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Falvo L, Bona A, Heniff M, Cooper D, Moore M, Doos D, Sarmiento E, Hobgood C, Ahmed R. How to HEEAL: A Patient and Peer-Centric Simulation Curriculum for Medical Error Disclosure. MedEdPORTAL 2024; 20:11394. [PMID: 38567116 PMCID: PMC10985053 DOI: 10.15766/mep_2374-8265.11394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 01/05/2024] [Indexed: 04/04/2024]
Abstract
Introduction Medical errors are an unfortunate certainty with emotional and psychological consequences for patients and health care providers. No standardized medical curriculum on how to disclose medical errors to patients or peers exists. The novel HEEAL (honesty/empathy/education/apology-awareness/lessen chance for future errors) curriculum addresses this gap in medical education through a multimodality workshop. Methods This 6-hour, two-part curriculum incorporated didactic and standardized patient (SP) simulation education with rapid cycle deliberate practice (RCDP). The morning focused on provider-patient error disclosure; the afternoon applied the same principles to provider-provider (peer) discussion. Summative simulations with SPs evaluated learners' skill baseline and improvement. Formative simulations run by expert simulation educators used RCDP to provide real-time feedback and opportunities for adjustment. Medical knowledge was measured through pre- and postintervention multiple-choice questions. Learners' confidence and attitude towards medical errors disclosure were surveyed pre- and postintervention with assistance of the Barriers to Error Disclosure Assessment tool, revised with the addition of several questions related to provider-provider disclosure. Results Fourteen medical students participated in this pilot curriculum. Statistical significance was demonstrated in medical knowledge (p = .01), peer-disclosure skills (p = .001), and confidence in medical error disclosure (p < .001). Although there was improvement in patient-disclosure skills, this did not reach statistical significance (p = .05). Discussion This curriculum addresses the need for designated training in medical error disclosure. Learners gained knowledge, skills, and confidence in medical error disclosure. We recommend this curriculum for medical students preparing for transition to residency.
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Affiliation(s)
- Lauren Falvo
- Assistant Professor, Department of Emergency Medicine, Indiana University School of Medicine
| | - Anna Bona
- Assistant Professor, Department of Emergency Medicine, Indiana University School of Medicine
| | - Melanie Heniff
- Associate Professor, Department of Emergency Medicine, Indiana University School of Medicine
| | - Dylan Cooper
- Professor, Department of Emergency Medicine, Indiana University School of Medicine
| | - Malia Moore
- Assistant Professor, Department of Emergency Medicine, Indiana University School of Medicine
| | | | - Elisa Sarmiento
- Biostatistician II, Department of Emergency Medicine, Indiana University School of Medicine
| | - Cherri Hobgood
- Professor, Department of Emergency Medicine, Penn State College of Medicine; Adjunct Professor, Department of Emergency Medicine, University of North Carolina at Chapel Hill School of Medicine; Founder, Center for Leadership Life
| | - Rami Ahmed
- Professor, Department of Emergency Medicine, Indiana University School of Medicine
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Dougherty R, Fornari A, Farina G, Olvet DM. Medical Error Disclosure: An Entrustable Professional Activity During an Objective Standardized Clinical Examination for Clerkship Students. MedEdPORTAL 2024; 20:11382. [PMID: 38380273 PMCID: PMC10876916 DOI: 10.15766/mep_2374-8265.11382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/14/2023] [Indexed: 02/22/2024]
Abstract
Introduction Most health care providers will be involved in a medical error during their careers. It is critical that future physicians receive formal training on error disclosure. Methods We designed a formative skills-based objective standardized clinical exam (OSCE) for fourth-year medical students to assess competence in disclosing an error during a required entrustable professional activity. Faculty observed the encounter and completed a checklist evaluating students' performance in communication skills and content knowledge. Students received immediate formative feedback. They then participated in a facilitated case-based experience, discussed the critical elements of disclosure, utilized role-play to reinforce skills, and reflected on self-care practices. Finally, students completed a survey evaluating their perception of the OSCE's impact on their disclosure knowledge, skills, and attitudes. Results Ninety-two students participated in the OSCE. Of those, 67 (73%) completed a retrospective pre/post survey assessing their disclosure knowledge, skills, and attitudes. Forty-one (62%) did not identify the error. Students who identified the error (26, 39%) were more likely to use the two-patient identifier than students who did not identify the error, χ2(1) = 13.3, p < .001. Self-reported comfort and confidence in disclosure improved, as did self-care practices (ps ≤ .005). Discussion Students agreed that health care providers should disclose an error and know how to do so. Student self-reported comfort in disclosure and knowledge of how to disclose and how to report an error all improved following the OSCE and structured debrief. The OSCE and case-based experience can be adapted for implementation in curricula about error disclosure.
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Affiliation(s)
- Rebecca Dougherty
- Associate Professor, Department of Medicine and Science Education, Zucker School of Medicine at Hofstra/Northwell
| | - Alice Fornari
- Professor, Department of Family Medicine and Science Education, Zucker School of Medicine at Hofstra/Northwell
| | - Gino Farina
- Professor, Department of Emergency Medicine and Science Education, Zucker School of Medicine at Hofstra/Northwell
| | - Doreen M. Olvet
- Associate Professor, Department of Science Education, Zucker School of Medicine at Hofstra/Northwell
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Tang I, Rupley D. An Interactive Curriculum to Teach Person-Centered Contraceptive Counseling. MedEdPORTAL 2023; 19:11368. [PMID: 38116180 PMCID: PMC10728363 DOI: 10.15766/mep_2374-8265.11368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/22/2023] [Indexed: 12/21/2023]
Abstract
Introduction Following the Dobbs v. Jackson Women's Health Organization Supreme Court decision, it is increasingly important for all providers to be equipped to counsel on contraceptive options. Current curricula are insufficient for medical students to attain competency in contraceptive counseling. Quality contraceptive counseling requires patient-centered communication skills, which are also critical in many other clinical scenarios. Systematic teaching of patient-centered communication is lacking, both in contraceptive counseling and more broadly. Methods We developed a person-centered contraceptive counseling curriculum containing a reference guide, 5- to 10-minute interactive online module, and 30-minute formative standardized patient session for clerkship-year medical students. Performance during formative sessions was evaluated using a checklist, with standardized patients and preceptors providing real-time feedback. We used surveys of knowledge, self-perceived skills, and attitudes about patient-centered counseling to compare students who did and did not receive the curriculum. Results Twenty-seven students received the new curriculum. The reference guide and online module were easily integrated into a clinical rotation without requiring additional time spent by educators. The formative session required more resources to implement but was valuable for students to solidify the communication skills in the new curriculum. Checklist results showed that students demonstrated many of the counseling skills taught in the module. Survey results about the impact of the new curriculum were promising but limited by the small sample size. Discussion The curriculum successfully introduced patient-centered contraceptive counseling skills and provided a valuable practice opportunity. Other sites could adapt components of this curriculum to enhance education in person-centered contraceptive counseling.
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Affiliation(s)
- Irene Tang
- First-Year Resident, Department of Obstetrics and Gynecology, University of Washington School of Medicine
| | - Devon Rupley
- Assistant Professor, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
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Spigner ST, Rivera NV, Ufomata E, Mark EG, Grieve V, Faeder M, Fulmer VL, Van Deusen R, Gowl C, Hofkosh D, Eckstrand KL. Assessing Patient Goals for Gender-Affirming Hormone Therapy: A Standardized Patient Case for Medical Students. MedEdPORTAL 2023; 19:11356. [PMID: 38028957 PMCID: PMC10654112 DOI: 10.15766/mep_2374-8265.11356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 07/31/2023] [Indexed: 12/01/2023]
Abstract
Introduction Inadequate coverage of transgender and gender-diverse (TGD) health in the UME curriculum contributes to the scarcity of competent physicians to care for TGD patients. Increasing TGD health skills-based curricula in UME can help address TGD health disparities. We developed a standardized patient (SP) case to assess TGD health skills-based competencies and attitudes among medical students. Methods An interdisciplinary team, including individuals with lived TGD experience, developed the SP case that was completed by second-year medical students at the University of Pittsburgh School of Medicine in January 2020. After the TGD SP session, students and faculty completed a postsession survey to assess the degree to which the case met the learning objectives. Students were assessed via self-reports, faculty reports, and SP video evaluations. Results Seventy second-year medical students, 30 faculty facilitators, and eight SPs participated in 2020. Students reported being significantly more prepared to care for TGD patients (Z = -5.68, p < .001) and to obtain a gender history (Z = -5.82, p < .001). Both faculty and students felt that skills for caring for TGD patients were important in medical education and agreed the case should remain in the curriculum. Discussion The case effectively honed and assessed students' ability to collect a gender history and discuss goals for hormone therapy with TGD patients. It should complement ongoing curricula to effectively train medical students in TGD health care. Developing these skills in students directly addresses the barriers that many TGD patients experience in health care settings.
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Affiliation(s)
- Sabina T. Spigner
- Fourth-Year Medical Student, University of Pittsburgh School of Medicine
- Co-primary author
| | - Nicole V. Rivera
- Clinical Instructor, Department of Psychiatry, Warren Alpert Medical School at Brown University
- Co-primary author
| | - Eloho Ufomata
- Associate Professor, Department of Medicine, University of Pittsburgh School of Medicine
| | - Elyse G. Mark
- Third-Year Medical Student, University of Pittsburgh School of Medicine
| | - Victoria Grieve
- Assistant Professor, Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy
| | - Morgan Faeder
- Assistant Professor of Psychiatry and Neurology, Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Valerie L. Fulmer
- Director, Standardized Patient Program, University of Pittsburgh School of Medicine
| | - Reed Van Deusen
- Associate Professor, Department of Medicine, University of Pittsburgh School of Medicine
| | - Catherine Gowl
- Standardized Patient Program Specialist, University of Pittsburgh School of Medicine
| | - Dena Hofkosh
- Emeritus Professor of Pediatrics, University of Pittsburgh School of Medicine
| | - Kristen L. Eckstrand
- Assistant Professor, Department of Psychiatry, University of Pittsburgh School of Medicine
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Guizado de Nathan G, Shaw LK, Doolen J. Social Determinants of Health: A Multilingual Standardized Patient Case to Practice Interpreter Use in a Telehealth Visit. MedEdPORTAL 2023; 19:11364. [PMID: 38028958 PMCID: PMC10643468 DOI: 10.15766/mep_2374-8265.11364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 09/14/2023] [Indexed: 12/01/2023]
Abstract
Introduction The growing diversity of the United States population and strong evidence of disparities in health care make it critically important to educate health care professionals to effectively address issues of culture. To that end, we developed a simulation for teaching interpreter use in a telehealth setting. Our contribution of non-English language preference (NELP) patient cases in Spanish, Tagalog, French, and Igbo advances existing literature by combining the skills of interpreter use and telehealth while widening the array of cultures represented. Methods Simulations were implemented for two cohorts of 60 first-year medical students. In the pilot, nine groups of six to seven students and one faculty met via Zoom with an NELP patient complaining of fatigue, weakness, and cough. When students determined the need for an interpreter, faculty admitted one to the meeting, and the telehealth visit continued. Postsession activities included debriefing and writing a progress note. Results Course evaluation comments from the first cohort and a postencounter survey of the second cohort were positive. They revealed that students learned to speak slower, in shorter phrases, and directly to the patient. Learners completed note documentation according to a rubric. Discussion This low-stakes activity provides faculty with a resource for introducing cultural competence into the curriculum. The original Spanish version of the case has been translated into three additional languages, providing a diverse representation of the NELP population. Important points for communicating through an interpreter are practiced in a telehealth setting with a fatigue case.
