Cost-effectiveness of peer role play and standardized patients in undergraduate communication training

Trauma-informed precepting: A novel curriculum for faculty development

PURPOSE

Traumatic experiences are ubiquitous and associated with negative impacts on health and wellbeing in patients, students, and clinicians. Trauma-informed care (TIC) is a harm reduction framework that aims to minimize re-traumatization and the negative health impacts of trauma. TIC is increasingly being incorporated into undergraduate medical education (UME) curricula; however, to date, there is no standardized curriculum to support faculty in precepting TIC clinical skills.

METHODS

We created a series of five educational modules in an asynchronous online format to support faculty in the instruction and precepting of TIC clinical skills in UME. The modules instruct on trauma epidemiology, trauma-informed clinical skills, trauma-informed precepting, and trauma-informed self-care (TISC). The modules are interactive and utilize multimedia content.

RESULTS

Fifty-three faculty members of the primary care clerkship participated in the modules. After the modules, faculty demonstrated increased knowledge of TIC, though their comfort in applying principles with patients and students was unchanged.

DISCUSSION

We present a novel, standardized curriculum to support faculty in the practice and precepting of TIC clinical skills. The intervention is shown to promote knowledge surrounding TIC. In the future, pairing these asynchronous modules with in-person training may be necessary to improve comfort with the application of these skills.

Impact of Multimodal Intervention on Empathy Levels in Medical Students: A Questionnaire-Based Study

Background Empathy is essential for effective doctor-patient communication. It enables doctors to understand patients' emotions and concerns, facilitating personalized care and support. Empathy can be cultivated through various methods and training programs. Objective The study aims to assess the effectiveness of a multimodal intervention involving interactive lectures, peer role-play, and guided reflection in enhancing empathy levels among second-year medical undergraduate students in India. Methods This study utilized a questionnaire-based, pre- and post-test interventional design. Seventy-nine second-year medical students were included after obtaining their informed consent. The students received the intervention through an interactive lecture on communication skills, role-play on selected case studies, and guided reflection. The empathy levels were assessed using the Toronto Empathy Questionnaire (TEQ) before and after the intervention. The Mann-Whitney U test was utilized to compare pre-test and post-test TEQ scores. A univariate analysis of variance was conducted to explore the relationship between demographic variables and post-test TEQ scores. Statistical significance was considered at p ≤ 0.05. Results The TEQ score improved significantly (p=0.009) after the intervention. The univariate analysis indicated that gender, style of education, and place of residence did not have a statistically significant impact on post-test scores. Conclusion The study demonstrates that a multimodal intervention significantly enhances the empathy level of medical students, highlighting the potential of focused interventions to reduce gender disparities in empathy levels. There were no significant differences in empathy scores based on gender, place of residence, or schooling, suggesting the intervention's benefits may apply to all medical students.

A Generative Pretrained Transformer (GPT)-Powered Chatbot as a Simulated Patient to Practice History Taking: Prospective, Mixed Methods Study

BACKGROUND

Communication is a core competency of medical professionals and of utmost importance for patient safety. Although medical curricula emphasize communication training, traditional formats, such as real or simulated patient interactions, can present psychological stress and are limited in repetition. The recent emergence of large language models (LLMs), such as generative pretrained transformer (GPT), offers an opportunity to overcome these restrictions.

OBJECTIVE

The aim of this study was to explore the feasibility of a GPT-driven chatbot to practice history taking, one of the core competencies of communication.

METHODS

We developed an interactive chatbot interface using GPT-3.5 and a specific prompt including a chatbot-optimized illness script and a behavioral component. Following a mixed methods approach, we invited medical students to voluntarily practice history taking. To determine whether GPT provides suitable answers as a simulated patient, the conversations were recorded and analyzed using quantitative and qualitative approaches. We analyzed the extent to which the questions and answers aligned with the provided script, as well as the medical plausibility of the answers. Finally, the students filled out the Chatbot Usability Questionnaire (CUQ).

RESULTS

A total of 28 students practiced with our chatbot (mean age 23.4, SD 2.9 years). We recorded a total of 826 question-answer pairs (QAPs), with a median of 27.5 QAPs per conversation and 94.7% (n=782) pertaining to history taking. When questions were explicitly covered by the script (n=502, 60.3%), the GPT-provided answers were mostly based on explicit script information (n=471, 94.4%). For questions not covered by the script (n=195, 23.4%), the GPT answers used 56.4% (n=110) fictitious information. Regarding plausibility, 842 (97.9%) of 860 QAPs were rated as plausible. Of the 14 (2.1%) implausible answers, GPT provided answers rated as socially desirable, leaving role identity, ignoring script information, illogical reasoning, and calculation error. Despite these results, the CUQ revealed an overall positive user experience (77/100 points).

CONCLUSIONS

Our data showed that LLMs, such as GPT, can provide a simulated patient experience and yield a good user experience and a majority of plausible answers. Our analysis revealed that GPT-provided answers use either explicit script information or are based on available information, which can be understood as abductive reasoning. Although rare, the GPT-based chatbot provides implausible information in some instances, with the major tendency being socially desirable instead of medically plausible information.

Developing a virtual patient: design, usability, and learning effect in communication skills training

BACKGROUND

Literature shows that Virtual Patients (VPs) find extensive usage in the field of health sciences, especially in the post-pandemic period. VPs are successfully utilized in developing various effective skills like medical interview. However, this technology is quite new in Turkey and has not yet been used in communication skills training in a structured form. This research aimed to develop a virtual patient to improve the communication skills of medical students.

METHODS

Developmental research method was used in the study. The implementation phase involved the one group posttest quasi-experimental design. The study group comprised of experts in various fields and 213 medical students. Needs Analysis Form, Scenario Building Form, System Validation Form, Communication Skills Assessment Form, and Interview Form were used as data collection tools. The research primarily concentrated on ensuring minimal errors within the system and enhancing students' communication skill scores.

RESULTS

The study found that VP was effective in teaching communication skills. Communication skills improved from a mean score of 36.74 in the first interview with 15 students to 74.2 in the final application with 198 students. It was determined that the students who practiced repeatedly (n = 26) made 17% more effective interviews than their first practices (score: 89.2). The script matching of the VP was 83%. Other data obtained from the students generally showed that the VP application was developed in accordance with the purpose, that it was user-friendly, and that the scenarios were adequate.

CONCLUSION

VPs like this have the potential to develop skills such as history taking, clinical reasoning, etc., which are very important in the field of health sciences.

Simulation for communication training in neonatology

Communication skills training is a core competency for neonatal-perinatal medicine (NPM) fellows, yet many neonatology fellowship programs do not have formal communication skills curricula. Since the late 1990s, experiential learning that includes role-play and simulation has become the standard for communication training. NPM fellows who receive simulation-based communication skills training report greater comfort with difficult conversations in the NICU. Most communication skills studies in neonatology focus on antenatal counseling, with some studies regarding family meetings and end of life conversations. Published examples for simulation-based communication skills curricula exist, with ideas for adapting them to meet the needs of local resources.

A cost analysis of a 5-day simulation-based learning program for speech-language pathology student training

Purpose: There is poor reporting of the cost of simulation and greater transparency is needed. The primary study aim was to conduct a financial analysis of the university/training institution costs associated with a 5-day simulation-based learning program for speech-language pathology students. The secondary aim was to consider the economic costs of the model.Method: Costs associated with the delivery of a 5-day simulation-based learning program for speech-language pathology students from six Australian universities were collected regarding: (a) pre-program training, (b) personnel, (c) room hire, (d) equipment, and (e) consumables. Both financial costs and economic costs (Australian dollar, at June 2017) were calculated per university site, and per student.Result: The simulation program was run 21 times involving 176 students. Average total financial cost per program ranged from $4717 to $11 425, with cost variation primarily attributed to local labour costs and various use of in-kind support. Average financial cost per student was $859 (range $683-$1087), however this was almost double ($1461 per student, range $857-$2019) in the economic cost calculation. Personnel was the largest contributing cost component accounting for 76.6% of financial costs. Personnel was also the highest contributing cost in the economic analysis, followed by room hire.Conclusion: This study provides clarity regarding financial and economic costing for a 5-day simulation-based learning program. These data can help universities consider potential up-front financial costs, and well as strategies for financial cost minimisation, when implementing simulation-based learning within the university context.

