology Clinic. JCO Oncol Pract 2021; 17:e714-e729. [PMID: 33606559 DOI: 10.1200/op.20.00881] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Most pediatric palliative care (PPC) education is trainee-directed, didactic, or simulation-based and therefore limited in scope, realism, and audience. We explored whether an embedded pediatric palliative oncology (PPO) clinic is associated with improved pediatric oncology provider palliative care comfort, knowledge, and attitudes toward PPC and if the model is feasible for both clinical care and education of providers of all levels. METHODS Oncology providers (oncologists, advanced practice providers, and fellows) were enrolled in this study. Based on interaction with the PPO clinic, two cohorts were defined: PPO providers (n = 11, 37.9%) and non-PPO providers (n = 18, 62.1%). Providers in both groups responded to qualitative and quantitative questionnaires about the feasibility and acceptability of PPO clinic, their attitudes toward PPC, and knowledge and comfort in PPC concepts at baseline and 1 year. Descriptive statistics were performed; demographic and outcome variables across cohorts by PPO grouping and experience were compared. RESULTS All 29 pediatric oncology providers reported acceptability of a PPO clinic and favorable attitudes about PPC. The most feasible clinic model was oncology followed by PPO visits. Non-PPO group and less experienced (≤ 10 years) providers had greater improvement in knowledge and comfort with PPC skills than PPO group or more experienced providers. Providers lacked comfort in non-pain symptom management skills. CONCLUSION This embedded PPO clinic model was feasible, acceptable, and highly rated by responding oncology clinicians, but was insufficient as a sole method of educating multidisciplinary oncology providers. Methods of combining clinical and formal education are needed to impart sustained educational change.
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Affiliation(s)
- Erin E Falk
- Emory University School of Medicine, Atlanta, GA
| | - Kristen E Allen
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA
| | - Nicholas P DeGroote
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA
| | - Karen Wasilewski-Masker
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, GA
| | - Katharine E Brock
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, GA.,Department of Pediatrics, Division of Palliative Care, Emory University, Atlanta, GA
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Johnsen HM, Briseid HS, Brodtkorb K, Slettebø Å, Fossum M. Nursing students' perceptions of combining hands-on simulation with simulated patients and a serious game in preparing for clinical placement in home healthcare: A qualitative study. NURSE EDUCATION TODAY 2021; 97:104675. [PMID: 33302184 DOI: 10.1016/j.nedt.2020.104675] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 10/15/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND There is a growing demand to provide complex healthcare services in patients' own homes. However, high quality home healthcare clinical placements are often difficult to obtain, and arranging laboratory-based simulations to provide relevant clinical-practical learning experiences for all students is resource intensive. OBJECTIVES The aim of this study was to explore nursing students' perceptions of using a blended simulation approach, including hands-on simulation with simulated patients and a video-based serious game, in preparation for their home healthcare clinical placements. DESIGN An exploratory qualitative design using focus group interviews was utilized. SETTING AND PARTICIPANTS Second- and third-year nursing students in home healthcare courses in Norway participated in this study. METHODS Five focus group interviews were conducted with a total of 26 nursing students. Data were collected over two semesters in three home healthcare courses. The data were analyzed using thematic content analysis. RESULTS The study identified four main themes that influenced students' perceptions of combining the two simulations. These included personal engagement, contextual and environmental factors, a safe and structured learning environment, as well as organizational and technical factors. In relation to the different themes, students expressed that disadvantages in one simulation were counteracted in the other. CONCLUSIONS The blended simulation approach was perceived to address curricular objectives in different but complementary ways. The blended simulation approach was perceived to facilitate personal engagement and reflections and to provide relevant clinical-practical learning experiences. However, results also indicated that the organization of such a blended simulation approach (i.e., group compositions and size), facilitation from teachers, and technical issues (i.e., with medical equipment and the serious game) may influence students' perceptions and satisfaction directly. The results should provide useful information for designing future teaching strategies in Bachelor of Nursing programs.
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Affiliation(s)
- Hege M Johnsen
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.
| | - Hanne S Briseid
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Kari Brodtkorb
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Åshild Slettebø
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Mariann Fossum
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
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Simeone IM, Berning JN, Hua M, Happ MB, Baldwin MR. Training Chaplains to Provide Communication-Board-Guided Spiritual Care for Intensive Care Unit Patients. J Palliat Med 2021; 24:218-225. [PMID: 32639178 PMCID: PMC7840304 DOI: 10.1089/jpm.2020.0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2020] [Indexed: 11/12/2022] Open
Abstract
Background: Chaplain-led communication-board-guided spiritual care may reduce anxiety and stress during an intensive care unit (ICU) admission for nonvocal mechanically ventilated patients, but clinical pastoral education does not teach the assistive communication skills needed to provide communication-board-guided spiritual care. Objective: To evaluate a four-hour chaplain-led seminar to educate chaplains about ICU patients' psychoemotional distress, and train them in assistive communication skills for providing chaplain-led communication-board-guided spiritual care. Design: A survey immediately before and after the seminar, and one-year follow-up about use of communication-board-guided spiritual care. Subjects/Setting: Sixty-two chaplains from four U.S. medical centers. Measurements: Multiple-choice and 10-point integer scale questions about ICU patients' mental health and communication-board-guided spiritual care best practices. Results: Chaplain awareness of ICU sedation practices, signs of delirium, and depression, anxiety, and post-traumatic stress disorder in ICU survivors increased significantly (all p < 0.001). Knowledge about using tagged yes/no questions to communicate with nonvocal patients increased from 38% to 87%, p < 0.001. Self-reported skill and comfort in providing communication-board-guided spiritual care increased from a median (interquartile range) score of 4 (2-6) to 7 (5-8) and 6 (4-8) to 8 (6-9), respectively (both p < 0.001). One year later, 31% of chaplains reported providing communication-board-guided spiritual care in the ICU. Conclusions: A single chaplain-led seminar taught chaplains about ICU patients' psychoemotional distress, trained chaplains in assistive communication skills with nonvocal patients, and led to the use of communication-board-guided spiritual care in the ICU for up to one year later.