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Affiliation(s)
- Gigi Guizado de Nathan
- Former Standardized Patient Coordinator, Clinical Simulation Center of Las Vegas, University of Nevada, Las Vegas
| | - Laura K. Shaw
- Associate Professor, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas
| | - Jessica Doolen
- Associate Professor in Residence, School of Nursing, University of Nevada, Las Vegas
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Hsiung K, Skaug L, Daunis D. Communicating a Plan for Involuntary Psychiatric Admission: A Standardized Patient Workshop Intervention for General Psychiatry Residents. MedEdPORTAL 2023; 19:11355. [PMID: 37854310 PMCID: PMC10579457 DOI: 10.15766/mep_2374-8265.11355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 07/26/2023] [Indexed: 10/20/2023]
Abstract
Introduction One important and often difficult act of communication common in psychiatry is communication regarding the need for involuntarily commitment for psychiatric treatment. Thus, we designed an educational workshop for psychiatry residents on how to communicate the plan for involuntarily commitment to a psychiatric hospital. Methods Using faculty expertise, we created a protocol to guide trainees on how to structure conversations around involuntary commitment. Residents first attended a didactic on the protocol, followed by a 1-hour workshop with standardized patients (SPs) 1 week later. The workshop consisted of three 14-minute simulated scenarios with the SP with debriefing. Trainees filled out pre- and postworkshop surveys. Results Fifteen and 12 residents completed the pre- and postworkshop surveys, respectively. Residents' perceived comfort level in their ability to deliver involuntary commitment news significantly improved after the workshop when compared to before (3.0 vs. 3.7 for pre- and postworkshop surveys, respectively). Residents trended toward intending to make more changes to their approach after the workshop when compared to before (2.2 vs. 2.6, respectively). Feedback on the didactic and workshop were largely positive. Discussion To our knowledge, our intervention is the first designed specifically to teach psychiatry residents how to communicate to patients that they are being involuntarily committed to emergent psychiatric treatment. This educational model has potential for improving resident skills and confidence in having difficult conversations around involuntary commitment.
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Affiliation(s)
- Kimberly Hsiung
- Third-Year Resident, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center
| | - Laura Skaug
- Senior Standardized Patient Educator, Center for Experiential Learning and Assessment, Vanderbilt University Medical Center
| | - Daniel Daunis
- Assistant Professor, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center
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Sizemore J, Bailey A, Sankineni S, Clark K, Manivannan S, Kolar M, Warden M, Sofka S. Training to Transition: Using Simulation-Based Training to Improve Resident Physician Confidence in Hospital Discharges. MedEdPORTAL 2023; 19:11348. [PMID: 37720418 PMCID: PMC10502193 DOI: 10.15766/mep_2374-8265.11348] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 06/13/2023] [Indexed: 09/19/2023]
Abstract
Introduction Hospital discharge is a highly critical and complex process that is prone to medical errors, poor communication, and ineffective synchronization of transitional teams. Improving safety during postacute care transitions has become a national focus. Simulation-based training is an underutilized method of instruction for medical resident transitions of care education. Methods As an integral part of a transitions curriculum, 36 PGY 1 residents from internal medicine and transitional year residency programs underwent a discharge simulation utilizing a trained simulated participant (SP) and a lay caregiver. The objective of the training was to implement a simulation-based education intervention to improve transition practices and discharge communication in graduate medical education. A faculty observer used a case-specific discharge rubric to standardize feedback to the resident and observed the resident navigate the electronic medical record (EMR) for discharge orders. Pretest and posttest surveys assessing resident attitudes and confidence regarding specific areas of the discharge process were distributed to all participating residents for completion. Results Thirty-six internal medicine and transitional year residents (100%) completed an observed discharge simulation with an SP and a separate encounter with the EMR discharge navigator. All 36 residents (100%) completed the pretest survey, and 23 (63%) completed the postsurvey evaluation. Postsurvey results showed residents agreed (92%, p < .05) that the simulation increased their confidence in safely discharging a patient. Discussion Simulation encounters are an effective adjunct to postacute care transition education.
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Affiliation(s)
- Jenna Sizemore
- Assistant Professor and Associate Program Director, Internal Medicine Residency Program, Department of Medicine, West Virginia University School of Medicine
| | - Andrea Bailey
- Clinical Assistant Professor and Director of Simulation, West Virginia University School of Nursing
| | - Spoorthi Sankineni
- Consulting Associate, Duke Primary Care and Department of Medicine, Duke University School of Medicine
| | - Karen Clark
- Professor, Department of Medicine, West Virginia University School of Medicine
| | - Shanthi Manivannan
- Associate Professor and Section Chief, Department of Medicine, West Virginia University School of Medicine
| | - Maria Kolar
- Professor, Department of Medicine, and Associate Program Director, Transitional Year Residency Program, West Virginia University School of Medicine
| | - Mary Warden
- Associate Professor, Department of Medicine and Department of Medical Education, and Program Director, Transitional Year Residency Program, West Virginia University School of Medicine
| | - Sarah Sofka
- Professor, Department of Medicine, and Program Director, Internal Medicine Residency Program, West Virginia University School of Medicine
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Wilson LA, Harder B, Kelley C, Powell R, Foster M, Roberts E. Geriatric Telehealth: A Standardized Patient Case for Medical Students. MedEdPORTAL 2023; 19:11345. [PMID: 37706040 PMCID: PMC10495538 DOI: 10.15766/mep_2374-8265.11345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 06/12/2023] [Indexed: 09/15/2023]
Abstract
Introduction The COVID-19 pandemic has necessitated the rapid expansion of telemedicine. However, there has been minimal coverage of telemedicine in traditional undergraduate medicine curricula. Telemedicine presents specific challenges in the geriatric population, including unfamiliarity with technology, cognitive and sensory barriers, inclusion of family and/or caregivers, multimorbidity, and a high degree of medical complexity. Methods We developed a workshop to allow rising third-year medical students to practice a telemedicine patient encounter while developing skills for assessing and communicating with geriatric patients. This 90-minute workshop consisted of an introductory didactic presentation and a standardized patient activity for small groups of two to five students. Students' level of comfort with telemedicine for assessment of geriatric patients was evaluated with a pre- and postsurvey. Results Fifty-eight students participated in the workshop and completed the surveys (presurvey = 58, postsurvey = 40), with roughly half (52%) reporting prior experience with telemedicine. A 5-point Likert-type scale (1 = very uncomfortable, 5 = very comfortable) was used. Students reported statistically significant increases in comfort using telemedicine (presurvey = 3.1, postsurvey = 3.9, p < .001) and using telemedicine for patients ≥65 years (presurvey = 2.8, postsurvey = 3.9, p < .001) after completing the workshop. Discussion Medical students' comfort levels using telemedicine and caring for patients ages 65 and older with a telehealth visit improved after participating in this workshop. To help prepare students for telehealth practice in their future careers, educators should provide them with opportunities to practice and develop this critical skill set.
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Affiliation(s)
- Lindsay A. Wilson
- Associate Professor, Division of Geriatrics, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine
| | - Brianna Harder
- Assistant Professor, Division of Geriatrics, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine
| | - Casey Kelley
- Research Assistant, Division of Geriatrics, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine
| | - Ross Powell
- Resident Physician, Department of Internal Medicine, East Carolina University
| | - Megan Foster
- Resident Physician, Department of Family Medicine, University of Virginia School of Medicine
| | - Ellen Roberts
- Associate Professor, Division of Geriatrics, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine
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Remsberg CM, Richardson B, Bray BS, Wilson M, Kobayashi R, Klein T, Anderson J, Peterson S, Gigray C, DeWitt D. An Interactive Online Interprofessional Opioid Education Training Using Standardized Patients. MedEdPORTAL 2023; 19:11328. [PMID: 37560407 PMCID: PMC10406977 DOI: 10.15766/mep_2374-8265.11328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 04/12/2023] [Indexed: 08/11/2023]
Abstract
Introduction Opioid pain management is complex and requires a collaborative approach. To prepare health professions students to care for patients who have chronic pain, we developed an interprofessional education (IPE) session for delivery using a virtual platform that featured a standardized patient (SP) interaction. Methods The SP case highlighted a patient on opioids for chronic low back pain resulting from a car accident. Despite no improvement in pain or function, the patient continued taking opioids and developed behaviors that could represent opioid misuse. During the synchronous, online session, interprofessional teams of students interviewed an SP and collaborated to develop a holistic care plan to address the patient's pain and potential opioid misuse. The session evaluation included pre- and postsession surveys. Results Over 750 students from medicine, pharmacy, nursing, and social work programs participated in the virtual IPE sessions during a single year. Students rated the session positively. Matched survey responses suggested improved confidence in knowledge and skills, and learning through Zoom was rated favorably. Discussion We successfully implemented a synchronous online IPE session involving SP interactions that allowed students to practice team-based care of a patient with chronic pain who was taking opioids. Based on the success of this IPE session, including the success of the online delivery model, future IPE sessions will continue virtually.
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Affiliation(s)
- Connie M. Remsberg
- Associate Professor, Department of Pharmaceutical Sciences, Washington State University College of Pharmacy and Pharmaceutical Sciences
| | - Barbara Richardson
- Associate Professor, Department of Medical Education and Clinical Sciences, Washington State University Elson S. Floyd College of Medicine
| | - Brenda S. Bray
- Professor, Department of Medical Education and Clinical Sciences, Washington State University Elson S. Floyd College of Medicine
| | - Marian Wilson
- Associate Professor, Department of Nursing and System Science, Washington State University College of Nursing
| | - Rie Kobayashi
- Professor, Eastern Washington University School of Social Work
| | - Tracy Klein
- Associate Professor, Department of Nursing and System Science, Washington State University College of Nursing
| | - Jennifer Anderson
- Coordinator, Collaboration for Interprofessional Health Education Research and Scholarship (CIPHERS), Washington State University Elson S. Floyd College of Medicine
| | - Sarah Peterson
- Research Assistant, Department of Medical Education and Clinical Sciences, Washington State University Elson S. Floyd College of Medicine
| | - Carrie Gigray
- Simulation Education Specialist, Virtual Clinical Center, Washington State University Elson S. Floyd College of Medicine
| | - Dawn DeWitt
- Professor, Department of Medical Education and Clinical Sciences, Washington State University Elson S. Floyd College of Medicine; Director, Collaboration for Interprofessional Health Education Research and Scholarship (CIPHERS), Washington State University Elson S. Floyd College of Medicine
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Prasad L, Hockstein S, Safdieh JE, Harvey K, Christos PJ, Kang Y. An Objective Structured Clinical Exam on Breaking Bad News for Clerkship Students: In-Person Versus Remote Standardized Patient Approach. MedEdPORTAL 2023; 19:11323. [PMID: 37484524 PMCID: PMC10359437 DOI: 10.15766/mep_2374-8265.11323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/06/2023] [Indexed: 07/25/2023]
Abstract
Introduction Telemedicine training for medical students is critical as that modality becomes integral to patient care. This formative standardized patient (SP) objective structured clinical exam (OSCE) lets students discuss miscarriage diagnosis and treatment virtually. Methods The SP OSCE was a mandatory session during the obstetrics and gynecology clerkship. Students received immediate feedback and optional individual reviews with clerkship directors. Students completed a nonmandatory survey at the end to describe their experience. SPIKES protocol student responses (i.e., proportion of correct responses) from in-person and remote SP versions were compared. Results Between July 2019 and March 2020, 79 students completed the in-person OSCE. Between July 2020 and June 2021, 149 students completed the remote SP encounter OSCE. Students who participated in the remote versus the in-person OSCE were more likely to admit their lack of knowledge when not equipped (p = .02), be seated during the encounter (p = .03), show listening body language (p = .13), assess the SP's perception (p = .19) and understanding (p = .20), and correct the SP's misunderstandings (p = .14). Of 84 students from eight rotations, including both in-person and remote formats, 99% believed learning objectives were clear, 91% felt preparation material was adequate, 95% thought the instructor summarized important points, 97% learned something in caring for gynecological patients, and 96% perceived the OSCE to be a worthwhile educational experience. Discussion The remote OSCE was well received by students. Breaking bad news virtually met assessment goals. Telemedicine training should be incorporated into medical school curricula.