Impact of using peer role-playing on the clinical skills performance of pediatric trainees

OBJECTIVE

The aim of this study was to evaluate the impact of peer role-playing on the clinical skills performance of pediatric trainees.

METHODS

Seventy-eight clinical medicine trainees were randomly divided into a role-playing group and a traditional teaching group, with 39 students in each group. The role-playing group alternated between the roles of clinicians and patients, while the traditional teaching group received the bedside teaching mode of verbal instruction. After two weeks traineeship, mini-Clinical Evaluation Exercise(Mini-CEX) was used to evaluate the trainees' competence in physician-patient communication and clinical practice. A questionnaire was given to the role-playing group to assess their satisfaction with the method.

RESULTS

The Mini-CEX scores showed that the role-playing group had superior clinical skills (p < 0.05), including communication, history taking, professionalism, organization, clinical skills, and physical examination, compared to the traditional teaching group. Furthermore, trainee satisfaction was high with the role-playing method,and the satisfaction were more than 95%.

CONCLUSION

The role-playing method effectively improved the clinical skills of pediatric trainees, developed clinical communication skills, and enhanced the application of medical knowledge in a simulated medical environment.

Impact of a Brief Suicide Prevention Training with an Interactive Video Case Assessment on Student Pharmacist Outcomes

OBJECTIVE

To determine whether a brief suicide prevention training with an interactive video case (Pharm-SAVES) improves student pharmacists' suicide prevention knowledge and self-efficacy.

METHODS

Student pharmacists (N = 146) from 2 United States universities completed the 75-minute Pharm-SAVES training in September 2021. Suicide prevention knowledge and self-efficacy were measured via an online pre-test and post-test, and a post-test interactive video case assessed self-efficacy to engage in SAVES steps (recognize Signs, Ask about suicide, Validate feelings, Expedite a National Suicide Prevention Lifeline [NSPL] referral, and Set a follow-up reminder). Paired samples t tests compared pre-test and post-test scores (alpha = 0.05). Three months later, students indicated if they had used Pharm-SAVES in practice.

RESULTS

Mean knowledge and self-efficacy significantly improved from pre-test to post-test. The interactive video case assessment revealed that students were least confident asking about suicide, moderately confident referring to or calling the NSPL on behalf of patients, and most confident following up with patients. Three months later, 17 (11.6%) students reported that they had recognized someone with suicide warning signs (S in SAVES). Among them, 9 (52.9%) reported asking the person with warning signs if they were considering suicide (A in SAVES), 13 (76.5%) validated feelings (V in SAVES), 3 (9.4%) called the NSPL for the patient, and 6 (35.3%) referred to the NSPL (E in SAVES).

CONCLUSION

Pharm-SAVES increased student pharmacists' suicide prevention knowledge and self-efficacy. Within 3 months, more than 10% had used Pharm-SAVES skills with at-risk individuals. All Pharm-SAVES content is now online and available for asynchronous or synchronous instruction.

Enhancing History-Taking Skills in Medical Students: A Practical Guide

History-taking skills are an essential part of the medical school curriculum. However, from the author's experience and available literature, students consistently report a lack of confidence in their history-taking abilities, and as a result, feel underprepared for upcoming summative communication skills assessments. Therefore, as medical students at the University of Cambridge, we used evidence-based education to create a history-taking teaching programme that aimed to increase confidence and preparedness for communication skills exams. This article outlines 12 tips to be used when teaching history-taking skills to medical students. These tips were created using student feedback, personal experience, and wider literature on the topic. Creating and teaching an effective history-taking course can take significant effort and time. However, we hope this guide provides a starting framework that can be quickly applied to allow users to create effective history-taking skills courses for their students.

Artificial Intelligence Supporting the Training of Communication Skills in the Education of Health Care Professions: Scoping Review

BACKGROUND

Communication is a crucial element of every health care profession, rendering communication skills training in all health care professions as being of great importance. Technological advances such as artificial intelligence (AI) and particularly machine learning (ML) may support this cause: it may provide students with an opportunity for easily accessible and readily available communication training.

OBJECTIVE

This scoping review aimed to summarize the status quo regarding the use of AI or ML in the acquisition of communication skills in academic health care professions.

METHODS

We conducted a comprehensive literature search across the PubMed, Scopus, Cochrane Library, Web of Science Core Collection, and CINAHL databases to identify articles that covered the use of AI or ML in communication skills training of undergraduate students pursuing health care profession education. Using an inductive approach, the included studies were organized into distinct categories. The specific characteristics of the studies, methods and techniques used by AI or ML applications, and main outcomes of the studies were evaluated. Furthermore, supporting and hindering factors in the use of AI and ML for communication skills training of health care professionals were outlined.

RESULTS

The titles and abstracts of 385 studies were identified, of which 29 (7.5%) underwent full-text review. Of the 29 studies, based on the inclusion and exclusion criteria, 12 (3.1%) were included. The studies were organized into 3 distinct categories: studies using AI and ML for text analysis and information extraction, studies using AI and ML and virtual reality, and studies using AI and ML and the simulation of virtual patients, each within the academic training of the communication skills of health care professionals. Within these thematic domains, AI was also used for the provision of feedback. The motivation of the involved agents played a major role in the implementation process. Reported barriers to the use of AI and ML in communication skills training revolved around the lack of authenticity and limited natural flow of language exhibited by the AI- and ML-based virtual patient systems. Furthermore, the use of educational AI- and ML-based systems in communication skills training for health care professionals is currently limited to only a few cases, topics, and clinical domains.

CONCLUSIONS

The use of AI and ML in communication skills training for health care professionals is clearly a growing and promising field with a potential to render training more cost-effective and less time-consuming. Furthermore, it may serve learners as an individualized and readily available exercise method. However, in most cases, the outlined applications and technical solutions are limited in terms of access, possible scenarios, the natural flow of a conversation, and authenticity. These issues still stand in the way of any widespread implementation ambitions.

Evaluation of a Theory-Based Virtual Counseling Application in Nursing Education

Effective communication skills in nursing are necessary for high-quality nursing care, but given the decline in nursing students' attitudes and their low self-confidence in effective communication with patients, a participatory and experiential training method is needed. Therefore, a virtual counseling application was developed using artificial intelligence and a three-dimensional avatar to facilitate learning of communication skills. This study aimed to evaluate the effectiveness of this theory-based virtual intervention on nursing students' learning attitudes, communication self-efficacy, and clinical performance. A longitudinal quasi-experimental study was conducted. Ninety-three undergraduate nursing students received virtual patient trainings with four clinical scenarios over 2 years. Data were analyzed using McNemar test and analysis of variance. Virtual patient training improved students' learning attitudes toward communication skills for scenarios involving the pregnant woman (20.4%, P = .03) and depressed patient (17.1%, P = .01) and enhanced perceived self-efficacy for scenarios involving the pregnant woman (22.6%, P = .002) and stressed nursing student (18.3%, P = .002). Students received lower clinical communication scores for pediatric, obstetric, and medical practicums compared with a previous cohort who received no training. Overall, this virtual counseling application can provide a valuable and cost-effective communication learning resource for the nursing curriculum.

Student standardized patients versus occupational standardized patients for improving clinical competency among TCM medical students: a 3-year prospective randomized study

BACKGROUND

Standardized patient (SP) simulations are well-recognized patterns for practicing clinical skills and interactions. Our previous study showed that a simulation program using occupational SP for Traditional Chinese Medicine (OSP-TCMs) was efficient, however, a high cost and time-intensive nature have limited its use. TCM postgraduates trained as student SPs (SSP-TCMs) present a potentially cost-effective alternative. The purpose of this study was to examine and determine whether SSP simulation offered more benefits over didactic training alone for improving clinical competency among TCM medical students, and conduct a multifaceted analysis comparing SSP-TCMs and OSP-TCMs.