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Affiliation(s)
- Ilaria M. Simeone
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Joel N. Berning
- Pastoral Care and Education Department, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - May Hua
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Mary Beth Happ
- Center for Research and Health Analytics, Ohio State University College of Nursing, Columbus, Ohio, USA
| | - Matthew R. Baldwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Caz B, Sarmasoglu Kilikcier S. Interaction with an ostomy patient in a laboratory setting: Expectations and experiences of first-year nursing students. NURSE EDUCATION TODAY 2021; 96:104638. [PMID: 33189000 DOI: 10.1016/j.nedt.2020.104638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 10/02/2020] [Accepted: 10/13/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Interacting with real patients is an important component of nursing education in all learning settings. OBJECTIVES This study aimed to determine the expectations and experiences of first-year nursing students' interaction with a real patient with an ostomy in the clinical skill laboratory. METHOD The phenomenological qualitative study was carried out with 17 first-year undergraduate nursing students. Data was collected via focus group interviews during pre- and post-nursing students and real patient with an ostomy interaction. Semi-structured questions were used during the focus group interviews. The data were analyzed by inductive content analysis method. RESULTS The findings are presented under two contexts: expectations of first-year nursing students related to interaction with an ostomy patient and experiences of first-year nursing students related to interaction with an ostomy patient. The two contexts were divided into five main themes: Emotions regarding interaction with a real patient with an ostomy, providing ostomy care to a real patient with an ostomy, predictions for living with an ostomy, effects of interaction with a real patient with an ostomy, and real patient engagement in nursing education. CONCLUSIONS In consequence of the research, the first-year nursing students were enthusiastic about the interaction with the real patient. The most important contribution to interaction with a patient was breaking down the prejudices of students concerning being a patient and having an illness. Real patients should engage in varied learning environments in nursing education, particularly via patients with different illnesses and health conditions.
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Affiliation(s)
- Busra Caz
- Gazi University Faculty of Medicine Training and Research Hospital, 06560 Ankara, Turkey.
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Pahwa AK, Eaton K, Apfel A, Bertram A, Ridell R, Cayea D. Effect of a high value care curriculum on standardized patient exam in the Core Clerkship in Internal Medicine. BMC MEDICAL EDUCATION 2020; 20:365. [PMID: 33059679 PMCID: PMC7560311 DOI: 10.1186/s12909-020-02303-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/10/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND With almost 20% unnecessary spending on healthcare, there has been increasing interest in high value care defined as the best care for the patient, with the optimal result for the circumstances, delivered at the right price. The American Association of Medical Colleges recommend that medical students are proficient in concepts of cost-effective clinical practice by graduation, thus leading to curricula on high value care. However little is published on the effectiveness of these curricula on medical students' ability to practice high value care. METHODS In addition to the standard curriculum, the intervention group received two classroom sessions and three virtual patients focused on the concepts of high value care. The primary outcome was number of tests and charges for tests on standardized patients. RESULTS 136 students enrolled in the Core Clerkship in Internal Medicine and 70 completed the high value care curriculum. There were no significant differences in ordering of appropriate tests (3.1 vs. 3.2 tests/students, p = 0.55) and inappropriate tests (1.8 vs. 2.2, p = 0.13) between the intervention and control. Students in the intervention group had significantly lower median Medicare charges ($287.59 vs. $500.86, p = 0.04) and felt their education in high value care was appropriate (81% vs. 56%, p = 0.02). CONCLUSIONS This is the first study to describe the impact of a high value care curriculum on medical students' ordering practices. While number of inappropriate tests was not significantly different, students in the intervention group refrained from ordering expensive tests.
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Affiliation(s)
- Amit K Pahwa
- Division of Hospital Medicine, Division of General Pediatrics, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
| | - Kevin Eaton
- Divsion of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Harvey 806, Baltimore, MD, 21287, USA
| | - Ariella Apfel
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 2024 East Monument Street, Baltimore, MD, 21287, USA
| | - Amanda Bertram
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Rebecca Ridell
- Office of Assessment and Evaluation, Johns Hopkins University School of Medicine, 2024 East Monument Street, Room 1-200, Baltimore, MD, 21287, USA
| | - Danelle Cayea
- Division of Geriatrics, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Easter Avenue, Mason Lord Building Center Tower Suite, Baltimore, MD, 2200, USA
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Johnson KB, Kiser J, Mauriello SM. Transitioning from pre-clinical to clinical dental radiology, a pilot study: Student perceived influences on confidence. J Dent Educ 2020; 85:23-30. [PMID: 32839963 DOI: 10.1002/jdd.12386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/03/2020] [Accepted: 08/11/2020] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Producing radiographic images requires the use of ionizing radiation, which has been well documented for its potentially detrimental effects on human tissues. Therefore, dental hygiene students begin their radiographic training by practicing on manikins in a pre-clinical environment. Use of manikins does not allow for patient interaction factors. No published dental studies have examined factors important in helping dental hygiene students develop confidence during the transition from manikins to working with live patients in a clinical radiology setting. PURPOSE/OBJECTIVES The purpose of this study was to identify students' perceived influences on confidence and ultimately on performance when transitioning from a pre-clinical radiology setting to working with live patients. Specific research questions that were answered by this qualitative study were (1) What pre-clinical radiographic experiences did students feel were beneficial for transitioning from manikins to live patients? (2) What were the primary factors that students felt they struggled with when initially taking radiographs on patients? METHODS A qualitative study design was implemented in 2017. Data were obtained from students in a 2-year dental hygiene program. Survey responses, focus group feedback, and observation data were used to identify common themes. Emergent themes were reported using frequencies, emic and etic expressions. RESULTS Four themes surfaced surrounding patient management, communication, appointment mechanics, and infection control. CONCLUSION The use of standardized simulated patients may enhance clinical preparedness and confidence.
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Affiliation(s)
- K Brandon Johnson
- Division of Diagnostic Sciences, Oral and Maxillofacial Radiology Program, University of North Carolina Chapel Hill Adams School of Dentistry in Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessica Kiser
- Dental Hygiene Program, Cape Fear Community College in Wilmington, Chapel Hill, North Carolina, USA
| | - Sally M Mauriello
- Division of Comprehensive Oral Health, Periodontology Program, University of North Carolina - Chapel Hill Adams School of Dentistry in Chapel Hill, Chapel Hill, North Carolina, USA
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Lawrie M, Brubacher SP, Powell MB, Boud D. Forensic interviewers' perceptions of the utility of mock interviews with trained actors as a training tool for child interviewing. CHILD ABUSE & NEGLECT 2020; 106:104553. [PMID: 32464485 DOI: 10.1016/j.chiabu.2020.104553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The use of mock interviews (also known as role play), particularly using trained actors as interviewees, has demonstrated positive effects on communication training but little is known about how learners engage with these practice activities. OBJECTIVE The current study was conducted to determine what perceptions forensic interviewers hold about mock interviews as a learning exercise for developing skills for child interviewing, and whether there are negative perceptions that could potentially have an impact on the helpfulness of the exercise. PARTICIPANTS Written reflections were obtained from 35 US forensic interviewing professionals who were enrolled in an online child interviewer training program. METHODS Common themes were extracted from the reflections to establish forensic interviewers' perceptions of aspects of the mock interview. Extraction of themes assisted in the determination of whether perceptions impacted the manner and degree to which interviewers engaged in the mock interview process. RESULTS Results suggest that regardless of potential anxiety, learners experience multiple benefits from the mock interview. CONCLUSIONS Findings from the present study suggests suggest most trainees perceive mock interviews favourably, and they are useful in child interview training programs.