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Affiliation(s)
- Lona Prasad
- Assistant Professor and Director, Clerkship for Undergraduate Medical Education, Department of Obstetrics and Gynecology, New York-Presbyterian/Weill Cornell Medicine
| | - Steven Hockstein
- Associate Professor and Associate Director, Clerkship for Undergraduate Medical Education, Department of Obstetrics and Gynecology, New York-Presbyterian/Weill Cornell Medicine
| | - Joseph E. Safdieh
- Professor and Vice Chair of Education, Department of Neurology, New York-Presbyterian/Weill Cornell Medicine
| | - Kevaughn Harvey
- Clinical Skills Coordinator, New York-Presbyterian/Weill Cornell Medicine
| | - Paul J. Christos
- Associate Professor of Research in Population Health Sciences, Division of Biostatics, New York-Presbyterian/Weill Cornell Medicine
| | - Yoon Kang
- Associate Professor, Medical Education, Office of Medical Education, Weill Cornell Medicine
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Famouri ML, Hernandez S, Omlor RL, Lane-Brown M, Evans SM, McIntosh D, Denizard-Thompson N. Active Bystander Training: Using Standardized Patient Methodology to Teach Residents to Navigate Microaggressions in Patient Encounters. MedEdPORTAL 2023; 19:11298. [PMID: 36760336 DOI: 10.15766/mep_2374-8265.11298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/26/2022] [Indexed: 12/24/2022]
Abstract
Introduction Studies show that physicians and medical trainees who identify as underrepresented in medicine or as women experience higher rates of microaggressions during patient encounters. We designed, implemented, and evaluated an active bystander training workshop focused on mitigating microaggressions using standardized patient (SP) methodology. Methods Internal medicine faculty members and chief residents led the workshop. Participants included 31 PGY 1 categorical and preliminary internal medicine residents. They participated in three case simulations with SPs involving microaggressions from patients toward a member of the health care team. Prior to the case simulations, a brief presentation outlined examples of microaggressions and reviewed the behavioral response framework WAKE (work with who you are, ask questions/make direct statements, involve key people, and employ distraction techniques). After each encounter, residents debriefed with an internal medicine faculty member and discussed questions related to each scenario. Results All 31 residents participated in the workshop and, before and after the activity, completed a survey that asked them to rank their agreement with statements via a Likert scale. Participants reported statistically significant improvement in recognizing microaggressions (12% reported increase, p = .002), the ability to respond to patients who exhibit microaggressions (23% reported increase, p < .001), and the ability to debrief with team members (20% reported increase, p < .001). Discussion SP simulations can be an effective teaching modality for microaggression response strategies during patient encounters. Additional studies are needed to further characterize the workshop's effect on other medical workforce trainees and retention of skills over time.
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Norton ZS, Olson KB, Sanguino SM. Addressing Vaccine Hesitancy Through a Comprehensive Resident Vaccine Curriculum. MedEdPORTAL 2022; 18:11292. [PMID: 36654981 PMCID: PMC9792628 DOI: 10.15766/mep_2374-8265.11292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/10/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Vaccine hesitancy can lead to incomplete vaccination, increased risk of vaccine-preventable diseases, and distrust or conflict between physicians and patients. Yet many physicians are uncomfortable navigating vaccine hesitancy and educating vaccine-hesitant patients and families. We developed a vaccine hesitancy curriculum to increase vaccine knowledge, comfort, and communication skills in pediatric residents. METHODS The curriculum consisted of four interactive 40-minute sessions delivered to pediatric residents over 10 months. The first two sessions discussed recommended childhood vaccines, the third session examined common vaccine misconceptions, and the final session reviewed vaccine hesitancy-specific communication skills, incorporating practice through role-playing. Residents completed pre- and posttests assessing knowledge and comfort as well as receiving a standardized patient (SP) assessment of vaccine-specific communication skills after the curriculum. RESULTS Thirty-five residents were in the educational intervention group and 35 in a control group. Pretest scores did not differ significantly between the groups. The mean knowledge score for the intervention group increased from 47% on the pretest to 66% on the posttest. The mean self-reported comfort score (1 = low comfort, 5 = high comfort) for the intervention group increased from 2.9 on the pretest to 3.8 on the posttest. The control group showed no difference between pre- and posttest scores for knowledge or comfort. The mean postintervention SP assessment score was significantly higher for the intervention group (78%) than the control group (52%). DISCUSSION Implementation of a comprehensive vaccine hesitancy curriculum resulted in improved vaccine knowledge, self-reported comfort, and communication skills among pediatric residents.
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Affiliation(s)
- Zarina S. Norton
- Assistant Professor, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago; Assistant Professor, Department of Medical Education, Northwestern University Feinberg School of Medicine
| | - Kaitlyn B. Olson
- General Pediatrician, Department of Pediatrics, Cottage Children's Medical Center
| | - Sandra M. Sanguino
- Associate Professor, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago; Associate Professor, Department of Medical Education, and Senior Associate Dean for Medical Education, Northwestern University Feinberg School of Medicine
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Tookes HE, Tomita-Barber J, Taldone S, Shane M, Imm MR, Ford H, St. Onge J, Forrest DW, Bartholomew TS, Serota DP. Opioid Use Disorder Curriculum: Medicine Clerkship Standardized Patient Case, Small-Group Activity, and Patient Panel. MedEdPORTAL 2022; 18:11248. [PMID: 35692601 PMCID: PMC9127032 DOI: 10.15766/mep_2374-8265.11248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/11/2022] [Indexed: 11/27/2022]
Abstract
Introduction The overdose crisis remains a critical public health problem, creating an urgent need to train physicians in the treatment and management of opioid use disorder (OUD). Our medicine clerkship module aimed to close this gap by training and assessing students' motivational interviewing skills, harm reduction knowledge, and use of nonstigmatizing language in the treatment of patients with OUD. Methods We evaluated the impact of a small-group, case-based activity and patient panel on the clinical documentation skills of students in a medicine clerkship. Clinical documentation was based on an observed structured clinical examination of a standardized patient with OUD and was evaluated using a grading rubric that followed the module learning objectives. Students also submitted reflections on the curriculum. Results Qualitative responses (n = 40) from students evaluating the small-group activity and patient panel exercise revealed overall student satisfaction with the patient panel and exposure to patients living with OUD. Three themes emerged from student reflections: (1) humanity, (2) different paths to recovery, and (3) using nonstigmatizing language. For the quantitative test, students' (n = 39) mean clinical documentation scores before and after the small-group activity and patient panel increased from 10.1 to 11.3 out of 13.5 possible points. There was a significant difference between mean pretest and posttest scores (p < .001). Discussion The medicine clerkship provided an acceptable and feasible opportunity for implementing a multifaceted educational experience for students with significant immediate impact on their evaluation of patients with OUD.
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Affiliation(s)
- Hansel E. Tookes
- Associate Professor of Clinical Medicine, Department of Medicine, University of Miami Leonard M. Miller School of Medicine
| | - Jasmine Tomita-Barber
- First-Year Resident, Department of Medicine, University of Miami Leonard M. Miller School of Medicine
| | - Sabrina Taldone
- Assistant Professor of Clinical Medicine, Department of Medicine, University of Miami Leonard M. Miller School of Medicine
| | - Morgan Shane
- Assistant Professor of Clinical Medicine, Department of Medicine, University of Miami Leonard M. Miller School of Medicine
| | - Matthew R. Imm
- Assistant Professor of Clinical Medicine, Department of Medicine, University of Miami Leonard M. Miller School of Medicine
| | - Henri Ford
- Dean and Chief Academic Officer, University of Miami Leonard M. Miller School of Medicine
| | - Joan St. Onge
- Professor of Clinical Medicine, Department of Medicine, University of Miami Leonard M. Miller School of Medicine
| | - David W. Forrest
- Research Associate Professor, Department of Public Health Sciences, University of Miami Leonard M. Miller School of Medicine
| | - Tyler S. Bartholomew
- Research Assistant Professor, Department of Public Health Sciences, University of Miami Leonard M. Miller School of Medicine
| | - David P. Serota
- Assistant Professor of Clinical Medicine, Department of Medicine, University of Miami Leonard M. Miller School of Medicine
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Weingartner L, Noonan EJ, Bohnert C, Potter J, Shaw MA, Holthouser A. Gender-Affirming Care With Transgender and Genderqueer Patients: A Standardized Patient Case. MedEdPORTAL 2022; 18:11249. [PMID: 35664552 PMCID: PMC9120312 DOI: 10.15766/mep_2374-8265.11249] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/21/2022] [Indexed: 11/18/2022]
Abstract
Introduction Transgender and gender-diverse (TGD) patients experience health disparities and bias in health care settings. To improve care for TGD patients, medical trainees can practice gender-affirming care skills such as inclusive communication and discussing hormone therapy through patient simulation. Systematically evaluating these simulation outcomes also helps educators improve training on gender-affirming care. Methods A standardized patient case with a patient establishing primary care was developed for rising third-year medical students. The case featured multiple patient iterations to portray individuals with the same health history but a different gender identity and/or sex assigned at birth. Each student was randomly assigned to one patient encounter. Gender-affirming care skills were assessed through standardized patient checklists, postencounter notes, and preventive care recommendations. Results Over 2 years, 286 students participated in the simulation. Transgender men and women, cisgender men and women, and genderqueer patients were portrayed. Performance gaps such as misgendering patients and incorrect cancer screening recommendations based on perceived gender identity (rather than sex assigned at birth) were documented. Ninety-eight percent of students agreed that the encounter helped them practice clinical skills needed to see actual patients, and students described the case as challenging but important. Discussion This case served dual roles for medical training: (1) Students working with TGD patients practiced skills for gender-affirming care, and (2) portraying TGD patients along with cisgender patients allowed educators to identify biased recommendations that necessitated additional training. The outcomes further highlighted the importance of students routinely practicing gender-inclusive communication with all patients during simulation.
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Affiliation(s)
- Laura Weingartner
- Director of Research for Health Professions Education, Undergraduate Medical Education, University of Louisville School of Medicine
| | - Emily J. Noonan
- Assistant Professor, Undergraduate Medical Education, University of Louisville School of Medicine
| | - Carrie Bohnert
- Director, Standardized Patient Program, Undergraduate Medical Education, University of Louisville School of Medicine
| | - Jennifer Potter
- Professor, Department of Medicine, Harvard Medical School; Co-chair, The Fenay Institute
| | - M. Ann Shaw
- Vice Dean for Undergraduate Medical Education, University of Louisville School of Medicine
| | - Amy Holthouser
- Senior Associate Dean for Undergraduate Medical Education, University of Louisville School of Medicine
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Stokes SC, McFadden NR, Salcedo ES, Beres AL. Firearm Safety Counseling for Patients: An Interactive Curriculum for Trauma Providers. MedEdPORTAL 2022; 18:11237. [PMID: 35615406 PMCID: PMC9085984 DOI: 10.15766/mep_2374-8265.11237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 01/12/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Firearm injuries are a major public health concern. Safe firearm storage is recommended by multiple medical organizations. However, rates of firearm safety counseling are particularly low among trauma providers. Educational initiatives for other provider groups have proven to be effective. We hypothesized that educating trauma providers to offer safety counseling would be similarly effective. METHODS We developed a didactic session around safe firearm storage counseling for trauma providers consisting of a lecture followed by an interactive session with standardized patients. Session participants completed pre- and postsurveys evaluating their knowledge about firearm storage, self-efficacy in providing firearm storage counseling, and attitudes towards firearm safety. We compared differences between pre- and postsurvey data using chi-square tests. RESULTS The didactic session was delivered to target trauma providers: three trauma nurse practitioners, 42 general surgery residents, and 26 emergency medicine residents. After the session, participants were more likely to know the optimal way to safely store a firearm and to be confident in effectively counseling patients about safe firearm storage. Learners were not more likely to believe that providers have a responsibility to counsel patients on firearm safety. DISCUSSION A didactic session on safe firearm storage counseling was associated with increased rates of knowledge and self-efficacy. The session did not change attitudes among trauma providers, although, prior to the session, most providers already believed they had a responsibility to counsel patients on safe firearm storage. Similar curricula should be piloted at other trauma centers.
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Affiliation(s)
- Sarah C. Stokes
- Resident, Department of Surgery, University of California, Davis, School of Medicine
| | - Nikia R. McFadden
- Resident, Department of Surgery, University of California, Davis, School of Medicine
| | - Edgardo S. Salcedo
- Professor, Department of Surgery, University of California, Davis, School of Medicine
| | - Alana L. Beres
- Associate Professor, Department of Surgery, University of California, Davis, School of Medicine
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Jones MK, Gupta KR, Peters TR, Beardsley JR, Jackson JM. Antiviral Pharmacology: A Standardized Patient Case for Preclinical Medical Students. MedEdPORTAL 2022; 18:11242. [PMID: 35539004 PMCID: PMC9038986 DOI: 10.15766/mep_2374-8265.11242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Pharmacology is an important learning topic in preclinical medical education. Simulated patient encounters allow students to apply basic science knowledge in a clinical setting and have been useful in previous studies of pharmacology education. We developed a standardized patient (SP) encounter to reinforce antiviral pharmacology content for first-year medical students. METHODS Students were instructed to recommend a medication for shingles during an SP encounter and to answer questions from the SP on mechanism of action and adverse effects. Students then attended a large-group debrief session. Following the activity, students evaluated the exercise through a voluntary survey. For knowledge assessment, students were randomized into two groups to complete three multiple-choice questions either before or after the learning activity. RESULTS In 2020 and 2021, 144 and 145 students, respectively, participated. In 2020, there was no significant difference in the proportion of correct answers between the pre- and postsimulation groups (p > .05). In 2021, the postsimulation group significantly outperformed the presimulation group in knowledge of mechanism of action (p < .01) and adverse effects (p < .01), but no difference was seen between the groups regarding medication selection (p = .27). Most learners assessed the instructional design as effective for the tasks assigned. DISCUSSION This SP activity provided an opportunity for early medical students to practice integrating antiviral pharmacology knowledge into a patient encounter and was well received by learners. The instructional method offers a clinically relevant approach for reinforcing pharmacology knowledge for preclinical medical students.