METHODS

This was a prospective, single-blinded, randomized controlled trial. Fourth-year TCM undergraduates were recruited as trainees from the Clinical Medical School, Chengdu University of TCM. Data were collected from September 2018 to December 2020. Trainees were randomly divided into the three following groups: traditional method training group, OSP-TCM training group, and SSP-TCM training group (1:1:1). At the end of a 10-week curriculum, trainees received a two-station examination comprising a systematic online knowledge test and an offline clinical performance examination. Post-training and post-exam questionnaires were administered to collect feedback from these trainees.

RESULTS

Students assigned to the SSP-TCM training and OSP-TCM training groups received favorable marks for the "systematic knowledge test" and "TCM clinical skills" (2018, P^a=0.018, P^b=0.042; 2019, P^a=0.01, P^b=0.033; 2020, P^a=0.035, P^b=0.039) compared to the TM trainees. Additionally, trainees in the intervention groups demonstrated a positive post-training edge in scores of "medical records" (2018, P^a=0.042, P^b=0.034; 2019, P^a=0.032, P^b=0.042; 2020, P^a=0.026, P^b=0.03) and "TCM syndrome differentiation and therapeutic regimen" (2018, P^b=0.032; 2019, P^a=0.037, P^b=0.024; 2020, P^a=0.036, P^b=0.043). For the simulation encounter assessment given by SP-TCMs, OSP-TCM trainees and SSP-TCM trainees scored higher than TM trainees (2018, P^a=0.038, P^b=0.037; 2019, P^a=0.024, P^b=0.022; 2020, P^a=0.019, P^b=0.021). For the feedback questionnaires, the students in TM group provided less positive feedback for training efficacy and test performance compared to those in the SSP-TCM and OSP-TCM groups. The trainees responded that the training effect of clinical simulations was similar between the SSP-TCM and OSP-TCM groups. SSP-TCMs were more responsive to unexpected emergencies (P^a=0.022, P^b>0.05) and more likely to encourage questioning (P^a=0.029, P^b>0.05) but tended to provide implied hints (P^c=0.015) and utilize medical jargon (P^c=0.007) as compared to OSP-TCMs.

CONCLUSION

Simulation training for SSP-TCMs and OSP-TCMs showed great benefits for enhancing clinical competency. SSP-TCM simulation was feasible, practical, and cost-effective, and may serve as an alternative method to OSP-TCM simulation.

Content and characteristics of evidence in the use of standardized patients for advanced practice nurses: A mixed-studies systematic review

OBJECTIVES

The use of Standardized Patients (SPs) as a supplement to traditional clinical experience is of interest in the advanced practice nursing curriculum. Yet, evidence exploring this area is limited. This systematic review aims to consolidate and synthesize findings on the available evidence of using standardized patients (SPs) on advanced practice nurse (APN) students' learning and assessment experiences.

DESIGN

Mixed-studies systematic review.

DATA SOURCES

PubMed, EMBASE, Cochrane Library, CINAHL, Scopus, PsycINFO, and ProQuest Dissertations and Theses from the inception of each database to May 2022.

REVIEW METHODS

Quantitative, qualitative, and mixed-method studies involving the use of SPs for education and assessments among APN students were included in this review.

RESULTS

Twenty studies were included. Three themes were identified through thematic synthesis: (1) Benefits associated with standardized patients, (2) Uniqueness of standardized patient experience, and (3) Preference and way forward. Overall, these students benefited from refining knowledge, clinical skills, and communication skills, and perceived a boost in confidence in their nursing competencies through SP simulations. More studies with rigorous methodology are needed to ascertain the causal relationships between SP simulations and APN students. Future studies should evaluate the cost-effectiveness of SP, especially in low-income countries. Inter-professional SP simulations and hybrid simulations should be explored further. Considerations for improvements include allocating more sessions for multisource feedback, offering dyadic or group support, and providing assessments that are more formative during simulations.

CONCLUSIONS

SP simulation can complement traditional clinical experience in providing APN students with the knowledge, clinical skills, and communication skills in the real-world context.

The Use of Simulated Patients Is more Effective than Student Role Playing in Fostering Patient-Centred Attitudes during Communication Skills Training: A Mixed Method Study

Objective

While simulated patients (SPs) are considered a standard tool in communication skills training, there is no evidence thus far of their comparative benefit to the more cost-effective option of student role playing. We compared the effectiveness of both approaches in developing patient-centred attitudes in students.

Methods

We retrospectively compared students who participated in the clinical communication course (CCC), based on student role playing (CCCsp-, n = 160), to students who participated in the CCC with SPs (CCCsp+, n = 146), and students with no formal CCC (CCC-, n = 122). We used validated questionnaires to assess patient centredness. We also conducted focus group interviews (FGI) to better understand the impact of CCC with sp.

Results

Students after the CCC with simulated patients achieved a significantly higher score in the patient-practitioner orientation scale than other groups (p < 0.001).

Conclusions

There is a strong positive correlation between the implementation of simulated patients and patient-centred attitudes among students. Data from the FGI revealed that students perceived training with SP as more realistic, safe, and engaging than student role playing. Practice Implications. Our research provides evidence to justify costs and resources invested in simulated patient programs.

The Acceptability of Avatar Patients for Teaching and Assessing Pediatric Residents in Communicating Medical Ambiguity

BACKGROUND

Simulation offers a means to assess resident competence in communication, but pediatric standardized patient simulation has limitations. A novel educational technology, avatar patients (APs), holds promise, but its acceptability to residents, educational relevance, and perception of realism have not been determined.

OBJECTIVE

To determine if APs are acceptable, provide a relevant educational experience, and are realistic for teaching and assessment of a complex communication topic.

METHODS

Pediatric residents at one academic institution participated in an AP experience from 2019 to 2021 consisting of 2 scenarios representing issues of medical ambiguity. After the experience, residents completed a survey on the emotional relevance, realism, and acceptability of the technology for assessment of their communication competence.

RESULTS

AP actor training required approximately 3 hours. Software and training was provided free of charge. Actors were paid $30/hour; the total estimated curricular cost is $50,000. Sixty-five of 89 (73%) pediatric residents participated in the AP experience; 61 (93.8%) completed the survey. Forty-eight (78.7%) were emotionally invested in the scenarios. The most cited emotions evoked were anxiety, uncertainty, concern, and empathy. The conversations were rated by 49 (80.3%) as realistic. APs were rated as beneficial for learning to communicate about medical ambiguity by 40 (65.5%), and 41 (66.7%) felt comfortable having APs used to assess their competence in this area.

CONCLUSIONS

Pediatric residents were emotionally invested in the AP experience and found it to be realistic. The experience was rated as beneficial for learning and acceptable to be used for assessment of how to communicate medical ambiguity.

Effect of moderation on rubric criteria for inter-rater reliability in an objective structured clinical examination with real patients

Objectives: Objective structured clinical examinations (OSCEs) are used to assess clinical competence in medical education. Evaluations using video-recorded OSCEs are effective in reducing costs in terms of time and human resources. To improve inter-rater reliability, these evaluations undergo moderation in the form of a discussion between the raters to obtain consistency in grading according to the rubric criteria. We examined the effect of moderation related to the rubric criteria on the inter-rater reliability of a video-recorded OSCE with real patients.

Methods

Forty OSCE videos in which students performed range-of-motion tests at shoulder abduction on real patients were assessed by two raters. The two raters scored videos 1 to 10 without moderation and videos 11 to 40 with moderation each time. The inter-rater reliability of the OSCE was calculated using the weighted kappa coefficient.

Results

The mean scores of the weighted kappa coefficients were 0.49 for videos 1 to 10, 0.57 for videos 11 to 20, 0.66 for videos 21 to 30, and 0.82 for videos 31 to 40.

Conclusions

An assessment of video-recorded OSCEs was conducted with real patients in a real clinical setting. Repeated moderation improved the inter-rater reliability. This study suggests the effectiveness of moderation in OSCEs with real patients.

Teaching how to break bad news in Oncology: In-class vs. virtual peer role-plays

BACKGROUND

We report two different peer role-play training courses for breaking bad news (BBN) in Oncology, the classic "in-class" model and the "virtual" peer role-play (VPRP) model developed during the SARS-CoV-2 pandemic.