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Affiliation(s)
- Melanie Lawrie
- Centre for Investigative Interviewing, Griffith Criminology Institute, Griffith University, QLD, Australia
| | - Sonja P Brubacher
- Centre for Investigative Interviewing, Griffith Criminology Institute, Griffith University, QLD, Australia.
| | - Martine B Powell
- Centre for Investigative Interviewing, Griffith Criminology Institute, Griffith University, QLD, Australia
| | - David Boud
- Centre for Research in Assessment and Digital Learning, Deakin University, Victoria, Australia; Faculty of Arts and Social Sciences, University of Technology Sydney, NSW, Australia; Work and Learning Research Centre, Middlesex University, London, UK
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Romme S, Bosveld MH, Van Bokhoven MA, De Nooijer J, Van den Besselaar H, Van Dongen JJJ. Patient involvement in interprofessional education: A qualitative study yielding recommendations on incorporating the patient's perspective. Health Expect 2020; 23:943-957. [PMID: 32496648 PMCID: PMC7495081 DOI: 10.1111/hex.13073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/21/2020] [Accepted: 04/26/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patient involvement in interprofessional education (IPE) is a new approach in fostering person-centeredness and collaborative competencies in undergraduate students. We developed the Patient As a Person (PAP-)module to facilitate students in learning from experts by experience (EBEs) living with chronic conditions, in an interprofessional setting. This study aimed to explore the experiences of undergraduate students, EBEs and facilitators with the PAP-module and formulate recommendations on the design and organization of patient involvement in IPE. METHODS We collected data from students, EBEs and facilitators, through eight semi-structured focus group interviews and two individual interviews (N = 51). The interviews took place at Maastricht University, Zuyd University of Applied Sciences and Regional Training Center Leeuwenborgh. Conventional content analysis revealed key themes. RESULTS Students reported that learning from EBEs in an interprofessional setting yielded a more comprehensive approach and made them empathize with EBEs. Facilitators found it challenging to address multiple demands from students from different backgrounds and diverse EBEs. EBEs were motivated to improve the person-centredness of health care and welcomed a renewed sense of purpose. CONCLUSIONS This study yielded six recommendations: (a) students from various disciplines visit an EBE to foster a comprehensive approach, (b) groups of at least two students visit EBEs, (c) students may need aftercare for which facilitators should be receptive, (d) EBEs need clear instruction on their roles, (e) multiple EBEs in one session create diversity in perspectives and (f) training programmes and peer-to-peer sessions for facilitators help them to interact with diverse students and EBEs.
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Affiliation(s)
- Sjim Romme
- Maastricht UniversityMaastrichtThe Netherlands
| | | | - Marloes A. Van Bokhoven
- Department of Family MedicineCare and Public Health Research Institute (CAPHRI)Maastricht UniversityMaastrichtThe Netherlands
| | - Jascha De Nooijer
- School of Health Professions EducationMaastricht UniversityMaastrichtThe Netherlands
| | - Hélène Van den Besselaar
- Department of Family MedicineCare and Public Health Research Institute (CAPHRI)Maastricht UniversityMaastrichtThe Netherlands
| | - Jerôme J. J. Van Dongen
- Department of Family MedicineCare and Public Health Research Institute (CAPHRI)Maastricht UniversityMaastrichtThe Netherlands
- Research Centre for Community CareZuyd University of Applied SciencesHeerlenThe Netherlands
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Gamble AS, Nestel D, Bearman M. Listening to young voices: The lived experiences of adolescent simulated patients in health professional education. NURSE EDUCATION TODAY 2020; 91:104476. [PMID: 32474133 DOI: 10.1016/j.nedt.2020.104476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/06/2020] [Accepted: 05/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Learners should be exposed to the core principles of adolescent specific communication and assessment frameworks as part of health professional curricula. How this is done can vary considerably, but the inclusion of adolescents seems an ideal and realistic option. However, securing their participation can be challenging. A viable option to adolescent patients may be adolescent simulated patients. OBJECTIVE This study describes adolescents' lived experiences of being simulated patients in health professional education. DESIGN & SETTING An interpretive phenomenological approach involving ten adolescent simulated patients from two health professional education programs in Australia. METHODS Consenting/assenting adolescents participated in semi-structured audio-recorded interviews. Data was transcribed verbatim and analysed using van Manen's phenomenological approach. RESULTS Adolescents offered unique insights and intimate knowledge of their lived experiences of simulated patient work. Adolescents reflected upon the often positive but sometimes challenging journey of simulated patient work. The identification of harm, largely unrecognized by adolescents themselves is the most concerning finding of this study. CONCLUSIONS The experiences of adolescent simulated patients can help to shape the future of their involvement. However, their experiences also reveal myriad challenges. The implications for ethical practice must be reviewed before inclusion of adolescents as simulated patients is a feasible option.
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Affiliation(s)
- Andree S Gamble
- Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.
| | - Debra Nestel
- Monash Institute for Health and Clinical Education, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia; Department of Surgery, Melbourne Medical School, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Australia
| | - Margaret Bearman
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Australia
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Rockey NG, Ramos GP, Romanski S, Bierle D, Bartlett M, Halland M. Patient participation in medical student teaching: a survey of hospital patients. BMC MEDICAL EDUCATION 2020; 20:142. [PMID: 32381082 PMCID: PMC7206775 DOI: 10.1186/s12909-020-02052-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite the common practice of involving in-patients in the teaching of medical students little is known about the experience for patients. This study investigated inpatients' willingness, motivations and experience with participation in medical student bedside teaching. METHODS In-patients at a tertiary hospital who participated in medical student teaching answered a 22 question survey. The survey examined the motivations, impact and overall experience for these patients. RESULTS During July and August of 2019, 111 patients aged 19-93 years completed the survey. Most patients who were approached by preceptors to participate in teaching agreed to participate (74%). Ninety-six percent of patients felt like they could have said no if they had not wanted to participate in medical student teaching. Ninety percent of patients valued the time they spent with students. CONCLUSIONS Most hospital inpatients are willing to participate in medical student teaching in order to be helpful, and most have a positive experience. Preceptors in undergraduate medical education should prioritize a quality informed consent process and understand that the teaching experience can be mutually productive for patients and students.