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Affiliation(s)
| | | | | | - James R. Beardsley
- Assistant Professor, Department of Internal Medicine, Wake Forest School of Medicine
| | - Jennifer M. Jackson
- Associate Professor, Department of Pediatrics, Wake Forest School of Medicine
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Lu WH, Baldelli P, Migdal P, Iuli R, Strano-Paul L, Zacharoff KL. Early Refill of an Opioid Medication: Recognizing Personal Biases Through Clinical Vignettes and OSCEs. MedEdPORTAL 2022; 18:11234. [PMID: 35497675 PMCID: PMC8986891 DOI: 10.15766/mep_2374-8265.11234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/06/2022] [Indexed: 06/14/2023]
Abstract
Introduction Efforts to improve pain education and knowledge about prescription opioid misuse and opioid/substance use disorder in undergraduate medical education continue to be inadequate. To advance educational practices and address training needs to counter the opioid epidemic, we created a longitudinal pain and addiction curriculum that includes three patient vignettes in which the patient requests an early refill of opioid medication. The goal was to introduce students to the potential impact of personal biases on health care delivery and medical decision-making with patients who have pain and/or substance use disorders. Methods Three clinical vignettes were presented to early matriculating medical students (MS 1s) using a progressive case disclosure approach in the format of a PowerPoint presentation with embedded audio interactions and follow-up audience response system questions. The same vignettes were converted into OSCEs for early clinical clerkship students (MS 3s). Results A total of 180 MS 1s participated in the case presentations, and 124 MS 3s participated in the OSCE session. There was a significant difference between students' level of comfort and individual patient requests for early prescription refills in both student cohorts. MS 1s were significantly more likely to provide the early refill to the elderly female patient compared to the two middle-age male patients, whereas a majority of MS 3s wanted more information. Discussion This module can be presented to medical students who have little clinical exposure and to health care trainees at other levels of clinical exposure.
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Affiliation(s)
- Wei-Hsin Lu
- Director of Assessment and Evaluation and Research Assistant Professor of Preventive Medicine, Renaissance School of Medicine at Stony Brook University
| | - Perrilynn Baldelli
- Director, Clinical Simulation Center, Renaissance School of Medicine at Stony Brook University
| | - Phyllis Migdal
- Clinical Assistant Professor, Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University
| | - Richard Iuli
- Director, Pathways to Success, Office of Academic Affairs, Renaissance School of Medicine at Stony Brook University
| | - Lisa Strano-Paul
- Clinical Professor of Medicine and Assistant Dean for Clinical Education, Renaissance School of Medicine at Stony Brook University
| | - Kevin L. Zacharoff
- Clinical Instructor and Distinguished Visiting Scholar in Medical Humanities, Compassionate Care, and Preventive Medicine, Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University
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Adkins LD, Harris BS, Gesher C, Reynolds T, Branford K, Baldwin M, Dotters-Katz S. Understanding Patient Evaluation of Abnormal Uterine Bleeding (AUB): A Standardized Patient Case on AUB for OB/GYN Clerkship Students. MedEdPORTAL 2022; 18:11216. [PMID: 35136836 PMCID: PMC8795174 DOI: 10.15766/mep_2374-8265.11216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/27/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The differential diagnosis for abnormal uterine bleeding (AUB) among reproductive-age women is broad and includes common and life-threatening conditions. Recognition and accurate diagnosis of AUB are important but can be challenging for medical students. We developed a standardized patient (SP) encounter for medical students during their OB/GYN clerkship. METHODS We implemented two SP encounters, on AUB and dyspareunia, that included a postencounter note and SP evaluations. Here, we describe the implementation of the SP encounter on AUB. Students received formative feedback on their interpersonal and history-taking skills, differential diagnosis, and management plan from the SP as well as OB/GYN residents and faculty. Student cumulative feedback was obtained mid-clerkship and following the clerkship. Summary statistics and qualitative data for students' experiences are reported. RESULTS SP cases were implemented at the Duke University School of Medicine with 101 second-year medical students who completed the encounter from September 2018 to July 2019. Regarding the AUB case, SPs identified students as adequate history takers, with a mean evaluation score of 3.45 (SD = 0.15) out of 5. Most students (94%) correctly identified at least one diagnosis and provided evidence. Endometrial cancer/hyperplasia (63%) and uterine leiomyoma (60%) were most likely to be identified. Regarding both SP encounters, of the 82 students (81%) completing the end-of-clerkship survey, 57% indicated that the experience enhanced their overall learning at least adequately well or better. DISCUSSION The AUB case provided students with the opportunity to exercise their diagnostic and management skills.
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Affiliation(s)
| | - Benjamin S. Harris
- Clinical Fellow, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center
| | - Cescille Gesher
- Program Coordinator, Department of Obstetrics and Gynecology, Duke University Medical Center
| | - Tracey Reynolds
- Assistant SP Trainer and External Client Coordinator of the Clinical Skill Program, Office of Curricular Affairs, Duke University School of Medicine
| | - Kelly Branford
- Director of the Clinical Skills Program, Office of Curricular Affairs, Duke University School of Medicine
| | - Melody Baldwin
- Assistant Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Duke University Medical Center
| | - Sarah Dotters-Katz
- Director of Undergraduate Medical Education and Associate Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Duke University Medical Center
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Perez ED, Keesee L, Moore CN, Gallegos BA, Guest HA, Franco HH, Hoffman CA. Connecting the dots: Bridging virtual to in-person physical assessment. Teach Learn Nurs 2022; 17:147-150. [PMID: 35035318 PMCID: PMC8747492 DOI: 10.1016/j.teln.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 11/02/2022]
Abstract
When restrictions imposed by COVID-19 prevented prelicensure nursing students from practicing skills in the simulation center, the faculty designed a plan to bridge the gap from virtual to in-person skill performance for physical assessments. The faculty anticipated an inadequacy of head-to-toe assessment skills related to the lack of face-to-face clinical. Therefore, the faculty used the Plan-Do-Study-Act model (Agency for Healthcare Research and Quality, 2020) for quality improvement to address the skill performance issue. The plan used colored adhesive "garage sale" dots to identify anatomical landmarks to help students with correct stethoscope placement during their first in-person simulation after a virtual semester. Pre- and post-tests were administered to assess confidence in assessment skills. Using this method on standardized patients in simulation, nursing students reported increased confidence in stethoscope placement. Students of all healthcare disciplines could benefit from the economical dotting process to learn correct stethoscope placement.
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Affiliation(s)
| | - Lea Keesee
- Texas Tech University Health Sciences Center School at Odessa, Odessa, TX, USA
| | | | | | - Heather Ann Guest
- Texas Tech University Health Sciences Center at Abilene, Abilene, TX, USA
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Meyer BD, Fearnow B, Smith HL, Morgan SG, Quinonez RB. Implementing Standardized Patient Caregivers to Practice Difficult Conversations in a Pediatric Dentistry Course. MedEdPORTAL 2022; 18:11201. [PMID: 35036525 PMCID: PMC8720916 DOI: 10.15766/mep_2374-8265.11201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/31/2021] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Standardized patient (SP) methodology has been used in health professional education to help students develop communication, deeper diagnostic reasoning, and critical thinking skills. Few examples demonstrate the use of SPs to practice difficult conversations with pediatric caregivers in the pediatric dentistry literature. The objective of this educational activity was to describe the implementation of three SPs in a pediatric dentistry course for second-year dental students. METHODS We developed three SP encounters covering interactions with caregivers of an infant with severe early childhood caries, an adolescent on the path to gender affirmation, and a child with autism and dental caries whose caregiver was resistant to fluoride- and silver-containing dental materials. We describe the case design process, rubric construction and calibration, student debriefing, and pandemic modifications. We evaluated the effectiveness of the implementation by thematic analysis of student reflections following each encounter using a qualitative descriptive framework. RESULTS Eighty-three students completed each encounter. Qualitative analysis showed that students preferred a more realistic encounter by having a child or other distraction present. Students relied on different elements of motivational interviewing depending on the objective of each encounter and the age of the patient. Overall, the SP encounters were well received by students and faculty as an alternative or supplement to traditional student evaluation methods. DISCUSSION We noted a number of lessons learned about implementing SP methodology in pediatric dental education. With these experiences now in place, future evaluations should measure student performance in the SP encounters against student performance during clinical care.
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Affiliation(s)
- Beau D. Meyer
- Assistant Professor, Division of Pediatric Dentistry, The Ohio State University College of Dentistry
- Corresponding author:
| | - Bethany Fearnow
- Curriculum Innovation Consultant, Academic Affairs, University of North Carolina at Chapel Hill Adams School of Dentistry
| | - Hannah L. Smith
- Fourth-Year Dental Student, University of North Carolina at Chapel Hill Adams School of Dentistry
| | - Sarah G. Morgan
- Fourth-Year Dental Student, University of North Carolina at Chapel Hill Adams School of Dentistry
| | - Rocio B. Quinonez
- Professor, Division of Pediatric and Public Health, and Associate Dean for Educational Leadership and Innovation, Academic Affairs, University of North Carolina at Chapel Hill Adams School of Dentistry
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Cristiano JA, Jackson JM, Shen E, Williams DM, Ellis LR. Integrating the Electronic Health Record Into Patient Encounters: An Introductory Standardized Patient Exercise for Preclinical Medical Students. MedEdPORTAL 2022; 18:11209. [PMID: 35047666 PMCID: PMC8727442 DOI: 10.15766/mep_2374-8265.11209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/25/2021] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Increasingly, use of the electronic health record (EHR) is interwoven into even the most basic patient care tasks. Accordingly, learning how to utilize the EHR during patient encounters is important for medical students as they develop their clinical skills. Existing EHR curricula have focused primarily on doctor-patient relationship skills. We developed a session for our preclinical students on EHR-related doctor-patient relationship skills as well as on using the EHR to verify data and focus one's history taking. METHODS We developed student notes, three training videos, four standardized patient (SP) cases, and a simplified, simulated EHR based on these cases. Students reviewed the notes and videos prior to class. During class, students practiced EHR-related communication and data-collection strategies by interviewing an SP while interacting with the simulated EHR. Following each encounter, students received feedback from a small group of peers and faculty. RESULTS Two-hundred eighty-nine second-year medical students participated this session in 2019 and 2020, and 27 (19%, 2019) and 40 (28%, 2020) students, respectively, completed the postsession evaluation. Most respondents rated the SP activity as extremely or quite effective for practicing doctor-patient relationship strategies while interacting with the EHR (89%, 2019; 83%, 2020) and for practicing verification of EHR data during a patient encounter (81%, 2019; 86%, 2020). DISCUSSION This training session was effective for introducing preclinical medical students to fundamental concepts and skills related to incorporating the EHR into patient encounters and offers a low-cost approach to teaching early medical students these important skills.