METHODS

Each session included 20-25 4th year medical students supervised by two practitioners experienced in oncology. After an ice breaking activity to exchange with students on means to promote hope to patients when BBN, peer role-plays started. Pre-and post-session questionnaires were submitted to evaluate students' satisfaction, attitudes, and perceptions. Pre-and post-session knowledge test were realized. Each student has participated to only one peer-role play either "in-class" (2018) or VPRP (2020).

RESULTS

In 2018, a total of 222 students received the "in-class" training. In 2020, a total 431 students received the VPRP training. For almost all students it was the first peer role-play training session. Before training, reported level of confidence in BBN was low. After training, students of the VPRP group were highly satisfied regarding quality (realism, organization). Students also reported great interest and perceived benefits. Students who underwent "in-class" training course showed a significantly higher improvement (+1.9 points) of their knowledge scores compared to those who underwent the VPRP training course (+0.7 points) (P-value=2e-16).

CONCLUSION

The two methods seem beneficial to improve knowledge skills in BBN although "in-class" training class seem to be more efficient. To our knowledge, this is the first comparison between virtual and in-class peer-role play training for BBN in oncology.

Improving Serious Illness Communication: Testing the Serious Illness Care Program with Trainees

BACKGROUND

Early conversations about patients' goals and values improve care, but clinicians struggle to conduct them. The systems-based Serious Illness Care Program (SICP) helps clinicians have more, better, and earlier conversations. Central to this approach is a clinician conversation guide for patient encounters. While the SICP works for practicing clinicians, it has not been tested with medical trainees.

INTERVENTION

We adapted the SICP training to emphasize assessing prognostic awareness and responding to emotion. We developed a 2.5-hour SICP workshop for medical students and medical interns that included large- and small-group work, practice with an actor, and interdisciplinary clinician facilitators. We trained 81 students and 156 interns and obtained anonymous quantitative and qualitative feedback.

OUTCOMES

Eighty-six percent of students and 91% of residents rated the session as "very good" or "excellent" and >90% of all learners would either recommend this training or intended to apply this to their practice. Post-session learner confidence increased in all communication skills. Learners said the training provided a helpful framework and useful language for these conversations. Resident documentation of serious illness conversations in the medical record increased dramatically during the year following training commencement.

CONCLUSIONS

Grounded in principles of adult learning theory, this training was rated highly by trainees and resulted in demonstrable practice change. These early learners were more flexible and willing to try this approach than practicing clinicians who tend to resist or revert to old habits. A Guide represents a new paradigm for teaching communication skills and is valued by early learners.

Role-Play versus Standardised Patient Simulation for Teaching Interprofessional Communication in Care of the Elderly for Nursing Students

This study aims to describe and compare the effects of standardised patient simulation and role-play in the acquisition and retention of interprofessional communication in elderly care competence amongst nursing students. In this controlled clustered randomised trial, 121 nursing students attended a workshop on interprofessional communication in elderly care using role-play or standardised patient simulation. The study was conducted between September 2017 and February 2018. Participants’ knowledge, self-efficacy and communication skills were assessed using a simulated scenario at pre-test, post-test and 6-week follow-up points. Between-subject and within-subject differences were measured using counts and proportions of participants who achieved competence. Regardless of the strategy applied, a significant improvement in knowledge, skills, self-efficacy and overall interprofessional communication competence was found between pre-test and post-test. Moreover, there were significant differences between pre-test and follow-up for all the studied variables, but no differences were found between post-test and follow-up. Lastly, when comparing the success rates of both strategies, no significant differences were observed (p > 0.05). In conclusion, standardised patient simulation and role-play have been shown to promote an improvement on knowledge, self-efficacy and interprofessional communication skills in nursing students, although it is not possible to state which strategy is the most adequate for teaching this competency.

Comparing trained student peers versus paid actors as standardized patients for simulated patient prescription counseling

Background

Simulation can be a useful tool for teaching and assessing clinical skills, but can also be costly and faculty-time intensive. It is defined as a technique to create an activity to portray a real experience for purpose of practicing or evaluating. Simulations can use standardized patients (SPs), which can be paid actors (PASPs), staff and faculty, manikins, volunteers, or students from higher level cohorts, also known as advanced class standardized patients (ACSPs).

Objective

The objective of this study was to conduct a multifaceted analysis comparing ACSPs and PASPs, based on student performance in the assessment, student preference of SP type, and SP performance as an actor.

Methods

ACSPs and PASPs were used in a summative prescription counseling role play. For the evaluation, students counseled a SP about a new prescription medication and answered questions about taking an over-the-counter product with the new medication. The interaction was recorded and evaluated by faculty using a previously developed rubric. SP performance was evaluated by faculty using a separate rubric to determine how well the patient role was performed. A pre- and post-evaluation survey was completed by student pharmacists to gather student preferences about SPs and confidence in their counseling skills. Data were evaluated using a paired t-test.

Results

One hundred sixty-seven student pharmacists completed the summative prescription counseling evaluation. Student pharmacists performed well overall with minimal differences between SP types. Students preferred PASPs to role play the patient but felt that the actor type did not affect their performance.

Conclusions

ACSPs performed the role of the SP well for a summative prescription counseling session without impacting student performance compared to PASPs and with reduced cost. However, students preferred PASPs, and PASPs were better at role playing the patient.

Tutor-Student Partnership in Practice OSCE to Enhance Medical Education

BACKGROUND

Training of examiners is essential to ensure the quality of objective structured clinical examination (OSCE). We aimed to study a perceived effectiveness of tutor-student partnership in a practice OSCE module by novice OSCE tutors and medical students.

METHOD

We implemented a practice OSCE at a medical faculty in France with novice tutors and third year medical students as partners. Each tutor (n = 44) served as a partner for the group of 5 students in the conception of the scenario and as an evaluator of the tutored station. Students (n = 303) were involved in the conception of a case and the roles of a physician, evaluator and a simulated patient. Data were obtained through self-assessment questionnaires. Descriptive statistics were used to analyze items of the questionnaires. Free-form answers were coded and analyzed thematically.

RESULTS

A total of 36 tutors (82%) and 185 students (61%) responded to the questionnaires. The intervention was well perceived. Thirty-two percent of the tutors reported some difficulties in the assessment of student performance and were disposed to receive further training. Fifty-five percent of the students considered the participation in the OSCE case development appropriate to their level of knowledge, and 70% perceived it as beneficial allowing them to set their learning goals.

CONCLUSION

This initiative provides a relevant method beneficial to OSCE tutors, medical students, and the faculty. Tutors learn how to assess student performance according to expected achievement levels. It allows students to be engaged as partners in co-creation of learning and teaching.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01421-9.

Standardized vs peer-played patients for learning how to break bad news in lung cancer: A prospective crossover study

CONTEXT

Residents in respiratory medicine are often confronted with breaking bad news to patients. In communication skill training, a recurring question is whether to use standardized or peer-played patients for simulation METHODS: In this prospective single-center crossover study in pulmonology residents, a range of scenarios were performed during training sessions using standardized or peer-played patients. The aim was to assess whether patient type did alter the quality of the role-play. The residents completed post-scenario questionnaires about the role-play of each scenario, but also pre- and post-session questionnaires about their perception of the effectiveness of both modalities, and pre- and post-testing questionnaires about the psychological impact of the training.

RESULTS

Collectively, 4 scenarios were performed 52 times and evaluated 208 times by 52 residents. The use of standardized patients appeared to improve the quality of the patient role (8.8 ± 1.0 vs. 8.3 ± 1.1; p = 0.001) and the general quality of role-play (8.8 ± 1.0 vs. 8.2 ± 0.9; p = 0.008), without affecting the quality of the physician role played by the resident. There were no significant differences between standardized and peer-played patients regarding learning interest or psychological impact. Regardless of the modality, the training sessions did appear to significantly affect the residents' evaluations of their ability to break bad news to patients (5.7 ± 1.1 vs. 7.4 ± 1.1; p < 10-4).

CONCLUSION

Our results did not point to a superiority of either of these modalities for learning how to break bad news. Both may be used, depending on the local resources.