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Affiliation(s)
- Nathan G Rockey
- Mayo Clinic Alix School of Medicine, 200 1st SW, Rochester, MN, 55905, USA
| | | | - Susan Romanski
- Department of Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Dennis Bierle
- Department of Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Matthew Bartlett
- Department of Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Magnus Halland
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st SW, Rochester, MN, 55905, USA.
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Ward A, Bethea J, Hsu R. Exploring life with a long-term condition using asynchronous online communication. PATIENT EDUCATION AND COUNSELING 2019; 102:2325-2329. [PMID: 31447196 DOI: 10.1016/j.pec.2019.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/11/2019] [Accepted: 08/16/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE We describe the development and evaluation of a novel programme that uses an online patient portal system to provide medical students with early and authentic experience of patient interaction. METHODS Focus group discussions were held with students, tutors and patients who had taken part in the first year of the programme. RESULTS The programme provided an opportunity for early patient interaction in a safe environment. Students were able to practice communication skills learnt elsewhere in the course as well as identifying some of the different skills required for asynchronous online interactions. The approach gave opportunities to develop understanding of aspects of life with a long-term condition. CONCLUSION Using an online patient portal system to interact with a patient enabled students to develop and apply their communication skills in a safe environment and gain a holistic view of a patient's experience. PRACTICE IMPLICATIONS Medical students need to be equipped with the skills needed to communicate electronically with patients. Current medical curricula currently focus on more traditional models of the consultation. Further research is needed to establish best practice in this rapidly growing area.
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Affiliation(s)
- Andy Ward
- Leicester Medical School, University of Leicester, Leicester, UK.
| | - Jane Bethea
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Ron Hsu
- Leicester Medical School, University of Leicester, Leicester, UK
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Mohiaddin H, Malik A, Murtagh GM. Maximizing the acquisition of core communication skills at the start of medical training. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:727-735. [PMID: 31695549 PMCID: PMC6717721 DOI: 10.2147/amep.s212727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Clinical communication teaching for medical undergraduates may involve real patient contact alongside simulated patient (SP) contact. However, there is still comparatively little known about the experience of learning with real patients and how that may impact on the SP encounter. AIM To explore the impact of real patient contact on the experience of communication skills training and SP contact for first-year medical undergraduate students. METHODS As part of the 6-year MBBS undergraduate medical degree at Imperial College London, students are obliged to undertake communication skills training, which involves teaching with simulated and real patients. In 2017 (toward the end of formal teaching), a small sample of Year 1 medical students, who had taken part in extra-curricular teaching with real patients were recruited for the study to compare their performance with a control group in a SP encounter. The performance of both groups was analyzed alongside follow-up focus group data from a sample of the study group. RESULTS Quantitative analysis revealed there was no significant difference in communication skills during a scored SP interview between students with real patient contact and those without. Focus group data, however, revealed valuable insights into the experience of learning with real patients. Students reported a marked increase in their confidence and ability to naturalize their communication skills as a result of real patient contact. Students also reported that skills gained through real patient contact may not always transfer easily to the SP setting. CONCLUSION Real patient contact is an invaluable component of communication training for undergraduate medical students. For successful implementation, there needs to be a clear curricular purpose at pedagogical, practical and organizational levels. Students' experience of real patient contact can provide an informed foundation upon which to implement other modes of teaching.
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Affiliation(s)
- Hasan Mohiaddin
- Faculty of Medicine, Sir Alexander Fleming Building, South Kensington Campus, Imperial College London, LondonSW7 2AZ, UK
| | - Anam Malik
- Faculty of Medicine, Sir Alexander Fleming Building, South Kensington Campus, Imperial College London, LondonSW7 2AZ, UK
| | - Ged M Murtagh
- Division of Surgery, Department of Surgery and Cancer, St Mary’s Campus, Imperial College London, LondonW2 1BL, UK
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Herrmann-Werner A, Loda T, Wiesner LM, Erschens RS, Junne F, Zipfel S. Is an obesity simulation suit in an undergraduate medical communication class a valuable teaching tool? A cross-sectional proof of concept study. BMJ Open 2019; 9:e029738. [PMID: 31383708 PMCID: PMC6688692 DOI: 10.1136/bmjopen-2019-029738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE With the growing prevalence of overweight and obesity, medical students should be prepared to engage in weight management and obesity-related communications in order to prevent patients from having stigmatising experiences. In addition, medical students should have training to reduce anti-fat prejudices. DESIGN Cross-sectional proof of concept study. SETTING University Hospital Tuebingen, Germany. PARTICIPANTS 246 participants (207 second-year medical students, 13 standardised patients (SPs) and 22 teachers) took part in the study. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the assessment of degree of reality of the encounter with the SP wearing an obesity simulation suit (OSS). The secondary outcome was the evaluation of students' awareness and prejudice against patients with obesity in a simulated role play. Additionally, a description of the advantages and disadvantages when using such a teaching tool is delivered. RESULTS The OSS contributed to a realistic perception of the patient group depicted in a role play according to students, teachers and SPs. OSS body mass index estimation by students, teachers and SPs correctly was over 30 kg/m2-thus in the range of obesity. In a selected subscale of the Anti-Fat Attitudes Test, students showed significantly stronger anti-fat stigmatisation compared with teachers and SPs. CONCLUSIONS An OSS worn by an SP is a valuable teaching tool to raise awareness about patients with obesity. It gives a realistic picture of the encounter. Stigmatisation was low in general but was especially present in the students. Further research should include intervention studies to address this issue.