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Affiliation(s)
- Joseph A. Cristiano
- Assistant Professor, Department of Internal Medicine, Section of General Internal Medicine, Wake Forest School of Medicine
- Corresponding author:
| | - Jennifer M. Jackson
- Associate Professor, Department of Pediatrics, Section of Pediatric Hospital Medicine, Wake Forest School of Medicine
| | - E Shen
- Assistant Professor, Department of Internal Medicine, Section of General Internal Medicine, Wake Forest School of Medicine
| | - Donna M. Williams
- Associate Professor, Department of Internal Medicine, Section of General Internal Medicine, Wake Forest School of Medicine
| | - Leslie R. Ellis
- Associate Professor, Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine
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Lai J, Tillman D. Curriculum to Develop Documentation Proficiency Among Medical Students in an Emergency Medicine Clerkship. MedEdPORTAL 2021; 17:11194. [PMID: 34820512 PMCID: PMC8590992 DOI: 10.15766/mep_2374-8265.11194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Documenting a clinical encounter is a core skill for entering residency, but medical students often receive scant dedicated documentation training, leading to a high rate of inadequate information. Utilizing adult experiential learning theory, we created and implemented an educational resource to train medical students on how to proficiently document an emergency department (ED) patient encounter. METHODS One hundred and five third- and fourth-year medical students participating in an emergency medicine clerkship took part in a brief orientation day documentation curriculum that included a group didactic, a review of reference materials, a standardized patient activity, a sample patient note writing assignment with individualized feedback, and supervising faculty physician feedback on real patient notes. Students were subsequently entrusted with primary documentation responsibility for all ED patients whose care they participated in. RESULTS After completing this curriculum, students' self-rated comfort with writing a high-quality note increased from 4.1 to 5.9 (p < .001) and knowledge about billing and coding increased from 2.9 to 5.5 (p < .001) on a 7-point scale. Among faculty physicians, 93% found student notes to always, usually, or frequently be clinically useful, and 86% reported that student notes always, usually, or frequently contained enough information for billing and coding. DISCUSSION This curriculum was effective at training medical students on proficient patient care documentation in emergency medicine. The relatively short amount of synchronous learning time required could aid in implementation, and the allowance of medical student notes to count for billing purposes could facilitate student and faculty buy-in.
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Affiliation(s)
- Jason Lai
- Clinical Assistant Professor, BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health
| | - David Tillman
- Director of Medical Student Education, BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health
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Lloyd MC, Ratner J, La Charite J, Ortiz R, Tackett S, Feldman L, Solomon BS, Shilkofski N. Addressing Trauma and Building Resilience in Children and Families: Standardized Patient Cases for Pediatric Residents. MedEdPORTAL 2021; 17:11193. [PMID: 34820511 PMCID: PMC8592119 DOI: 10.15766/mep_2374-8265.11193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) and trauma are common and can negatively impact children's health. Standardized patient (SP) learning may provide trainees with knowledge and skills to screen for and manage ACEs, apply trauma-informed care approaches, and teach resilience strategies. METHODS With content experts, we developed three SP cases based on common clinical encounters, as well as didactic and debriefing materials. Case 1 focused on somatic symptoms in an adolescent with ACEs, case 2 focused on an ACE disclosure by a parent, and case 3 focused on de-escalation. The workshop required facilitators, SPs, simulation exam room and meeting space, and audiovisual equipment. It lasted 4 hours and included an orientation (1 hour), the three SP cases (totaling 2 hours), and group debriefing (1 hour). RESULTS We conducted five identical workshops with 22 pediatric residents. Participants responded favorably to case fidelity and applicability to their clinical work. Resident mean self-assessment scores improved significantly from baseline. Specifically, we assessed comfort with inquiring about and discussing ACEs, explaining the health impacts of trauma, identifying protective factors, resilience counseling, and de-escalation. Over 90% of responses indicated that residents were likely to apply what they had learned to their clinical practice. DISCUSSION These findings demonstrate that our SP cases were well received and suggest that such curricula can help pediatric residents feel more prepared to address trauma and promote resilience. Future work will assess these outcomes, as well as behavior change, in a larger sample to further substantiate these promising findings.
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Affiliation(s)
- M. Cooper Lloyd
- Resident, Departments of Internal Medicine and Pediatrics, Johns Hopkins University School of Medicine
| | - Jessica Ratner
- Resident, Departments of Internal Medicine and Pediatrics, Johns Hopkins University School of Medicine
| | - Jaime La Charite
- Resident, Departments of Internal Medicine and Pediatrics, Johns Hopkins University School of Medicine
| | - Robin Ortiz
- Resident, Departments of Internal Medicine and Pediatrics, Johns Hopkins University School of Medicine
| | - Sean Tackett
- Associate Professor, Department of Medicine, Johns Hopkins Bayview Medical Center and Johns Hopkins University School of Medicine; Core Faculty, Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins University School of Medicine
| | - Leonard Feldman
- Associate Professor, Departments of Internal Medicine and Pediatrics, Johns Hopkins University School of Medicine
| | - Barry S. Solomon
- Professor, Department of Pediatrics, Johns Hopkins University School of Medicine
| | - Nicole Shilkofski
- Associate Professor, Department of Pediatrics, Johns Hopkins University School of Medicine
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Talwalkar JS, Fortin AH, Morrison LJ, Kliger A, Rosenthal DI, Murtha T, Ellman MS. An Advanced Communication Skills Workshop Using Standardized Patients for Senior Medical Students. MedEdPORTAL 2021; 17:11163. [PMID: 34124349 PMCID: PMC8155077 DOI: 10.15766/mep_2374-8265.11163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/06/2021] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Medical students often lack training in advanced communication skills encompassing emotionally fraught situations and those in which an intense emotional response is expected. Such skills are required for clinical situations encountered during residency. We created and evaluated an advanced communication skills workshop (ACSW) using standardized patients for senior medical students. The workshop emphasized communication skills for four scenarios-strong emotion, goals of care, medical error, and palliative care assessment-and utilized formative peer assessment and feedback. METHODS We created the four ACSW cases with case-specific communication behavior checklists and a common modified Master Interview Rating Scale in a Capstone Course for senior medical students. In groups of three, students rotated through three of four stations. Each student conducted one of the interviews while the other two completed the checklists and provided verbal feedback. We performed one-way analyses of variance on Likert responses and content analysis on open responses on a post-ACSW survey. RESULTS Ninety-one students completed the ACSW and survey. Students assigned high value to all four ACSW student roles: interviewer, observer, feedback recipient, and feedback provider. Students rated the experience above average to excellent on nearly all survey items. Open-response themes included "liked the opportunity to give or receive peer feedback" (46%) and "found the checklists helpful" (45%). DISCUSSION Feasible and well received by senior medical students, our ACSW offers an opportunity to practice and observe advanced communication skills and peer feedback. A peer-assisted, formative learning model, the ACSW efficiently addresses a key aspect of residency preparation.
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Affiliation(s)
- Jaideep S. Talwalkar
- Associate Professor, Departments of Medicine and Pediatrics, and Director of Clinical Skills, Yale School of Medicine
| | - Auguste H. Fortin
- Professor, Department of Medicine, and Director of Communication Skills Education, Yale School of Medicine
| | - Laura J. Morrison
- Associate Professor, Department of Medicine, and Director of Hospice and Palliative Medicine Fellowship, Yale School of Medicine
| | - Alan Kliger
- Clinical Professor, Department of Medicine, Yale School of Medicine
| | - David I. Rosenthal
- Assistant Professor, Department of Medicine, and Director of Capstone Course, Yale School of Medicine
| | - Tanya Murtha
- Assistant Professor, Department of Pediatrics (Critical Care Medicine), Columbia University
| | - Matthew S. Ellman
- Professor, Department of Medicine, and Director of Medical Student Palliative and End-of-Life Care Education, Yale School of Medicine
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Reid HW, Branford K, Reynolds T, Baldwin M, Dotters-Katz S. It's Getting Hot in Here: Piloting a Telemedicine OSCE Addressing Menopausal Concerns for Obstetrics and Gynecology Clerkship Students. MedEdPORTAL 2021; 17:11146. [PMID: 33937522 PMCID: PMC8079425 DOI: 10.15766/mep_2374-8265.11146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/18/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Although menopause is a common condition, trainees still express high levels of discomfort with managing climacteric symptoms. Trainees also receive little preparation for conducting telemedicine visits, which have become increasingly important in clinical care. We present a formative standardized patient (SP) encounter to introduce medical students to the diagnosis and treatment of menopausal symptoms and the process of conducting a telemedicine visit. METHODS We designed a virtual telemedicine encounter with an SP for medical students. Students received feedback via a post-encounter note on history taking, differential diagnosis, and diagnostics/management and an SP debrief. We collected student input on the experience at the midpoint and end of clerkship and analyzed it for recurring themes. We calculated summary statistics from student post-encounter notes. RESULTS Thirty-two OB/GYN students completed the menopause telemedicine SP encounter between April and June 2020. Students scored a median of 20 out of 45 (interquartile range: 18, 22) on the post-encounter note. All students correctly provided a diagnosis of perimenopause/menopause; however, 50% did not offer any strategy for counseling or managing menopausal symptoms. Students expressed discomfort with using a telehealth format (78%) but found it a useful skill to practice (47%). A majority (66%) found the educational encounter to be of excellent or above-average educational value. DISCUSSION While medical students demonstrated discomfort with both managing menopause and utilizing a telemedicine format, this SP case provided an opportunity for them to practice both skills in a safe learning environment. The majority of participants rated the learning experience highly.
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Affiliation(s)
- Hadley W. Reid
- Third-Year Medical Student, Duke University School of Medicine
| | - Kelly Branford
- Director of Clinical Skills Program, Office of Curricular Affairs, Duke University School of Medicine
| | - Tracey Reynolds
- Standardized Patient Coordinator, Office of Curricular Affairs, Duke University School of Medicine
| | - Melody Baldwin
- Assistant Professor, Department of Obstetrics and Gynecology, Duke University Medical Center
| | - Sarah Dotters-Katz
- Assistant Professor, Department of Obstetrics and Gynecology, Duke University Medical Center
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Garcia-Vassallo G, Edens EL, Heward B, Auerbach MA, Wong AH, Camenga D. Management of Adolescents With OUD: A Simulation Case for Subspecialty Trainees in Addiction Medicine and Addiction Psychiatry. MedEdPORTAL 2021; 17:11147. [PMID: 33889724 PMCID: PMC8056775 DOI: 10.15766/mep_2374-8265.11147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
Introduction The opioid epidemic impacts all ages, yet few published medical education curricula exist to train physicians on how to care for opioid use disorder (OUD) in adolescents, a developmental stage where confidentiality protection is appropriate and contributes to quality health care. We developed a simulation-based educational intervention to increase addiction medicine and addiction psychiatry trainees' confidence in managing adolescents with OUD. Methods Trainees completed a confidence survey and viewed an educational video covering state-specific confidentiality laws pertinent to treating adolescents with OUD. One week later, trainees participated in a simulated encounter where they described the scope of confidentiality to a trained actor, used the Clinical Opiate Withdrawal Scale to assess symptoms of opioid withdrawal, and explained adolescent-specific OUD medication treatment options. Immediately afterward, trainees completed a self-reflection and satisfaction survey and participated in a debriefing session with a faculty member where they identified learning goals. One month later, they completed the confidence survey to quantify changes in confidence. Results Thirty-five fellows (21 male, 14 female) completed the simulation-based educational intervention between 2016 and 2019. When asked to answer yes or no, 96% of participants described the exercise as effective and 100% (n = 26) would recommend it to peers. In addition, learners identified future learning goals, including researching specific topics and seeking out additional opportunities to evaluate adolescents with OUD. Discussion Based on our participants' report, this simulation-based educational intervention is an effective teaching method for increasing trainee confidence in managing adolescents with OUD.
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Affiliation(s)
| | - Ellen Lockard Edens
- Associate Professor and Associate Fellowship Director for Addiction Psychiatry, Department of Psychiatry, Yale School of Medicine
| | - Brady Heward
- Assistant Professor, Department of Psychiatry, Robert Larner, M.D., College of Medicine at the University of Vermont; Clinical Instructor, Department of Psychiatry, Yale School of Medicine
| | - Marc A. Auerbach
- Associate Professor, Departments of Emergency Medicine and Pediatrics, Yale School of Medicine
| | - Ambrose H. Wong
- Assistant Professor, Department of Emergency Medicine, and Associate Fellowship Director, Medical Simulation, Yale School of Medicine
| | - Deepa Camenga
- Associate Professor, Departments of Emergency Medicine and Pediatrics, Yale School of Medicine
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Ream M, Albert DVF, Lash T, Verbeck N, Weisleder P. Improving Child Neurology Residents' Communication Skills Through Objective Structured Clinical Exams. MedEdPORTAL 2021; 17:11120. [PMID: 33768152 PMCID: PMC7970633 DOI: 10.15766/mep_2374-8265.11120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 12/30/2020] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Child neurology has unique challenges in communication due to complex disorders with a wide array of prognoses and treatments. Effective communication is teachable through deliberate practice and coaching. Objective structured clinical exams (OSCEs) are one method of providing practice while assessing communication skills. Yet OSCEs have not been reported for child neurology residents. METHODS We developed simulated clinical cases centering on communication skills for child neurology residents, all with challenging clinical scenarios (e.g., disclosure of a medical error, psychogenic nonepileptic events). Standardized patients (SPs) portrayed the parents of pediatric patients and, in some scenarios, an adolescent patient. We used a modified Gap-Kalamazoo Communication Skills Assessment Form to assess communication skills. The assessment was completed by faculty, SPs, and the resident, and we measured agreement among raters. Residents were surveyed afterward regarding their experience. RESULTS Nine cases were developed and piloted. A total of 27 unique resident-case encounters with 16 individual trainees occurred over three annual implementations. Scores on the 360-degree assessment of communication skills showed that residents overwhelmingly underassessed their skills compared to other rater groups. Among 18 responses on the post-OSCE survey, the majority (77%) found the experience useful to their education and felt that the feedback from the SPs was helpful (61%) and the case portrayals were realistic (89%). DISCUSSION We implemented simulated cases for assessment and formative feedback on communication skills for child neurology residents. We provide a blueprint to develop this educational activity in other programs.