Virtual Standardized Patients for Mental Health Education

PURPOSE OF REVIEW

The training of psychiatrists and other mental health professionals requires education on a range of interpersonal, communication, and psychotherapy techniques. Classroom and workshop training must be augmented by experiential learning with feedback for skill implementation with fidelity. Virtual standardized patients (VSPs) are computerized conversational agents that can support experiential learning through standardized, consequence-free training environments at reduced costs.

RECENT FINDINGS

Research on mental health VSPs is rife with feasibility and acceptability pilot studies across various training populations and settings. Users have generally reported positive reactions to training with VSPs, though frustrations with some VSP speech recognition or VSP response relevance has been reported. Several studies have demonstrated a promising transfer of clinical skills from VSP training to human standardized patients and randomized trials supporting improved skill relative to reading or academic study are encouraging. As technology improves and natural language processing and accurate computer response generation for broad ranging conversational topics emerges, the field would benefit from research on the characteristics of effective VSPs for a range of purposes and trainee populations. Well-designed randomized evaluations of VSPs relative to best practices in education are needed, particularly regarding the impact of VSPs on clinical practice among actual patients.

Encouraging a Little Help from Our Friends: Resident Physician Burnout & Peer Communication Curriculum

INTRODUCTION

Resident physician burnout and depression rates are increasing faster than in the non-physician workforce. To foster a supportive community where such concerns may be addressed, residents can be educated in identification and first-line support of burnout in fellow residents. The literature has not described peer roleplaying applied toward aiding fellow residents with burnout.

METHOD

This pilot study evaluated an educational component aimed at fostering a strong emotional and informational social support system. The curriculum used peer roleplaying to develop self-awareness and social support, improve communication skills, and teach about existing mental health resources, thereby encouraging intervention. Residents listed behavioral manifestations of burnout and dysphoria that we developed into real-life scenarios. During experiential workshops, residents roleplayed "distressed" and "helper" residents and practiced communicating empathy. To tackle mental health stigma, all were required to practice expressing distress and seeking help. Residents completed a pre-roleplaying questionnaire, curriculum satisfaction questionnaire, and reflection essay.

RESULTS

All 42 Internal Medicine and Transitional Year residents (69% male, 93% international medical graduates) participated. Resident-reported comfort, competence, confidence, and knowledge increased, as did positive appraisals of the clinical teaching environment representing a safe atmosphere. Six themes were cited in >25% of essays: knowledge of communication techniques, knowledge of approach tactics or strategies, knowledge of hospital resources, commitment to helping colleagues, importance of burnout, and belief this training produced a better understanding of oneself.

CONCLUSION

As first-witnesses of resident physician distress, peers occupy an underutilized, yet crucial preventive and supportive role in burnout and mental health intervention, especially during times of shared crises such as the coronavirus pandemic. Creating roleplays from personal experiences facilitated meaningful discussion of burnout and dysphoric emotions. Roleplaying offered a low-cost, effective method to destigmatize and encourage discussion of burnout, educate on signs and symptoms, and learn available resources to offer an afflicted colleague in osteopathic and allopathic residency programs.

Using Videos to Teach Medical Learners How to Address Common Breastfeeding Problems

INTRODUCTION

Though breast milk is the recommended first food, only 84% of mothers try breastfeeding, and 19% of those babies are supplemented with formula by the second day of life. Mothers often fall short of their breastfeeding goals, which has been traced in part to primary care physicians' discomfort and lack of confidence in assisting breastfeeding mothers. A video-based educational intervention was developed to enhance learner comfort and confidence in supporting breastfeeding.

METHODS

Prior to watching the videos, two separate groups of learners (25 primary care residents and 40 medical students) were given two assessments to assess their baseline knowledge and self-perceived comfort and confidence with breastfeeding based on the American Academy of Pediatrics residency breastfeeding curriculum. We gave the learners a checklist to guide their observations while watching the videos. The learners repeated the assessments after watching the videos.

RESULTS

Students who participated showed a statistically significant increase in breastfeeding knowledge and self-perceived comfort and confidence in assisting mothers with common breastfeeding problems. Additionally, residents increased their knowledge and confidence, but not their comfort with breastfeeding.

DISCUSSION

The videos seem to have been most helpful in assisting learners with confidence with helping breastfeeding mothers and knowledge of breastfeeding. The videos also improved student comfort but were less effective in increasing residents' comfort as residents generally self-rated their comfort level as high preceding the video curriculum. These videos provide an effective way to begin sensitizing learners to the importance of breastfeeding, common challenges, and potential solutions for new mothers.

Interventions for improving medical students' interpersonal communication in medical consultations

BACKGROUND

Communication is a common element in all medical consultations, affecting a range of outcomes for doctors and patients. The increasing demand for medical students to be trained to communicate effectively has seen the emergence of interpersonal communication skills as core graduate competencies in medical training around the world. Medical schools have adopted a range of approaches to develop and evaluate these competencies.

OBJECTIVES

To assess the effects of interventions for medical students that aim to improve interpersonal communication in medical consultations.

SEARCH METHODS

We searched five electronic databases: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and ERIC (Educational Resource Information Centre) in September 2020, with no language, date, or publication status restrictions. We also screened reference lists of relevant articles and contacted authors of included studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), cluster-RCTs (C-RCTs), and non-randomised controlled trials (quasi-RCTs) evaluating the effectiveness of interventions delivered to students in undergraduate or graduate-entry medical programmes. We included studies of interventions aiming to improve medical students' interpersonal communication during medical consultations. Included interventions targeted communication skills associated with empathy, relationship building, gathering information, and explanation and planning, as well as specific communication tasks such as listening, appropriate structure, and question style.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed all search results, extracted data, assessed the risk of bias of included studies, and rated the quality of evidence using GRADE.

MAIN RESULTS

We found 91 publications relating to 76 separate studies (involving 10,124 students): 55 RCTs, 9 quasi-RCTs, 7 C-RCTs, and 5 quasi-C-RCTs. We performed meta-analysis according to comparison and outcome. Among both effectiveness and comparative effectiveness analyses, we separated outcomes reporting on overall communication skills, empathy, rapport or relationship building, patient perceptions/satisfaction, information gathering, and explanation and planning. Overall communication skills and empathy were further divided as examiner- or simulated patient-assessed. The overall quality of evidence ranged from moderate to very low, and there was high, unexplained heterogeneity. Overall, interventions had positive effects on most outcomes, but generally small effect sizes and evidence quality limit the conclusions that can be drawn. Communication skills interventions in comparison to usual curricula or control may improve both overall communication skills (standardised mean difference (SMD) 0.92, 95% confidence interval (CI) 0.53 to 1.31; 18 studies, 1356 participants; I² = 90%; low-quality evidence) and empathy (SMD 0.64, 95% CI 0.23 to 1.05; 6 studies, 831 participants; I² = 86%; low-quality evidence) when assessed by experts, but not by simulated patients. Students' skills in information gathering probably also improve with educational intervention (SMD 1.07, 95% CI 0.61 to 1.54; 5 studies, 405 participants; I² = 78%; moderate-quality evidence), but there may be little to no effect on students' rapport (SMD 0.18, 95% CI -0.15 to 0.51; 9 studies, 834 participants; I² = 81%; low-quality evidence), and effects on information giving skills are uncertain (very low-quality evidence). We are uncertain whether experiential interventions improve overall communication skills in comparison to didactic approaches (SMD 0.08, 95% CI -0.02 to 0.19; 4 studies, 1578 participants; I² = 4%; very low-quality evidence). Electronic learning approaches may have little to no effect on students' empathy scores (SMD -0.13, 95% CI -0.68 to 0.43; 3 studies, 421 participants; I² = 82%; low-quality evidence) or on rapport (SMD 0.02, 95% CI -0.33 to 0.38; 3 studies, 176 participants; I² = 19%; moderate-quality evidence) compared to face-to-face approaches. There may be small negative effects of electronic interventions on information giving skills (low-quality evidence), and effects on information gathering skills are uncertain (very low-quality evidence).  Personalised/specific feedback probably improves overall communication skills to a small degree in comparison to generic or no feedback (SMD 0.58, 95% CI 0.29 to 0.87; 6 studies, 502 participants; I² = 56%; moderate-quality evidence). There may be small positive effects of personalised feedback on empathy and information gathering skills (low quality), but effects on rapport are uncertain (very low quality), and we found no evidence on information giving skills. We are uncertain whether role-play with simulated patients outperforms peer role-play in improving students' overall communication skills (SMD 0.17, 95% CI -0.33 to 0.67; 4 studies, 637 participants; I² = 87%; very low-quality evidence). There may be little to no difference between effects of simulated patient and peer role-play on students' empathy (low-quality evidence) with no evidence on other outcomes for this comparison. Descriptive syntheses of results that could not be included in meta-analyses across outcomes and comparisons were mixed, as were effects of different interventions and comparisons on specific communication skills assessed by the included trials. Quality of evidence was downgraded due to methodological limitations across several risk of bias domains, high unexplained heterogeneity, and imprecision of results. In general, results remain consistent in sensitivity analysis based on risk of bias and adjustment for clustering. No adverse effects were reported.  AUTHORS' CONCLUSIONS: This review represents a substantial body of evidence from which to draw, but further research is needed to strengthen the quality of the evidence base, to consider the long-term effects of interventions on students' behaviour as they progress through training and into practice, and to assess effects of interventions on patient outcomes. Efforts to standardise assessment and evaluation of interpersonal skills will strengthen future research efforts.