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Affiliation(s)
- Anne Herrmann-Werner
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Teresa Loda
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Lisa M Wiesner
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Rebecca Sarah Erschens
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
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Bernardo MO, Cecilio-Fernandes D, Lima ARDA, Silva JF, Ceccato HD, Costa MJ, de Carvalho-Filho MA. Investigating the relation between self-assessment and patients' assessments of physicians-in-training empathy: a multicentric, observational, cross-sectional study in three teaching hospitals in Brazil. BMJ Open 2019; 9:e029356. [PMID: 31243037 PMCID: PMC6597646 DOI: 10.1136/bmjopen-2019-029356] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES This study investigated the associations between self-assessed empathy levels by physicians in training and empathy levels as perceived by their patients after clinical encounters. The authors also examined whether patient assessments were valid and reliable tools to measure empathy in physicians in training. DESIGN A multicentric, observational, cross-sectional study. SETTING This study was conducted in three public teaching hospitals in Brazil. PARTICIPANTS From the 668 patients invited to participate in this research, 566 (84.7%) agreed. Of these, 238 (42%) were male and 328 (58%) were female. From the invited 112 physicians in training, 86 (76.8%) agreed. Of the 86 physicians in training, 35 (41%) were final-year medical students and 51 (59%) were residents from clinical and surgical specialties. The gender distribution was 39 (45%) males and 47 (51%) females. PRIMARY AND SECONDARY OUTCOME MEASURES Physicians in training filled the Jefferson Scale of Physician Empathy (JSE) and the Interpersonal Reactivity Index. Patients answered the Jefferson Scale of Patient's Perceptions of Physician Empathy (JSPPPE) and the Consultation and Relational Empathy Scale (CARE). RESULTS This study found non-significant correlations between patient and physicians-in-training self-assessments, except for a weak correlation (0.241, p<0.01) between the JSPPPE score and the JSE compassionate care subscore. CARE and JSPPPE scales proved to be valid and reliable instruments. CONCLUSIONS Physicians-in-training self-assessments of empathy differ from patient assessments. Knowledge about empathy derived from self-assessment studies probably does not capture the perspective of the patients, who are key stakeholders in patient-centred care. Future research on the development of physician empathy or on outcomes of educational interventions to foster empathy should include patient perspectives.
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Affiliation(s)
- Mônica Oliveira Bernardo
- Radiology, Pontificia Universidade Catolica de Sao Paulo Faculdade de Ciencias Medicas e da Saude, Sorocaba, São Paulo, Brazil
| | - Dario Cecilio-Fernandes
- CEDAR - Center for Education Development and Research in Health Professions, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Julian Furtado Silva
- Internal Medicine, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, São Paulo, Brazil
| | - Hugo Dugolin Ceccato
- Internal Medicine, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, São Paulo, Brazil
| | - Manuel João Costa
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal
| | - Marco Antonio de Carvalho-Filho
- CEDAR - Center for Education Development and Research in Health Professions, University Medical Center Groningen, Groningen, The Netherlands
- Internal Medicine, Universidade Estadual de Campinas Faculdade de Ciencias Medicas, Campinas, São Paulo, Brazil
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Steinberg DJ, Vandenbussche K. Engaging Patients in Trainee Evaluations in Clinical Nutrition: a Pilot Intervention. MEDICAL SCIENCE EDUCATOR 2019; 29:57-60. [PMID: 34457450 PMCID: PMC8368267 DOI: 10.1007/s40670-018-00672-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Health professions trainee feedback rarely includes the patient voice, despite patients being experts in their own experience. Research supports including the patient voice; however, literature on the value of in-practice patient feedback is lacking. ACTIVITY A form was designed and implemented for patients to evaluate dietetic interns teaching a group class. Interns were surveyed to provide feedback. RESULTS Interns reported finding the feedback valuable and unique. The evaluations were felt to be credible. DISCUSSION Results support engaging patients in feedback for dietetic interns. Research should address different contexts, competencies other than communication and professionalism, and the impact to patients.
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Affiliation(s)
- Daphna J. Steinberg
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room M4115, Toronto, ON M4N 3M5 Canada
| | - Katherine Vandenbussche
- Michael Garron Hospital, Toronto East Health Network, 825 Coxwell Avenue, East York, ON M4C 3E7 Canada
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Englar RE. Using a Standardized Client Encounter to Practice Death Notification after the Unexpected Death of a Feline Patient Following Routine Ovariohysterectomy. JOURNAL OF VETERINARY MEDICAL EDUCATION 2019; 46:489-505. [PMID: 30806560 DOI: 10.3138/jvme.0817-111r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Death notification is an important skill for health care providers to carry out, yet few clinicians feel adequately prepared to complete this task. To address these gaps in clinical training, some medical educators have incorporated standardized patients (SPs) into the curriculum to allow students to practice death notification in a safe, controlled environment. Veterinary educators agree that end-of-life communication skills are essential for success in clinical practice, and many rely on standardized clients (SCs) for role-play concerning euthanasia. However, anticipatory loss is distinct from unexpected death, and death notification is strikingly absent from the veterinary literature. To introduce students to death notification, Midwestern University College of Veterinary Medicine (MWU CVM) developed a communications curriculum that culminated in a scripted encounter, "Basil, the Scottish Fold." Students must explain to an SC that his kitten died following routine ovariohysterectomy. Pre- and post-event surveys completed by 19 students demonstrated valuable lessons in death notification word choice, particularly what not to say. I hope that this teaching tool may be adapted for use by other colleges of veterinary medicine to allow students to practice death notification.
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Pilnick A, Trusson D, Beeke S, O’Brien R, Goldberg S, Harwood RH. Using conversation analysis to inform role play and simulated interaction in communications skills training for healthcare professionals: identifying avenues for further development through a scoping review. BMC MEDICAL EDUCATION 2018; 18:267. [PMID: 30453956 PMCID: PMC6245918 DOI: 10.1186/s12909-018-1381-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/05/2018] [Indexed: 05/09/2023]
Abstract
BACKGROUND This paper responds to previously published debate in this journal around the use of sociolinguistic methods in communication skills training (CST), which has raised the significant question of how far consultations with simulated patients reflect real clinical encounters. This debate concluded with a suggestion that sociolinguistic methods offer an alternative analytic lens for evaluating CST. We demonstrate here that the utility of sociolinguistic methods in CST is not limited to critique, but also presents an important tool for development and delivery. METHODS Following a scoping review of the use of role play and simulated interaction in CST for healthcare professionals, we consider the use of the specific sociolinguistic approach of conversation analysis (CA), which has been applied to the study of health communication in a wide range of settings, as well as to the development of training. DISCUSSION Role play and simulated interaction have been criticised by both clinicians and sociolinguists for a lack of authenticity as compared to real life interactions. However they contain a number of aspects which healthcare professionals report finding particularly useful: the need to think on one's feet in real time, as in actual interaction with patients; the ability to receive feedback on the simulation; and the ability to watch and reflect on how others approach the same simulation task in real time. Since sociolinguistic approaches can help to identify inauthenticity in role play and simulation, they can also be used to improve authenticity. Analysis of real-life interactions using sociolinguistic methods, and CA in particular, can identify actual interactional practices that are used by particular patient groups. These practices can then be used to inform the training of actors simulating patients. In addition, the emphasis of CA on talk as joint activity means that proper account can be taken of the way in which simulated interaction is co-constructed between simulator and trainee. We suggest that as well as identifying potential weaknesses in current role play and simulation practice, conversation analysis offers the potential to enhance and develop the authenticity of these training methods.