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Affiliation(s)
- Margie Ream
- Assistant Professor, Department of Pediatrics, Division of Child Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine
| | - Dara V. F. Albert
- Assistant Professor, Department of Pediatrics, Division of Child Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine
| | - Todd Lash
- Education Resource Specialist, Clinical Skills Education and Assessment Center, The Ohio State University College of Medicine
| | - Nicole Verbeck
- Research Specialist, Office of Curriculum and Scholarship, The Ohio State University College of Medicine
| | - Pedro Weisleder
- Professor, Department of Pediatrics, Division of Child Neurology, Nationwide Children's Hospital and The Ohio State University College of Medicine
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Gunasingha RM, Knudsen N, Scialla T, Shepherd A, Clay A. Vital Conversations: An Interactive Conflict Resolution Training Session for Fourth-Year Medical Students. MedEdPORTAL 2021; 17:11074. [PMID: 33511271 PMCID: PMC7830754 DOI: 10.15766/mep_2374-8265.11074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 09/30/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The AAMC has recognized the importance of effective teamwork and collaboration. One core Entrustable Professional Activity emphasizes creating a climate of mutual respect and trust and prioritizing team needs over personal needs, which leads to safe, timely, effective, efficient, and equitable patient care. Relationship conflicts, specifically, are associated with decreased productivity, complex information processing, and work satisfaction. Given the prevalence of conflict and its impact on health care workers, the lack of conflict resolution curricula in undergraduate medical education is surprising. We developed a curriculum formally introducing these skills and allowing practice in a simulated environment before students entered residency. METHODS Fourth-year medical students completed a conflict resolution exercise in a mandatory transition-to-residency course. Students completed online prework including reflection on teamwork and information on conflict resolution styles, participated in a simulated conflict with a standardized patient acting as a nurse, and afterward completed a self-evaluation with video review by the students' assigned coach and feedback on the session. RESULTS We collected complete responses from 108 students. We evaluated the curriculum for feasibility and acceptability by faculty and students. Most students agreed with faculty on their entrustment and milestone levels. Students found that the session prompted self-reflection and was a good review of conflict resolution. The standardized patient and faculty feedback was found to be the most useful by the students. DISCUSSION We successfully implemented a simulated but realistic conflict resolution exercise. Students found the exercise helpful in their preparation for residency.
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Affiliation(s)
| | - Nancy Knudsen
- Professor, Department of Anesthesiology, and Associate Professor, Department of Surgery, Duke University School of Medicine
| | - Timothy Scialla
- Adjunct Assistant Professor, Department of Medicine, Duke University School of Medicine
| | - Amanda Shepherd
- Clinical Assistant Professor, Department of Medicine, University of Washington School of Medicine
| | - Alison Clay
- Assistant Professor, Department of Surgery, and Assistant Professor, Department of Medicine, Duke University School of Medicine
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Ramkumar J, Rosencranz H, Herzog L. Asthma Exacerbation Triggered by Wildfire: A Standardized Patient Case to Integrate Climate Change Into Medical Curricula. MedEdPORTAL 2021; 17:11063. [PMID: 33437868 PMCID: PMC7792455 DOI: 10.15766/mep_2374-8265.11063] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Climate change presents unprecedented health threats. It is imperative that medical trainees understand the implications of climate change/planetary health on the physical and mental health and well-being of their patients. Medical professionals generally are not trained to consider climate change impacts in patient encounters. Hence, there is a need to train climate-aware providers who will be at the forefront of patient care in managing these current and emerging health impacts. METHODS We created a standardized patient (SP) case enhanced with details of risks and health impacts due to exposure to wildfire smoke. This session was deployed to 11 internal medicine clerkship students as part of a standard OSCE already included in our curriculum to evaluate core clinical and communication skills. Two cohorts, a group activity, and a one-on-one encounter were deployed and followed with a faculty debrief and learner assessments. RESULTS Students had increased awareness and knowledge of health impacts of climate change and potential actions for adaptation and mitigation. The improvements were statistically significant for the one-on-one cohort (p = .006). Postsimulation comments were favorable; students were more inclined to consider health impacts, risks, and vulnerabilities exacerbated by climate change. DISCUSSION Students had an increased recognition of climate change as a force impacting their patients' health which should be considered in patient care. This format allowed retention of well established curricular content, but also the inclusion of other crucial emerging issues that will impact public health locally and globally and foster the development of climate-aware health care providers.
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Affiliation(s)
- Japhia Ramkumar
- Clinical Associate Professor, Department of Medicine, University of Illinois College of Medicine at Urbana
- Corresponding author:
| | - Holly Rosencranz
- Clinical Associate Professor, Department of Medicine, University of Illinois College of Medicine at Urbana
| | - Leslie Herzog
- Retired Research Assistant, Department of Medicine, University of Illinois College of Medicine at Urbana
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Afonso N, Kelekar A, Alangaden A. "I Have a Cough": An Interactive Virtual Respiratory Case-Based Module. MedEdPORTAL 2020; 16:11058. [PMID: 33365392 PMCID: PMC7751326 DOI: 10.15766/mep_2374-8265.11058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/31/2020] [Indexed: 05/30/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has radically disrupted traditional models of medical education, forcing rapid evolution in the delivery of clinical training. As a result, clinical educators must quickly transition away from in-person sessions and develop effective virtual learning opportunities instead. This virtual resource was designed to replace a clinical simulation session for the physical examination course for medical students in the preclinical years. METHODS We designed an online interactive module in three sections for preclinical (first- or second-year) medical students who had not yet learned the respiratory physical exam. The first section incorporated demonstration and practice of the components of the respiratory physical exam that could be effectively taught via videoconferencing software. Following this, students conducted a telemedicine encounter with a standardized patient and received patient-centered feedback evaluating their communication skills. The final segment involved a case discussion and clinical reasoning component. RESULTS These sessions were implemented for 122 first-year medical students. The module was well received by the students. A majority felt that it helped improve their telemedicine communication skills (93%), interpretation of physical exam findings (84%), development of differential diagnosis (95%), and correlation of clinical and basic science content (93%). DISCUSSION Our pilot educational session demonstrates that this virtual instruction method is an effective tool for teaching basic clinical skills during medical school. Virtual learning resources allow remote instruction to take place and can be a supplement when face-to-face clinical teaching is not possible.
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Affiliation(s)
- Nelia Afonso
- Professor, Foundation Medical Studies, Oakland University William Beaumont School of Medicine
| | - Arati Kelekar
- Assistant Professor, Internal Medicine, Oakland University William Beaumont School of Medicine and Beaumont Health System
| | - Anjali Alangaden
- Third-Year Medical Student, Wayne State University School of Medicine
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Hagey JM, Toole J, Branford K, Reynolds T, Livingston E, Dotters-Katz SK. Understanding Sexual Complaints and History Taking: A Standardized Patient Case on Dyspareunia for Obstetrics and Gynecology Clerkship Students. MedEdPORTAL 2020; 16:11001. [PMID: 33150201 PMCID: PMC7597941 DOI: 10.15766/mep_2374-8265.11001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 06/11/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Learning to elicit a sexual history and counsel patients on sexual pain aligns with the Association of Professors of Gynecology and Obstetrics clerkship objectives. This topic can be challenging to cover due to lack of exposure in clinical encounters and inadequate coverage in preclinical studies. METHODS Second-year medical students in the OB/GYN clerkship participated in a standardized patient (SP) encounter on dyspareunia, receiving formative feedback on sexual history taking, differential diagnosis and management plan, and their SP's comfort during the encounter. Student feedback was obtained mid- and postclerkship. Summary statistics and regression models comparing SP encounter scores with shelf exam and clerkship scores are reported. RESULTS From September 2018 through July 2019, 101 students completed the encounter. Students asked an average of 3.9 of 13 sexual history questions. Sixty-six percent of students identified a correct diagnosis; 48% provided a management plan. The majority of students were very good or excellent at creating a safe environment. Most reported the encounter enhanced their learning (62%) and identified knowledge gaps (72%). SP encounter score was not associated with shelf exam score or clerkship letter grade but was associated with final clerkship score (unadjusted ß = 0.2, p = .009; adjusted ß = 0.1, p = .2). A summary didactic session was developed following student feedback. DISCUSSION This SP encounter and summary didactic session allowed students to improve their sexual history taking and may be associated with clerkship performance. These skills are necessary to advocate for patients with sensitive complaints across specialties.
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Affiliation(s)
- Jill M. Hagey
- Resident Physician, Department of Obstetrics and Gynecology, Duke University Medical Center
| | - Jordan Toole
- Undergraduate Medical Education Coordinator, Department of Obstetrics and Gynecology, Duke University Medical Center
| | - Kelly Branford
- Director of Clinical Skills Program, Office of Curricular Affairs, Duke University School of Medicine
| | - Tracey Reynolds
- Standardized Patient Coordinator, Office of Curricular Affairs, Duke University School of Medicine
| | - Elizabeth Livingston
- Professor, Department of Obstetrics and Gynecology, Duke University Medical Center
| | - Sarah K. Dotters-Katz
- Assistant Professor, Department of Obstetrics and Gynecology, Duke University Medical Center
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Shen E, Cristiano JA, Ellis LR. The Electronic Health Record Objective Structured Clinical Examination Station: Assessing Student Competency in Patient Notes and Patient Interaction. MedEdPORTAL 2020; 16:10998. [PMID: 33150200 PMCID: PMC7597945 DOI: 10.15766/mep_2374-8265.10998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 06/11/2020] [Indexed: 05/26/2023]
Abstract
INTRODUCTION The ability to utilize the electronic health record (EHR) without compromising the doctor-patient relationship (DPR) is an essential skill of all physicians and trainees, yet little time is spent on educating or assessing learners on needed techniques. To address this gap, we developed a conventional OSCE station coupled with a simulated patient chart within the Epic program in order to assess our students' skills utilizing the EHR during a patient encounter. METHODS Of third-year medical students, 119 were given full access to the patient's simulated chart 24 hours in advance of their OSCE to review clinical data. During an in-person OSCE with a standardized patient (SP), students performed a focused history and physical, using the EHR to verify allergies and medications. Students completed an electronic patient note graded by faculty. SPs evaluated the students on communication and interpersonal skills with specific rubric elements. Faculty graded the students' notes to evaluate their expression of clinical reasoning in the assessment and plan. RESULTS Training SPs and faculty to assess students on EHR skills was feasible. After implementation of a comprehensive curriculum focused on EHR and DPR, there was a significant difference on EHR-related communication skills (M = 76.4, SD = 17.6) versus (M = 37, SD = 28.9) before curriculum enhancement t (117.9) = -12.4, p <.001. DISCUSSION The EHR OSCE station provided a standardized method of assessing students' EHR skills during a patient encounter. Challenges still exist in the technological requirements to develop and deliver cases in today's EHR platform.