Simulated patient and role play methodologies for communication skills and empathy training of undergraduate medical students

BACKGROUND

Verbal and non-verbal communication, as well as empathy are central to patient-doctor interactions and have been associated with patients' satisfaction. Non-verbal communication tends to override verbal messages. The aim of this study was to analyze how medical students use verbal and non-verbal communication using two different educational approaches, student role play (SRP) and actor simulated patient (ASP), and whether the non-verbal behaviour is different in the two different poses.

METHODS

Three raters evaluated 20 students playing the doctor role, 10 in the SRP group and 10 in the ASP group. The videos were analyzed with the Calgary-Cambridge Referenced Observation Guide (CCG) and, for a more accurate evaluation of non-verbal communication, we also evaluated signs of nervousness, and posture. Empathy was rated with the CARE questionnaire. Independent Mann Whitney U tests and Qhi square tests were performed for statistical analysis.

RESULTS

From the 6 main tasks of the CCG score, we obtained higher scores in the ASP group for the task 'Gathering information' (p = 0.0008). Concerning the 17 descriptors of the CCG, the ASP group obtained significantly better scores for 'Exploration of the patients' problems to discover the biomedical perspective' (p = 0.007), 'Exploration of the patients' problems to discover background information and context' (p = 0.0004) and for 'Closing the session - Forward planning' (p = 0.02). With respect to non-verbal behaviour items, nervousness was significantly higher in the ASP group compared to the SRP group (p < 0.0001). Concerning empathy, no differences were found between the SRP and ASP groups.

CONCLUSIONS

Medical students displayed differentiated verbal and non-verbal communication behaviour during the two communication skills training methodologies. These results show that both methodologies have certain advantages and that more explicit non-verbal communication training might be necessary in order to raise students' awareness for this type of communication and increase doctor-patient interaction effectiveness.

'It clarified a lot': GP trainees as peer role players in a formative Clinical Skills Assessment (CSA)

INTRODUCTION

The MRCGP Clinical Skills Assessment (CSA) is a high stakes examination which a significant proportion of candidates fail on first sitting. To address this, deaneries have introduced candidate preparation, such as formative CSAs (f-CSA). One way to maximise the gains from a f-CSA is to use GP trainees as peer-role players (VRPs) instead of professional actors. Our aim was to explore trainee experiences of, and educational gains from, the VRP role.

METHOD

This qualitative study used semi-structured interviews to explore 15 VRPs' perceptions of peer roleplay. Questions were generated from the literature and from informal discussions with f-CSA organisers. Analysis was inductive and thematic.

RESULTS

Analysis identified three main themes. Role play gave participants insight into the exam in terms of what to expect and how to approach the exam. They commented on learning the importance of communication skills and acknowledging the patient's perspective. Finally, there were gains in terms of professional development, particularly in terms of observing good feedback.

DISCUSSION

GP trainees who role played patients in a formative CSA reported increased confidence and educational gains from their experience. Whether these perceived gains will be transferred to their own CSA performance later in training remains to be seen.

Relationship Between "Simulated Patient Scenarios and Role-Playing" Method and OSCE Performance in Senior Anesthesiology Residents: A Correlation Assessment Study

BACKGROUND

"Simulated-patient scenarios and role-playing" and OSCE are among the many non-traditional education methods with variable results in different clinical settings.

OBJECTIVES

This cross-sectional study was performed to assess the correlation between the results of these two methods in senior anesthesiology residents, with a special focus on four of the six ACGME core competencies.

METHODS

During two years, senior anesthesiology residents were subject to "simulated patient scenario and role-playing" sessions. Two faculty members took the role of the patient and one of the relatives. An objective checklist with 15 items was prepared to be rated by other department faculty members. Meanwhile, an ordered pattern of OSCE was prepared to cover four core competencies that were more related to this academic process (from a total of six core competencies). The mean and standard deviation of the score of each of the 15 items in the checklist were calculated. The correlation between cumulative checklist scoring results and OSCE exam results was assessed. A P value of less than 0.05 was considered significant.

RESULTS

A total of 40 senior anesthesiology residents, with 344 assessments by faculty members in 40 sessions, were enrolled in the study. The questionnaire's Cronbach's alpha reliability was 0.74. No statistically significant disparity was detected between the results of the two assessment methods, while the results of the two assessments had a significant correlation (two-tailed correlation coefficient = 0.886; P value < 0.001).

CONCLUSIONS

There was an objective relationship between the results of "simulated patient scenario and role-playing" strategies and the results of OSCE exams using an observer-based rating method. Thus, they could be used as surrogates in the assessment of core clinical competencies of senior anesthesiology residents.

Formative assessment of practical skills with peer-assessors: quality features of an OSCE in general medicine at the Heidelberg Medical Faculty

Background: Objective Structured Clinical Examinations (OSCEs) have become an established examination format at German medical faculties. Medical experts routinely use a summative assessment to evaluate practical and communicative skills, while the use of the OSCE format by student examiners, as a formative examination, remains rather limited. Objective: The formative OSCE program of the Department of General Practice and Implementation Research at the Heidelberg Medical Faculty, which is conducted and evaluated by peer tutors, is examined with regard to its quality criteria and compared with summative OSCEs from other departments. Methods: Difficulties and discriminatory power of individual testing stations were determined for the summative, as well as the formative OSCE, and compared with each other. To assess the reliability of the measurements, an analysis of the data was carried out using the Generalizability theory. In addition, a comparison is made between the assessments of student examiners and second assessments by medical experts. Results: The stations of the formative OSCE show similar difficulties as those of the summative comparison OSCEs (Pform=0.882; Psum=0.845 - 0.902). With respect to measurement reliability, there are no differences between the OSCE in General Medicine and the other subjects. The assessments of student examiners and medical experts correlate highly (r=0.888). Conclusion: The formative OSCE in General Medicine is comparable to the summative comparison formats in terms of its quality criteria. The use of student examiners can be a reliable alternative to medical experts in formative OSCEs.

Students as patients: A systematic review of peer simulation in health care professional education

CONTEXT

Evidence supports the substitution of both clinical placement time and traditional educational activities with simulation-based education (SBE). However, lack of resources can be a barrier to SBE implementation. Peer simulation provides an alternative to simulated patient (SP)-based SBE by educating students to portray patient roles. This diversifies learning experiences for students using SBE and may decrease costs.

OBJECTIVES

This study aimed to determine the impact of students portraying the roles of patients in a simulation-based learning environment (peer simulation) on learning outcomes in entry-level health care professional students.

METHODS

Seven databases were searched (from inception to 8 May 2019) using terms including 'peer simulation,' 'role-play' and 'simulated/standardised patient.' The studies included described a health care professional student SBE interaction involving peer simulation. Data were extracted by two independent investigators. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI) and Critical Appraisal Skills Programme (CASP). A descriptive analysis was completed and meta-analysis conducted in instances in which outcomes could be pooled.