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Affiliation(s)
- Alison Pilnick
- School of Sociology and Social Policy, University of Nottingham, Nottingham, NG7 2RD UK
| | - Diane Trusson
- Institute for Mental Health, University of Nottingham, Nottingham, UK
| | - Suzanne Beeke
- Language and Cognition Research Department, University College London, London, UK
| | - Rebecca O’Brien
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Sarah Goldberg
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Rowan H. Harwood
- School of Health Sciences, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Jin HR, Choi YJ. Three-dimensional needs of standardized patients in nursing simulations and collaboration strategies: A qualitative analysis. NURSE EDUCATION TODAY 2018; 68:177-181. [PMID: 29945097 DOI: 10.1016/j.nedt.2018.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 05/14/2018] [Accepted: 06/12/2018] [Indexed: 06/08/2023]
Abstract
Simulation-based education using standardized patients is recognized as an effective education method from which students can learn in a safe and controlled environment, and instructors can provide consistent education. It has been reported that the level of standardized patients' satisfaction in the simulation experience positively affects to their case mastery and providing feedback to learners. This study aimed to explore standardized patients' lived experiences on nursing simulation using qualitative research to provide empirical resources to facilitate collaboration with standardized patients for efficacious nursing simulation. Study participants were recruited from simulation centers and had experience with nursing simulation education as standardized patients within the last 3 years. Focus group interviews were conducted to explore experiences of the 12 standardized patients in nursing simulations. The focus group interviews were conducted with structured four steps of opening, transition, key, and ending questions, from which additional questions and discussions followed. They were recorded electronically and transcribed for analysis. Qualitative content analysis was used to analyze the data. Two researchers read the interview transcripts several times to become familiar with the content, and then interpreted them systematically. From the qualitative analysis of standardized patients' experiences on nursing simulation, 23 codes, 10 sub-categories, 4 categories, and a theme were derived. It would be concluded that standardized patients have serving, learning, and interpersonal needs on their simulation, which may be related to their experiences in the simulation that affects learning outcomes of the students' as well. By facilitating positive experiences of standardized patients, quality of nursing simulation could be increased to provide more active and effective learning opportunities for students.
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Affiliation(s)
- Hye-Rim Jin
- Chung-Ang University, Seoul, Republic of Korea; START Medical Simulation Center, Catholic University of Korea, Seoul, Republic of Korea
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O’Brien R, Goldberg SE, Pilnick A, Beeke S, Schneider J, Sartain K, Thomson L, Murray M, Baxendale B, Harwood RH. The VOICE study - A before and after study of a dementia communication skills training course. PLoS One 2018; 13:e0198567. [PMID: 29889878 PMCID: PMC5995402 DOI: 10.1371/journal.pone.0198567] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/21/2018] [Indexed: 11/20/2022] Open
Abstract
Background A quarter of acute hospital beds are occupied by persons living with dementia, many of whom have communication problems. Healthcare professionals lack confidence in dementia communication skills, but there are no evidence-based communication skills training approaches appropriate for professionals working in this context. We aimed to develop and pilot a dementia communication skills training course that was acceptable and useful to healthcare professionals, hospital patients and their relatives. Methods The course was developed using conversation analytic findings from video recordings of healthcare professionals talking to patients living with dementia in the acute hospital, together with systematic review evidence of dementia communication skills training and taking account of expert and service-user opinion. The two-day course was based on experiential learning theory, and included simulation and video workshops, reflective diaries and didactic teaching. Actors were trained to portray patients living with dementia for the simulation exercises. Six courses were run between January and May 2017. 44/45 healthcare professionals attended both days of the course. Evaluation entailed: questionnaires on confidence in dementia communication; a dementia communication knowledge test; and participants’ satisfaction. Video-recorded, simulated assessments were used to measure changes in communication behaviour. Results Healthcare professionals increased their knowledge of dementia communication (mean improvement 1.5/10; 95% confidence interval 1.0–2.0; p<0.001). Confidence in dementia communication also increased (mean improvement 5.5/45; 95% confidence interval 4.1–6.9; p<0.001) and the course was well-received. One month later participants reported using the skills learned in clinical practice. Blind-ratings of simulated patient encounters demonstrated behaviour change in taught communication behaviours to close an encounter, consistent with the training, but not in requesting behaviours. Conclusion We have developed an innovative, evidence-based dementia communication skills training course which healthcare professionals found useful and after which they demonstrated improved dementia communication knowledge, confidence and behaviour.
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Affiliation(s)
- Rebecca O’Brien
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Sarah. E. Goldberg
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- * E-mail:
| | - Alison Pilnick
- School of Sociology and Social Policy, University of Nottingham, Nottingham, United Kingdom
| | - Suzanne Beeke
- Division of Psychology and Language Sciences, UCL, London, United Kingdom
| | - Justine Schneider
- School of Sociology and Social Policy, University of Nottingham, Nottingham, United Kingdom
| | - Kate Sartain
- Dementia and Frail Older Persons PPI group, University of Nottingham, Nottingham, United Kingdom
| | - Louise Thomson
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Megan Murray
- Simulated Patients Workshop Team (SPWT), Market Harborough, Leicestershire, United Kingdom
| | - Bryn Baxendale
- Trent Simulation Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Rowan H. Harwood
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Department of Healthcare of the Older Person, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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Roebotham T, Hawthornthwaite L, Lee L, Lingard LA. Beyond catharsis: the nuanced emotion of patient storytellers in an educational role. MEDICAL EDUCATION 2018; 52:526-535. [PMID: 29430729 DOI: 10.1111/medu.13510] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/07/2017] [Accepted: 11/16/2017] [Indexed: 06/08/2023]
Abstract
CONTEXT As health care organisations seek to cultivate patient and family-centred care, patient storytelling has emerged as a valued educational resource. However, repeatedly harnessing patient perspectives to educate health care professionals may have consequences. We need robust insight into what it means to be a patient storyteller in order to ensure ethical and appropriate engagement with patients as an educational resource. METHODS Constructivist grounded theory was used to explore the experience of patients involved in a storytelling curriculum as part of hospital staff continuing education. All 33 storytellers were invited by e-mail to participate in the study. Twenty-six storytellers responded to the invitation, and 25 could be scheduled to participate. Using theoretical sampling, semi-structured interviews were conducted and analysed in a process that was inductive, iterative and comparative. RESULTS Participants described the central role of emotions in their storytelling experience, which varied from 1 to 25 tellings over a period of 1 month to 2 years. These emotions were shaped by the passage of time, repetition of storytelling and audience acknowledgement. However, emotion remained unpredictable and had lingering implications for storytellers' vulnerability. CONCLUSION The multiple storytelling experiences of our participants and ongoing educational nature of their role provides unique insight into how emotions ebb and flow across tellings, how emotions can be both a surprise and a rhetorical strategy, and how emotions are influenced by audience acknowledgement. These findings contribute to an emerging conversation regarding the power and politics of selecting and using storytellers for organisational purpose. Implications include how we support patient storytellers in educational roles and how we can sustainably integrate patient storytelling into health professional education.