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Affiliation(s)
- E. Shen
- Assistant Professor, Department of Internal Medicine, Section of General Internal Medicine, Wake Forest Baptist Health
| | - Joseph Anthony Cristiano
- Assistant Professor, Department of Internal Medicine, Section of General Internal Medicine, Wake Forest Baptist Health
| | - Leslie Renee Ellis
- Associate Professor, Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest Baptist Health
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Jackson JM, Stacey RB, Korczyk SS, Williams DM. The Simulated Cardiology Clinic: A Standardized Patient Exercise Supporting Medical Students' Biomedical Knowledge and Clinical Skills Integration. MedEdPORTAL 2020; 16:11008. [PMID: 33150203 PMCID: PMC7597946 DOI: 10.15766/mep_2374-8265.11008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Development of cardiac disease-related diagnostic skills-including hypothesis-driven data gathering, heart sound interpretation, and ECG interpretation-is an important component of medical student training. Prior studies indicate trainees' performance of these skills is limited. Simulation provides students with opportunities to practice integrating their developing knowledge in a relevant clinical context. We developed a simulated clinic activity for second-year medical students consisting of standardized patient (SP) cases representing cardiovascular (CV) diseases. METHODS Student small groups rotated through four SP encounters. For each case, one student performed the history, after which the whole small group listened to audio files of heart sounds, interpreted an ECG, and collaboratively developed a prioritized differential diagnosis. The CV course director met with students for a large-group debrief, highlighting key learning points. We collected learners' evaluations of the event through an online survey. RESULTS Of students, 276 participated in this activity over the course of 2 years. Nearly all students assessed the activity as extremely or quite effective for applying learning content from the CV course (97%, 2018; 93%, 2019), and for practicing how to approach chest pain, shortness of breath, palpitations, and fatigue (100%, 2018; 95%, 2019). The most helpful aspects were reinforcement of CV disease illness scripts, hypothesis-driven data gathering practice, ECG interpretation, and applying knowledge and skills in a realistic context. DISCUSSION SP encounters representing CV conditions can effectively provide opportunities for students to integrate basic science knowledge and clinical skills. Students assessed the activity as helpful and engaging.
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Affiliation(s)
- Jennifer M. Jackson
- Associate Professor, Department of Pediatrics, Wake Forest School of Medicine
| | - R. Brandon Stacey
- Associate Professor, Cardiology, Department of Internal Medicine, Wake Forest School of Medicine
| | | | - Donna M. Williams
- Associate Professor, Department of Internal Medicine, Wake Forest School of Medicine
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Bullard MJ, Fox SM, Heffner AC, Bullard CL, Wares CM. Unifying Resident Education: 12 Interdisciplinary Critical Care Simulation Scenarios. MedEdPORTAL 2020; 16:11009. [PMID: 33150204 PMCID: PMC7597944 DOI: 10.15766/mep_2374-8265.11009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
Introduction Unified critical care training within residency education is a necessity. We created a simulation-based curriculum designed to educate residents on core topics and procedural skills, which crossed all adult disciplines caring for critically ill patients. Methods Residents from seven adult disciplines participated in this annual program during intern year. Learners were grouped into mixed discipline cohorts. Each cohort attended three distinct 4-hour simulation-based sessions, each consisting of four scenarios followed by postevent debriefing. The curriculum included 12 total clinical scenarios. Scenarios covered a broad array of complex critical care topics facing all adult specialties and reinforced important system-specific initiatives. Assessments evaluated clinical performance metrics, self-reported confidence in curricular topics, procedural and communication skills, resident satisfaction, and interdisciplinary attitudes. Results Quantitative and qualitative data analyzed in three published works over the past 9 years of curricular programming has demonstrated highly satisfied learners along with improved: clinical performance; self-reported confidence in clinical topics, procedural, and communication skills; and interdisciplinary collegiality. Discussion Purposeful focus on curricular development that integrates basic, clinical, and procedural content, while promoting the development of interdisciplinary relationships and the practice of critical thinking skills, is vital for successful education and patient care. This curriculum was well received by interns, covered difficult to obtain GME milestones, and provided an opportunity for interdisciplinary education. In an era of limited time for devoted bedside teaching and variable training exposures to certain disease processes, the development and implementation of this curriculum has filled a void within our system for unified resident education.
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Affiliation(s)
- Mark J. Bullard
- Associate Professor, Department of Emergency Medicine, Carolinas Medical Center; Medical Director, Carolinas Simulation Center, Atrium Health
| | - Sean M. Fox
- Professor, Department of Emergency Medicine, Carolinas Medical Center, Atrium Health
| | - Alan C. Heffner
- Professor, Department of Emergency Medicine, Department of Internal Medicine, Division of Critical Care, Carolinas Medical Center, Atrium Health
| | | | - Catherine M. Wares
- Associate Professor, Department of Emergency Medicine, Carolinas Medical Center, Atrium Health
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Morris NA, Zimmerman EE, Pozner CN, Henderson GV, Milligan TA. Brain Death Determination: An Interprofessional Simulation to Determine Brain Death and Communicate with Families Focused on Neurology Residents. MedEdPORTAL 2020; 16:10978. [PMID: 33005731 PMCID: PMC7521065 DOI: 10.15766/mep_2374-8265.10978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/30/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Significant variation exists in determining brain death despite an expectation of competence for all neurology residents. In addition, family discussions regarding brain death are challenging and may influence organ donation. METHODS We developed two simulations of increasing complexity for PGY 2 and PGY 3 neurology residents. High-fidelity mannequins were used to simulate patients; standardized actors portrayed family members. In the first simulation, residents determined brain death and shared this information with a grieving family. In the second simulation, residents determined brain death in a more complicated scenario, requiring ancillary testing and accurate result interpretation. Following the determination, residents met with a challenging family. The residents worked with an interdisciplinary team and responded to the family's emotions, used active listening skills, and supported the family through next steps. RESULTS Twelve residents completed the simulations. Prior to the simulation, three (25%) residents felt comfortable discussing a brain death diagnosis; following the simulation, eight (67%) residents felt comfortable/very comfortable discussing brain death. Prior to the simulation, eight (67%) residents stated they knew prerequisites for performing a brain death examination and seven (58%) agreed they knew indications for ancillary testing; these numbers increased to 100% following the simulation. The number of residents who felt comfortable performing the brain death exam increased from five (42%) to 10 (83%). DISCUSSION This simulation of determining brain death and leading difficult family meetings was well-received by neurology residents. Further work should focus on the effects of simulation-based education on practice variation and organ donation consent rates.
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Affiliation(s)
- Nicholas A. Morris
- Assistant Professor, Department of Neurology, Program in Trauma, University of Maryland School of Medicine
| | - Eli E. Zimmerman
- Assistant Professor, Department of Neurology, Vanderbilt University School of Medicine
| | - Charles N. Pozner
- Associate Professor, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School
| | - Galen V. Henderson
- Assistant Professor, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School
| | - Tracey A. Milligan
- Assistant Professor, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School
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Jackson JM, Strowd LC, Peters TR. The Simulated Virology Clinic: A Standardized Patient Exercise for Preclinical Medical Students Supporting Basic and Clinical Science Integration. MedEdPORTAL 2020; 16:10957. [PMID: 32934980 PMCID: PMC7485908 DOI: 10.15766/mep_2374-8265.10957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 02/19/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Virology is inherently challenging due to the sheer volume of information medical students are responsible for learning. Cognitive integration of this content is critical for early medical students to practice applying this knowledge to diagnostic problem-solving. Simulation offers learners engaging opportunities to practice cognitive integration. We developed a simulated clinic activity for first-year medical students consisting of standardized patient (SP) encounters representing viral infections. METHODS Student small groups rotated through eight SP encounters during which they collected patient histories, reviewed physical exam findings, and developed a differential diagnosis and diagnostic plan for each case. The instructor debriefed students on the cases afterward. We assessed students' evaluation of the activity through online surveys. RESULTS Two hundred seventy-eight students participated in the simulated clinic in 2018 and 2019. Students rated the activity as very effective for learning about the infections represented and for providing opportunities to integrate clinical skills. Students agreed that the event's instructional design was appropriate for its objectives and that the problem-solving aspect was intellectually stimulating. They indicated that the most effective aspects were solidifying illness scripts for the infections represented, integrating knowledge and skills to diagnose patients in a realistic clinical context, and working collaboratively to problem-solve. DISCUSSION The simulated virology clinic is an effective method for providing students opportunities to integrate microbiology and clinical skills and has been positively received by students. This instructional method offers learners an opportunity to solidify illness scripts for viral infections using an interactive, collaborative approach.
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Affiliation(s)
- Jennifer M. Jackson
- Associate Professor, Department of Pediatrics, Wake Forest School of Medicine; Co-Course Director, Clinical Skills Curriculum, Wake Forest School of Medicine; Co-Course Director, Virology Course, Wake Forest School of Medicine; Assistant Dean for Curricular Innovation, Wake Forest School of Medicine
| | - Lindsay C. Strowd
- Assistant Professor, Department of Dermatology, Wake Forest School of Medicine; Director, Dermatology Thread, Wake Forest School of Medicine
| | - Timothy R. Peters
- Professor, Department of Pediatrics, Wake Forest School of Medicine; Associate Dean for Educational Strategy & Innovation, Wake Forest School of Medicine; Co-Course Director, Virology Course, Wake Forest School of Medicine
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Martin A, Jacobs A, Krause R, Amsalem D. The Mental Status Exam: An Online Teaching Exercise Using Video-Based Depictions by Simulated Patients. MedEdPORTAL 2020; 16:10947. [PMID: 32875093 PMCID: PMC7450674 DOI: 10.15766/mep_2374-8265.10947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 01/30/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The mental status exam (MSE) is a structured approach to gathering a patient's behavioral and cognitive information. Analogous to the physical exam, it provides a template to collect clinical data in a systematic fashion. The MSE is a core competency of undergraduate medical education (UME) and an entrustable professional activity in clinical psychiatry. METHODS We developed video clips of simulated patients depicting three adults respectively diagnosed with schizophrenia, obsessive-compulsive disorder, and bipolar disorder. We used three short video clips per condition to demonstrate an incremental number of psychiatric signs and symptoms. We used the nine video clips as calibrated stimuli for learners to identify components of the MSE using an online tool. RESULTS We piloted this online exercise among 37 volunteer students. Experienced learners performed better than novice ones on overall identification of MSE components (p <.001). Specifically, they were able to identify elements of the MSE following an ABC-STAMPS (appearance, behavior, cooperation; and speech, thought process and content, affect, mood, perceptions, suicidality) rubric. DISCUSSION This video-based scoring tool was easy to implement in a UME setting and well received by students as a formative didactic exercise and educational complement.
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Affiliation(s)
- Andrés Martin
- Riva Ariella Ritvo Professor, Child Study Center and Director, Standardized Patient Program, Yale School of Medicine; Visiting Professor, Faculty of Medicine of Tel-Aviv University
| | - Asaf Jacobs
- Fourth-Year Medical Student, Faculty of Medicine of Tel-Aviv University
| | | | - Doron Amsalem
- Child and Adolescent Psychiatry Resident, Sheba Medical Center and Faculty of Medicine of Tel-Aviv University
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Williams DM, Bruggen JT, Manthey DE, Korczyk SS, Jackson JM. The GI Simulated Clinic: A Clinical Reasoning Exercise Supporting Medical Students' Basic and Clinical Science Integration. MedEdPORTAL 2020; 16:10926. [PMID: 32782925 PMCID: PMC7412764 DOI: 10.15766/mep_2374-8265.10926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/10/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Cognitive integration is required to perform clinical decision-making tasks, even in the preclinical curriculum of medical school. Simulation supports students' cognitive integration by providing practical application of basic science knowledge in a relevant clinical context. To address the need for integrative activities in our curriculum, we implemented a simulated clinic exercise with cases representing gastrointestinal diseases for first-year medical students. METHODS Basic science and clinical skills course directors collaborated to design this simulated clinic event, during which student small groups rotated through a series of standardized patient encounters. During each encounter, one student performed the history and physical exam, following which the small group collaboratively developed a prioritized differential diagnosis. Afterwards, the gastroenterology course director debriefed students to highlight key learning points. We collected learner evaluation data following the event. RESULTS Two hundred eighty first-year medical students participated in the simulated clinic in 2018 and 2019. Students rated these events as effective for learning about clinical features of the diseases presented and for reinforcing skills learned in the clinical skills course. Students agreed that the small-group format, pace, and duration were appropriate and that the problem-solving aspect was intellectually stimulating. The most effective aspects were opportunities to solidify illness scripts, apply knowledge to solve a problem, and encounter diseases in a realistic clinical context. DISCUSSION This simulated clinic model effectively supported preclinical students' basic and clinical science integration to complete diagnostic reasoning tasks for gastrointestinal gastrointestinal conditions and was evaluated favorably by learners.