RESULTS

A total of 12 studies met the inclusion criteria. Constructs measured by the studies included communication, empathy, self-efficacy and confidence. Five randomised controlled trials compared peer simulation with the use of SPs and demonstrated greater or equivalent patient empathy gains in peer simulation. Meta-analysis determined no difference in communication capabilities between the two groups. Students perceived peer simulation as comparably valuable and frequently superior to other forms of learning. This review was unable to determine effective design features of peer simulation initiatives.

CONCLUSIONS

Students were positive about peer simulation, but there has been limited evaluation of learning outcome attainment. Significant heterogeneity was observed; studies were diverse in design, outcome measures and the training provided for peer patients. Peer simulation positively influences student communication and development of patient empathy and offers an alternative to learning with SPs. Further rigorous research is required to understand the impact of peer simulation for a broader range of learning outcomes and to confirm the impact of this developing educational approach.

Standardized Patients or Conventional Lecture for Teaching Communication Skills to Undergraduate Medical Students: A Randomized Controlled Study

OBJECTIVE

The conduct of a medical interview is a challenging skill, even for the most qualified physicians. Since a training is needed to acquire the necessary skills to conduct an interview with a patient, we compared role-play with standardized patients (SP) training and a conventional lecture for the acquisition of communications skills in undergraduate medical students.

METHODS

An entire promotion of third year undergraduate medical students, who never received any lessons about communications skills, were randomized into 4 arms: 1) SP 2 months before the testing of medical communications skills (SP); 2) conventional lecture 2 months before the testing (CL); 3) two control groups (CG) without any intervention, tested either at the beginning of the study or two months later. Students were blindly assessed by trained physicians with a modified 17-items Calgary-Cambridge scale.

RESULTS

388 students (98.7%) participated. SP performed better than CL, with significant statistical differences regarding 5 skills: the use of open and closed questions, encouraging patient responses, inviting the patient to clarify the missing items, encouraging of the patient's emotions, and managing the time and the conduct of the interview. The SP group specifically improved communications skills between the SP training and testing sessions regarding 2 skills: the use of open and closed questions and encouraging patient responses. No improvements in communications skills were observed in CG between the two time points, ruling out a possible time effect.

CONCLUSION

Role-play with standardized patients appears more efficient than conventional lecture to acquire communication skills in undergraduate medical students.

Peer Role-Play for Training Communication Skills in Medical Students: A Systematic Review

STATEMENT

Peer role-play (PRP) is a simulation-based training method (SBTM) in which medical students alternately play the patient's and clinician's role. This review aimed to assess the effectiveness of PRP for improving the communication skills of medical students. A systematic search was conducted in the MedLine, PsycInfo, and ERIC databases. Studies were qualitatively analyzed according to the Kirkpatrick evaluation level (Kirkpatrick level) and the Medical Education Research Study Quality Instrument.Twenty-two studies were included. Studies assessing the "reaction" of students (Kirkpatrick level 1, n = 15) found that PRP was appreciated, whereas those assessing the effect of PRP on "learning" (Kirkpatrick level 2, n = 12) found that PRP improves communication skills but no more than other SBTMs. No study assessed real-life "attitudes" or "clinical outcomes" (Kirkpatrick levels 3 and 4), whereas 2 studies found that using PRP had a better cost-efficacy ratio than the use of simulated patients. Compared with other SBTMs, PRP improved communication skills similarly in medical students and seemed less expensive.

Standardized Patients Versus Peer Role Play-Exploring the Experience, Efficacy, and Cost-Effectiveness in Residency Training Module for Breaking Bad News

BACKGROUND

Delivering bad news is a difficult task for the clinician and one that is important to address and nurture in residency training.

METHODS

Residents were assigned to receive communication training with either standardized patients (SP) or peer role play (RP). Anonymized pre- and post-questionnaires were filled by residents detailing their experience. Independent assessors blinded to the study hypothesis rated the residents' performance using a standardized plus-delta assessment form as a measure of effectiveness of either methods. In our study additionally, corresponding costs were assessed as man-hours resulting from the hours of work of SP, RP, and tutors in order to generate the incremental cost-effectiveness ratio for the use of SP against the use of RP.

SETTING

The study took place in a tertiary academic hospital, National University Hospital, Singapore.

PARTICIPANTS

A total of 15 junior residents in anesthetic training entered and completed the study and were evaluated during the 2017-2018 academic year.

RESULTS

The mean performance scores were 63.3% (RP group) and 74.3% (SP group) attributing advantage to the SP group. Costs however were slighter greater in the SP group (14 man-hours) versus (10 man-hours) in the RP group. The resulting incremental cost-effectiveness ratio was 0.36 man-hours per 1-point increase in the performance score when comparing SP to peer RP.

CONCLUSIONS

SPs proved to be the more cost-effective modality when employing communication training for delivering bad news. The successful experience and use of SPs should be balanced against the marginally lesser costs involved in peer RP in planning residency teaching sessions.

Best Practices in North American Pre-Clinical Medical Education in Sexual History Taking: Consensus From the Summits in Medical Education in Sexual Health

INTRODUCTION

This article discusses a blueprint for a sexual health communication curriculum to facilitate undergraduate medical student acquisition of sexual history taking skills and includes recommendations for important elements of a thorough sexual history script for undergraduate medical students.

AIM

To outline the fundamentals, objectives, content, timing, and teaching methods of a gold standard curriculum in sexual health communication.

METHODS

Consensus expert opinion was documented at the 2012, 2014, and 2016 Summits in Medical Education in Sexual Health. Additionally, the existing literature was reviewed regarding undergraduate medical education in sexual health.

MAIN OUTCOME MEASURES

This article reports expert opinion and a review of the literature on the development of a sexual history taking curriculum.

RESULTS

First-year curricula should be focused on acquiring satisfactory basic sexual history taking skills, including both assessment of sexual risk via the 5 Ps (partners, practices, protection from sexually transmitted infections, past history of sexually transmitted infections, and prevention of pregnancy) as well as assessment of sexual wellness-described here as a sixth P (plus), which encompasses the assessment of trauma, violence, sexual satisfaction, sexual health concerns/problems, and support for gender identity and sexual orientation. Second-year curricula should be focused on incorporating improved clinical reasoning, emphasizing sexual history taking for diverse populations and practices, and including the impact of illness on sexual health. Teaching methods must include varied formats. Evaluation may be best as a formative objective structured clinical examination in the first year and summative in the second year. Barriers for curriculum development may be reduced by identifying faculty champions of sexual health/medicine.

CLINICAL IMPLICATIONS

Medical students will improve their skills in sexual history taking, which will ultimately impact patient satisfaction and clinical outcomes. Future research is needed to validate this proposed curriculum and assess the impact on clinical skills.

STRENGTHS & LIMITATIONS

This article assimilates expert consensus and existing clinical guidelines to provide a novel structured approach to curriculum development in sexual health interviewing in the pre-clinical years.

CONCLUSION

The blueprint for developing sexual history taking skills includes a spiral curriculum with varied teaching formats, incorporation of a sexual history script that incorporates inquiry about sexual wellness, and longitudinal assessment across the pre-clinical years. Ideally, sexual health communication content should be incorporated into existing clinical interviewing and physical examination courses. Rubin ES, Rullo J, Tsai P, et al. Best Practices in North American Pre-Clinical Medical Education in Sexual History Taking: Consensus From the Summits in Medical Education in Sexual Health. J Sex Med 2018;15:1414-1425.

A Virtual Counseling Application Using Artificial Intelligence for Communication Skills Training in Nursing Education: Development Study

BACKGROUND

The ability of nursing undergraduates to communicate effectively with health care providers, patients, and their family members is crucial to their nursing professions as these can affect patient outcomes. However, the traditional use of didactic lectures for communication skills training is ineffective, and the use of standardized patients is not time- or cost-effective. Given the abilities of virtual patients (VPs) to simulate interactive and authentic clinical scenarios in secured environments with unlimited training attempts, a virtual counseling application is an ideal platform for nursing students to hone their communication skills before their clinical postings.