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Affiliation(s)
- Taylor Roebotham
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Lauren Lee
- Patient Experience, London Health Sciences Centre, London, Ontario, Canada
| | - Lorelei A Lingard
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Medicine, Western University, London, Ontario, Canada
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Hawthornthwaite L, Roebotham T, Lee L, O'dowda M, Lingard L. Three Sides to Every Story: Preparing Patient and Family Storytellers, Facilitators, and Audiences. Perm J 2018; 22:17-119. [PMID: 29702058 DOI: 10.7812/tpp/17-119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a growing recognition that patient engagement is necessary for the cultivation of patient- and family-centered care (PFCC) in the hospital setting. Acting on the emerging understanding that hearing stories from our patients gives valuable insight about our ability to provide compassionate PFCC, we developed an educational patient experience curriculum at our acute care teaching hospital. OBJECTIVES To understand the benefits and consequences of patient storytelling and to explore the impact of our curriculum on participants. METHODS The curriculum was codesigned with patients to illustrate the value and meaning of PFCC to health professional audiences. We surveyed audience members at nursing orientation events and interviewed the patient storytellers who shared their stories. RESULTS Participants indicated that patient stories could serve as lessons or reminders about the dimensions of PFCC and could inspire changes to practice. Storytellers reported an immensely rewarding experience and highlighted the value of educating and connecting with participants. However, they reported that the experience could also pose emotional challenges. CONCLUSION Careful and considerate facilitation of storytelling sessions is crucial to the delivery of a curriculum that is beneficial to both patients and participants. Our storytelling framework offers a novel approach to engaging patients in education, and it contributes to our existing understanding of how patient engagement efforts resonate within organizations.
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Affiliation(s)
- Lisa Hawthornthwaite
- Senior Patient Experience Specialist at the London Health Science Centre in London, Ontario, Canada.
| | - Taylor Roebotham
- Medical Student at the Schulich School of Medicine and Dentistry at Western University in London, Ontario, Canada.
| | - Lauren Lee
- Patient Advisor at the London Health Science Centre in London, Ontario, Canada.
| | - Mim O'dowda
- Patient Advisor at the London Health Science Centre in London, Ontario, Canada.
| | - Lorelei Lingard
- Founding Director and Senior Scientist for the Centre for Education Research and Innovation at Western University in London, Ontario, Canada.
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Dickinson BL, Lackey W, Sheakley M, Miller L, Jevert S, Shattuck B. Involving a real patient in the design and implementation of case-based learning to engage learners. ADVANCES IN PHYSIOLOGY EDUCATION 2018; 42:118-122. [PMID: 29357269 DOI: 10.1152/advan.00174.2017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Real patients offer unique opportunities to develop authentic, engaging, and transformative learning experiences for students. Patients are widely employed to teach clinical and interpersonal skills in the clerkship phase of their medical education (M3-M4), but have not been extensively included in the preclinical curriculum (M1-M2) when students are focused on acquiring foundational biomedical science knowledge. To maximize learning and help students connect foundational and clinical science concepts to real-world clinical problems, we involved a real patient in the creation and implementation of a case-based learning (CBL) activity in our preclinical curriculum. Using the patient's narrative as a framework, the CBL addressed relevant aspects of physiology, pathophysiology, anatomy, pharmacology, and nutrition, as well as clinical care decisions, health literacy, and medical ethics. The intervention was implemented with the 2019 and 2020 graduating medical school classes during the Gastrointestinal Systems course in the second year of our curriculum. The results of a survey revealed that, overall, a majority of the students agreed or strongly agreed that the activity increased engagement in class, increased the depth of discussion within their teams, increased the depth of discussion between teams, helped students to apply basic science concepts to the clinical material in the case, helped students better understand the disease processes described in the case, enhanced awareness of the complexity of patient care, provided an authentic learning experience, and elicited a feeling of empathy.
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Affiliation(s)
- Bonny L Dickinson
- Department of Biomedical Sciences, Western Michigan University Homer Stryker M.D. School of Medicine , Kalamazoo, Michigan
| | - Wendy Lackey
- Department of Biomedical Sciences, Western Michigan University Homer Stryker M.D. School of Medicine , Kalamazoo, Michigan
| | - Maria Sheakley
- Department of Biomedical Sciences, Western Michigan University Homer Stryker M.D. School of Medicine , Kalamazoo, Michigan
| | - Lisa Miller
- Department of Surgery, Western Michigan University Homer Stryker M.D. School of Medicine , Kalamazoo, Michigan
| | - Susan Jevert
- Department of Family Medicine, Western Michigan University Homer Stryker M.D. School of Medicine , Kalamazoo, Michigan
| | - Brandy Shattuck
- Department of Pathology, Western Michigan University Homer Stryker M.D. School of Medicine , Kalamazoo, Michigan
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Chua IS, Bogetz AL. Patient Feedback Requirements for Medical Students: Do Perceived Risks Outweigh the Benefits? Clin Pediatr (Phila) 2018; 57:193-199. [PMID: 28952367 DOI: 10.1177/0009922817696464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient feedback has increasingly become part of medical students' training and formative assessment. We conducted a qualitative study using focus groups to explore students' experiences soliciting patient feedback, including the benefits, challenges, and potential strategies to obtain it. Fifteen medical students participated. Thematic analysis revealed students' (1) discomfort soliciting feedback and concern of being viewed as self-serving; (2) concerns about eroding patient trust; (3) indifference to nonspecific, positive feedback; and (4) belief that informally solicited feedback is most helpful for their learning. Strategies for soliciting more useful patient feedback included (1) team-based solicitation, (2) empowering patients as teachers, and (3) development of feedback instruments that allow patients to comment on specific student-identified learning goals. Solicitation of patient feedback is challenging for medical students and provokes discomfort. Strategies to integrate patient feedback into medical student training and assessment must attend to students' needs so the value of patient feedback can be realized.
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Affiliation(s)
- Ian S Chua
- 1 Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA, USA.,2 Children's National Medical Center and the George Washington School of Medicine Health Sciences, Washington, DC, USA
| | - Alyssa L Bogetz
- 3 Stanford University School of Medicine, Palo Alto, CA, USA
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Aquilina T, Thompson SM, Metcalfe KHM, Hughes H, Sinclair L, Batt F. The involvement of older inpatients in medical student education. Eur Geriatr Med 2018; 9:77-82. [PMID: 29430268 PMCID: PMC5797205 DOI: 10.1007/s41999-017-0023-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/26/2017] [Indexed: 11/26/2022]
Abstract
Objectives To examine older inpatients’ experiences with medical student education, their views on future interactions, and to seek their opinion on the most important curricular topics related to geriatric medicine. Methods The study involved 112 non-confused inpatients older than 65 years of age, who completed a uniformed questionnaire on the day of their discharge from a teaching hospital. Results The mean age was 81 years, with equal number of male and female participants. 57% interacted with the students during their admission, the majority being interviewed and examined. Almost all (92%) of these patients described their experience as positive, some described it as time-consuming (23%), repetitive (19%) and tiresome (9%). 92% of all participants agreed that the older patients should be part of medical students’ education. Dementia, cardiac conditions, cancer, arthritis, isolation/loneliness were highlighted as the most important topics to teach medical students related to geriatric medicine, while patience and listening were listed as important skills. They suggested practical, easily implemented advice for the improvement of the interaction between students and older patients; including allowing more time for interactions and for students to speak louder. Conclusions Older patients felt positively about their interactions with medical students, and believed that older patients should be involved in medical student education. As well as medical conditions such as dementia, cardiac disease and cancer, these patients highlighted isolation and loneliness as important topics for undergraduate geriatric medical education, implying that students should learn about broader aspects of older patients’ health and wellbeing.
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Affiliation(s)
- T Aquilina
- Oxford University Medical School, Oxford, UK
| | - S M Thompson
- Departments of General (Internal) Medicine and Geratology, John Radcliffe Hospital, Oxford, UK.
| | | | - H Hughes
- Oxford University Medical School, Oxford, UK
| | - L Sinclair
- Oxford University Medical School, Oxford, UK
| | - F Batt
- Departments of General (Internal) Medicine and Geratology, John Radcliffe Hospital, Oxford, UK
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Park KM, Park KY, Kim NE, Seo BK, Park HK, Hwang HS. Effects of Module Development and Role Play Course on Clinical Practice Examination Scores during a 4th Year Clerkship. Korean J Fam Med 2018; 39:23-28. [PMID: 29383208 PMCID: PMC5788842 DOI: 10.4082/kjfm.2018.39.1.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/30/2016] [Accepted: 10/05/2016] [Indexed: 11/17/2022] Open
Abstract
Background After introduction of clinical skills assessment in the Korean Medical Licensing Examination, medical schools have reinforced both experiential learning with real patients and preparatory programs. This study was conducted to investigate whether a clinical practice examination (CPX) preparation program improves students' CPX score in terms of case specificity. Methods One hundred and thirteen senior students in a medical school participated in this study. During the fourth-year clerkship, 28 students (24.8%) from three rotation groups took a 3-day CPX preparation course consisting of module development, role play, and comprehensive physical exam skills training. Eleven rotation groups (n=85) were compared as control. Both the intervention and control group took two comprehensive CPXs before and after the clerkship was completed. Results There was no significant difference in age, sex, and school type between the two groups. On pre-test CPX, there was no significant difference in total and sectional scores between the two groups. On post-test CPX, total scores of the intervention group were higher than those of the control groups (69.5±4.3 vs. 67.5±4.4, P<0.05). History taking scores were higher in intervention groups (70.0±6.0 vs. 66.0±6.6, P=0.01). The station scores of vaginal discharge with case similarity were higher in the intervention groups (73.0±6.3 vs. 68.9±9.3, P=0.03). Conclusion A short CPX preparation course improved history taking ability, but its effect was greater only in a specific case, similar to the pre-course case. Whether this effect was due to the test experience or true improvement in competency requires further investigation.
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Affiliation(s)
- Kyong-Min Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Kye-Yeung Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Nam-Eun Kim
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Bong-Kyung Seo
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hoon-Ki Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hwan-Sik Hwang
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
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Kaplonyi J, Bowles KA, Nestel D, Kiegaldie D, Maloney S, Haines T, Williams C. Understanding the impact of simulated patients on health care learners' communication skills: a systematic review. MEDICAL EDUCATION 2017; 51:1209-1219. [PMID: 28833360 DOI: 10.1111/medu.13387] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/18/2017] [Accepted: 05/31/2017] [Indexed: 05/07/2023]
Abstract
CONTEXT Effective communication skills are at the core of good health care. Simulated patients (SPs) are increasingly engaged as an interactive means of teaching, applying and practising communication skills with immediate feedback. There is a large body of research into the use of manikin-based simulation but a gap exists in the body of research on the effectiveness of SP-based education to teach communication skills that impact patient outcomes. The aim of this systematic review was to critically analyse the existing research, investigating whether SP-based communication skills training improves learner-patient communication, how communication skill improvement is measured, and who measures these improvements. METHODS The databases Medline, ProQuest (Health & Medical Complete, Nursing and Allied Health Source) and CINAHL (EBSCOhost) Education Resources Information Centre (ERIC) were searched for articles that investigated the effects of SP-based education on the communication skills of medical, nursing and allied health learners. RESULTS There were 60 studies included in the review. Only two studies reported direct patient outcomes, one reporting some negative impact, and no studies included an economic analysis. Many studies reported statistically significant third-party ratings of improved communication effectiveness following SP-based education; however, studies were unable to be pooled for meta-analysis because of the outcome collection methods. There were a small number of studies comparing SP with no training at all and there were no differences between communication skills, contradicting the results from studies reporting benefits. Of the 60 studies included for analysis, 54 (90%) met the minimum quality score of 7/11, with four articles (7%) scoring 11/11. CONCLUSION SP-based education is widely accepted as a valuable and effective means of teaching communication skills but there is limited evidence of how this translates to patient outcomes and no indication of economic benefit for this type of training over another method.
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Affiliation(s)
| | - Kelly-Ann Bowles
- Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia
| | - Debra Nestel
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Debra Kiegaldie
- Faculty of Health Science, Youth and Community Studies, Holmesglen Institute and Healthscope Hospitals, Moorabbin, Victoria, Australia
| | - Stephen Maloney
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Terry Haines
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
- Allied Health Research Unit, Monash Health, Cheltenham, Victoria, Australia
| | - Cylie Williams
- Peninsula Health, Allied Health, Frankston, Victoria, Australia
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
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