OBJECTIVE

The aim of this study was to develop and test the use of VPs to better prepare nursing undergraduates for communicating with real-life patients, their family members, and other health care professionals during their clinical postings.

METHODS

The stages of the creation of VPs included preparation, design, and development, followed by a testing phase before the official implementation. An initial voice chatbot was trained using a natural language processing engine, Google Cloud's Dialogflow, and was later visualized into a three-dimensional (3D) avatar form using Unity 3D.

RESULTS

The VPs included four case scenarios that were congruent with the nursing undergraduates' semesters' learning objectives: (1) assessing the pain experienced by a pregnant woman, (2) taking the history of a depressed patient, (3) escalating a bleeding episode of a postoperative patient to a physician, and (4) showing empathy to a stressed-out fellow final-year nursing student. Challenges arose in terms of content development, technological limitations, and expectations management, which can be resolved by contingency planning, open communication, constant program updates, refinement, and training.

CONCLUSIONS

The creation of VPs to assist in nursing students' communication skills training may provide authentic learning environments that enhance students' perceived self-efficacy and confidence in effective communication skills. However, given the infancy stage of this project, further refinement and constant enhancements are needed to train the VPs to simulate real-life conversations before the official implementation.

Experiences of nursing students and examiners with the Objective Structured Clinical Examination method in physical assessment education: A mixed methods study

This study explores the experiences of undergraduate nursing students and examiners with the Objective Structured Clinical Examination (OSCE) as an evaluation of physical assessment skills. A mixed methods approach captures participants' perceptions and experiences with the OSCE. The sample consisted of 55 students enrolled in the physical assessment course and eight external examiners. Data were collected using a standardized questionnaire and focus group interviews, using semi-structured questions, recorded and transcribed for thematic analysis. Quantitative data were analyzed using SPSS software. Results indicated that participants regarded the OSCE as a valuable assessment tool that enhances in-depth learning and preparation of students for clinical practice. Participants also perceived the exam to be a stressful experience, citing the need for more time on examination stations. Recommendations for improving the OSCE process included extending preparation prior to the exam, training of simulated patients, adopting a blended learning model, and upgrading the setting of the exam. This paper supports evidence of the value of the OSCE as an appraisal of physical assessment skills in undergraduate nursing education.

Comparison of effect between simulated patient clinical skill training and student role play on objective structured clinical examination performance outcomes for medical students in Australia

PURPOSE

Optimal methods for communication skills training (CST) is an active area for research but the effect on communication performance in objective structured clinical examinations (OSCE) has not been so closely studied. Student role play (RP) for CST is common whilst volunteer simulated patient (SP) CST is cost-effective and provides authentic interactions. We assessed whether our volunteer SP CST improved OSCE performance compared to our previous RP strategy.

METHODS

We performed a retrospective, quasi-experimental study of two second year medical student cohorts' OSCE data in Australia. The 2014 cohort received RP-only CST (N=182) while the 2016 cohort received SP-only CST (N=148). T-test and ANOVA were used to compare the total scores for three assessment domains: generic communication, clinical communication and physical examination/procedural skills.

RESULTS

Baseline characteristics for groups (scores for Australian Tertiary Admission Rank (ATAR), Undergraduate Medicine and Health Sciences Admission Test (UMAT) and medicine program interview) showed no significantt difference between groups. For each domain, the SP-only CST group demonstrated superior outcomes in the OSCE and the difference between cohorts was significant (P < 0.01). Volunteer SP CST was superior to student RP CST when considering OSCE performance outcome., which was found across generic and clinical communication skills, and physical examination/procedural skills.

CONCLUSION

Better performance of the SP cohort in physical examination/procedural skills might be explained by the requirement for patient compliance and cooperation, facilitated by good generic communication skills. We recommend a volunteer SP Program as an effective and efficient way to improve CST for junior medical students.

Pediatric communication training: A project report on an innovative approach and its effects on student acceptance

AIM AND BACKGROUND

To elucidate the effects on the results of student evaluation after the revision of pediatric communication training. Students repeatedly rated communication training as moderate, and indicated an insufficient level of preparedness with regard to the medical background of the cases used. Also, tutoring was often perceived as unbalanced between medical and communicative issues associated with the tutor's profession-who was either a resident or a psychologist. In addition, peer role-play was frequently criticized for being used in a case featuring cultural and language barriers.

METHODS

Communication training was extensively remodeled. A blended learning concept was introduced with virtual patients in preparation for case-specific medical content, peer role-play was combined with standardized parents, and team teaching by residents and psychologists was introduced to strike a balance in discussions between medical and communicative matters. During the following term, the faculty's standardized evaluation was used to elicit overall rating and particular curricular changes of the communication training; overall ratings were compared to earlier evaluation results. In addition, teaching analysis polls (TAP) were conducted to obtain direct feedback from students about their perceptions of the remodeled training.

RESULTS

The overall rating of the communication training did not improve after course revision. Items on specific changes implemented in the training received only moderate ratings. In contrast, direct feedback through TAP revealed significant learning effects perceived through the blended approach, peer role-play and standardized parents, and team teaching. However, students made requests to shorten the training duration and expressed controversial opinions on the use of peer role-play and standardized parents.

CONCLUSIONS

Despite large efforts to improve teaching, evaluation results do not necessarily meet educators' expectations. If evaluations are more likely to measure acceptance alone among students, improvements in teaching might not be fully communicated to medical educators.

The implementation and evaluation of a communication skills training program for oncology nurses

Many nurses express difficulty in communicating with their patients, especially in oncology settings where there are numerous challenges and high-stake decisions during the course of diagnosis and treatment. Providing specific training in communication skills is one way to enhance the communication between nurses and their patients. We developed and implemented a communication skills training program for nurses, consisting of three teaching modules: responding empathically to patients; discussing death, dying, and end-of-life goals of care; and responding to challenging interactions with families. Training included didactic and experiential small group role plays. This paper presents results on program evaluation, self-efficacy, and behavioral demonstration of learned communication skills. Three hundred forty-two inpatient oncology nurses participated in a 1-day communication skills training program and completed course evaluations, self-reports, and pre- and post-standardized patient assessments. Participants rated the training favorably, and they reported significant gains in self-efficacy in their ability to communicate with patients in various contexts. Participants also demonstrated significant improvement in several empathic skills, as well as in clarifying skill. Our work demonstrates that implementation of a nurse communication skills training program at a major cancer center is feasible and acceptable and has a significant impact on participants' self-efficacy and uptake of communication skills.

Cost-Effectiveness of Using Standardized Patients to Assess Student-Pharmacist Communication Skills

Objective. To explore the cost-effectiveness of including standardized patients (SP) in the didactic curriculum for application and assessment of students' pharmacist-patient communication skills. Methods. Five role play/case study (RP/CS) activities from a communication skills curriculum were replaced with five SP encounters. Communication was assessed using a rubric. This study developed an economic model to examine the costs and effectiveness of replacing RP/CS events with SP events in knowledge-application and communication assessment. Costs consisted of SP hourly wages for training and delivery of SP events. Outcomes examined were the incremental cost-effectiveness ratio (ICER) per student. Results. The ICER comparing SP to RP/CS was $100.93 higher per student on first-attempt pass rates and $9.04 per one-point increase in the mean score. Conclusion. SP was more effective and more costly than RP/CS. Further research into students' willingness to pay needs to occur before determining if using SPs is cost-effective in teaching communication skills.

Improving Pharmacy Student Communication Outcomes Using Standardized Patients

Objective. To examine whether standardized patient encounters led to an improvement in a student pharmacist-patient communication assessment compared to traditional active-learning activities within a classroom setting. Methods. A quasi-experimental study was conducted with second-year pharmacy students in a drug information and communication skills course. Student patient communication skills were assessed using high-stakes communication assessment. Results. Two hundred and twenty students' data were included. Students were significantly more likely to have higher scores on the communication assessment when they had higher undergraduate GPAs, were female, and taught using standardized patients. Similarly, students were significantly more likely to pass the assessment on the first attempt when they were female and when they were taught using standardized patients. Conclusion. Incorporating standardized patients within a communication course resulted in improved scores as well as first-time pass rates on a communication assessment than when using different methods of active learning.