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Affiliation(s)
- Donna M. Williams
- Associate Professor, Department of Internal Medicine, Wake Forest School of Medicine
| | - Joel T. Bruggen
- Professor, Section of Gastroenterology, Department of Internal Medicine, Wake Forest School of Medicine
| | - David E. Manthey
- Professor, Department of Emergency Medicine, Wake Forest School of Medicine
| | - Sharon S. Korczyk
- Curriculum Coordinator, Academic Affairs, Wake Forest School of Medicine
| | - Jennifer M. Jackson
- Associate Professor, Department of Pediatrics, Wake Forest School of Medicine
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Tucker Edmonds B, Hoffman SM, Laitano T, McKenzie F, Panoch J, Litwiller A, Corcia MJD. Evaluating Shared Decision Making in Trial of Labor After Cesarean Counseling Using Objective Structured Clinical Examinations. MedEdPORTAL 2020; 16:10891. [PMID: 32342013 PMCID: PMC7182044 DOI: 10.15766/mep_2374-8265.10891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 10/21/2019] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Although shared decision making (SDM) is optimal for trial of labor after cesarean (TOLAC) counseling, resources to assess residents' clinical competency and communication skills are lacking. We addressed this gap by developing and testing an objective structured clinical examination (OSCE) to evaluate whether learners were able to use SDM in TOLAC counseling. METHODS We created three simulation scenarios with increasing complexity to assess the skills of residents in their first, second, or third postgraduate year in using SDM in TOLAC counseling. All cases involved a standardized patient requesting a TOLAC consultation. Residents were provided with a medical history and instructed to counsel and develop a care plan. A 10-item scoring rubric was used, and each item was rated 0 (absent), 1 (partial), or 2 (complete). Three coders independently rated the encounters; discrepancies were resolved by consensus. RESULTS Over 3 years, 39 residents participated in 60 OSCE encounters. The majority provided complete discussions of the clinical issue (93%), chances of success (72%), and maternal and fetal risks (100% and 85%, respectively) but obtained partial assessments of understanding (78%). Discussions of benefits were typically absent, with the exception of the maternal benefits (47%). More than 40% of residents did not discuss the patient's goals, 53% lacked discussion of uncertainties related to TOLAC, and half failed to explore the patient's preference, with most deferring a decision to a future encounter. DISCUSSION Residents consistently discussed diagnosis, prognosis, and maternal risks yet infrequently addressed goals and preferences-two critical elements of SDM.
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Affiliation(s)
- Brownsyne Tucker Edmonds
- Associate Professor, Department of Obstetrics and Gynecology, Indiana University School of Medicine
- Assistant Dean for Diversity Affairs, Indiana University School of Medicine
| | - Shelley M. Hoffman
- Research Coordinator, Department of Obstetrics and Gynecology, Indiana University School of Medicine
| | - Tatiana Laitano
- Research Assistant, Department of Obstetrics and Gynecology, Indiana University School of Medicine
| | - Fatima McKenzie
- Research Coordinator, Department of Obstetrics and Gynecology, Indiana University School of Medicine
| | - Janet Panoch
- Research Assistant, Department of Obstetrics and Gynecology, Indiana University School of Medicine
| | - Abigail Litwiller
- Associate Professor of Clinical Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of Illinois College of Medicine
- Associate Department Head for Education and Faculty Development, Department of Obstetrics and Gynecology, University of Illinois College of Medicine
- Residency Program Director, Department of Obstetrics and Gynecology, University of Illinois College of Medicine
| | - Mark J. Di Corcia
- Assistant Dean for Medical Education and Academic Affairs, Florida Atlantic University Charles E. Schmidt College of Medicine
- Associate Professor of Integrated Medical Science, Florida Atlantic University Charles E. Schmidt College of Medicine
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Cantone RE, Palmer R, Dodson LG, Biagioli FE. Insomnia Telemedicine OSCE (TeleOSCE): A Simulated Standardized Patient Video-Visit Case for Clerkship Students. MedEdPORTAL 2019; 15:10867. [PMID: 32051850 PMCID: PMC7012306 DOI: 10.15766/mep_2374-8265.10867] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 09/07/2019] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Telemedicine is a growing practice with minimal training in US medical schools. Telemedicine OSCE (TeleOSCE) simulations allow students to practice this type of patient interaction in a standardized way. METHODS The Insomnia-Rural TeleOSCE was implemented as part of a required clinical clerkship for students in their second, third, or fourth year of medical school. This case addressed a patient with depression in a medically underserved area. Students performed it as a formative experience and received immediate feedback. They then completed a survey to evaluate the experience. RESULTS Students (n = 287) rated the quality of the experience 7.59 out of 10. Comments showed that 61 learners thought the TeleOSCE was a positive experience, 35 wanted more teaching about telemedicine, 28 improved their understanding of barriers to care, 25 expressed concern over minimal other training, 23 found the TeleOSCE important and challenging, 16 appreciated the differences between in-person and remote visits, and 15 wanted fewer distractions. Eight students worried about how they would be judged, five learned from the technical limitations, five requested more time, five were skeptical of the utility, and five saw telemedicine as triage. DISCUSSION The TeleOSCE allows learners to gain exposure to telemedicine in a safe simulated teaching environment and assesses learner competencies. The TeleOSCE also improves students' understanding of barriers to care and the utility of telemedicine. It logistically allows faculty to directly assess distance students on their clinical reasoning and patient communication skills.
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Affiliation(s)
- Rebecca E. Cantone
- Assistant Professor, Department of Family Medicine, Oregon Health & Science University
- Director of Family Medicine Core Clinical Experience (Clerkship), Oregon Health & Science University
- Director of Family Medicine Student Education, Oregon Health & Science University
| | - Ryan Palmer
- Associate Dean of Medical Education, Northeast Ohio Medical University
| | | | - Frances E. Biagioli
- Professor, Department of Family Medicine, Oregon Health & Science University
- Vice Chair of Education, Department of Family Medicine, Oregon Health & Science University
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McCave EL, Aptaker D, Hartmann KD, Zucconi R. Promoting Affirmative Transgender Health Care Practice Within Hospitals: An IPE Standardized Patient Simulation for Graduate Health Care Learners. MedEdPORTAL 2019; 15:10861. [PMID: 32051844 PMCID: PMC7010321 DOI: 10.15766/mep_2374-8265.10861] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/26/2019] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Transgender patients frequently experience discrimination within health care settings due to provider lack of knowledge and bias resulting in poor service delivery. Team-based interprofessional collaboration is becoming a best practice for health professionals to improve patient-centered care and address these health disparities. METHODS A team-based interprofessional education simulation activity was developed as a teaching activity at a university for graduate health care learners in medicine, nursing, occupational therapy, physical therapy, physician assistant, social work, and health care administration programs over 2 years (N = 494). The simulation focused on a transgender patient brought to the emergency department (ED) after a workplace assault. Students were placed in interprofessional teams and asked to critique the initial ED interaction with the patient and then complete a team huddle and discharge planning meeting with a standardized patient. Student preparedness to engage in the Interprofessional Education Collaborative (IPEC) competencies was assessed through a posttest measure. RESULTS Student learners reacted overwhelmingly positively to the activities of the workshop. The averaging of 2 years of data yielded students responses of strongly agree and agree at 90% or higher for all IPEC core competencies, as well as for educational objectives of the workshop. DISCUSSION Reducing the structural, interpersonal, and individual stigma experienced by transgender patients requires institutions to offer experiential learning opportunities for future health care providers. This interprofessional education simulation experience focusing on transgender patients calls attention to the negative impact of stigma while also promoting competency in interprofessional practice.
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Affiliation(s)
- Emily L. McCave
- Associate Professor, Department of Social Work, Quinnipiac University
- Assistant Director, Center for Interprofessional Healthcare Education, Quinnipiac University
| | - Dennis Aptaker
- Clinical Assistant Professor, Department of Occupational Therapy, Quinnipiac University
| | - Kimberly D. Hartmann
- Professor, Department of Occupational Therapy, Quinnipiac University
- Director, Center for Interprofessional Healthcare Education, Quinnipiac University
| | - Rebecca Zucconi
- Assistant Professor, Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University
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Karpa K, Graveno M, Brightbill M, Fox G, Kelly S, Lehman E, Salvadia A, Shaw T, Smith D, Walko M, Sherwood L. Geriatric Assessment in a Primary Care Environment: A Standardized Patient Case Activity for Interprofessional Students. MedEdPORTAL 2019; 15:10844. [PMID: 31911935 PMCID: PMC6944254 DOI: 10.15766/mep_2374-8265.10844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 06/21/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Given the aging population and the benefits of comprehensive geriatric assessment to this subset of patients, an interprofessional education training approach may be advantageous for learners from a number of different health professions. METHODS Through intercollegiate collaborations involving seven different colleges, an interprofessional simulation using standardized patients was developed and instituted for learners in medicine, nursing, pharmacy, occupational therapy, physical therapy, dental hygiene, and dietitian programs. Herein, we describe the design of the simulation experience and examine its impact on students, as assessed primarily via written reflective comments provided via exit slips at the conclusion of the activity. RESULTS Of the 340 student participants, 83% submitted exit slips describing something gained from the interprofessional session that would not have occurred if students had completed the activity with only students from their own discipline. Three key themes were identified from these reflections: new understanding of roles and responsibilities of other disciplines, new knowledge or skills pertaining to geriatric assessments, and the value of teamwork. DISCUSSION Reflective comments from students regarding the interprofessional experience are evidence of this initiative's benefits, which include increasing knowledge of geriatric medical and allied health-provided care and attainment of interprofessional competencies.
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Affiliation(s)
- Kelly Karpa
- Professor, Department of Pharmacology, Pennsylvania State University College of Medicine
- Assistant Dean for Interprofessional Education, Pennsylvania State University College of Medicine
| | - Molly Graveno
- PharmD Candidate, Duquesne University School of Pharmacy
| | - Megan Brightbill
- Campus Associate Dean, Academic Affairs, Harrisburg Area Community College
| | - Gina Fox
- Lecturer, Occupational Therapy, Elizabethtown College
| | - Shawnee Kelly
- Assistant Teaching Professor, Department of Nutritional Sciences, Pennsylvania State University College of Health and Human Development
- Coordinator of Master of Professional Studies in Nutritional Sciences, Department of Nutritional Sciences, Pennsylvania State University College of Health and Human Development
| | - Erik Lehman
- Biostatistician, Department of Public Health Sciences, Pennsylvania State University College of Medicine
| | | | - Tanya Shaw
- Education Program Assistant, Pennsylvania State University College of Medicine
| | - Dylan Smith
- PharmD Candidate, Nesbitt School of Pharmacy, Wilkes University
| | - Matthew Walko
- Clinical Assistant Professor, Physical Therapy, Lebanon Valley College
| | - Lisa Sherwood
- Assistant Professor, Department of Medicine, Pennsylvania State University College of Medicine
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Ohmer M, Durning SJ, Kucera W, Nealeigh M, Ordway S, Mellor T, Mikita J, Howle A, Krajnik S, Konopasky A, Ramani D, Battista A. Clinical Reasoning in the Ward Setting: A Rapid Response Scenario for Residents and Attendings. MedEdPORTAL 2019; 15:10834. [PMID: 31773062 PMCID: PMC6869982 DOI: 10.15766/mep_2374-8265.10834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/21/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION There is a need for educational resources supporting the practice and assessment of the complex processes of clinical reasoning in the inpatient setting along a continuum of physician experience levels. METHODS Using participatory design, we created a scenario-based simulation integrating diagnostic ambiguity, contextual factors, and rising patient acuity to increase complexity. Resources include an open-ended written exercise and think-aloud reflection protocol to elicit diagnostic and management reasoning and reflection on that reasoning. Descriptive statistics were used to analyze the initial implementation evaluation results. RESULTS Twenty physicians from multiple training stages and specialties (interns, residents, attendings, family physicians, internists, surgeons) underwent the simulated scenario. Participants engaged in clinical reasoning processes consistent with the design, considering a total of 19 differential diagnoses. Ten participants provided the correct leading diagnosis, tension pneumothorax, with an additional eight providing pneumothorax and all participants offering relevant supporting evidence. There was also good evidence of management reasoning, with all participants either performing an intervention or calling for assistance and reflecting on management plans in the think-aloud. The scenario was a reasonable approximation of clinical practice, with a mean authenticity rating of 4.15 out of 5. Finally, the scenario presented adequate challenge, with interns and residents rating it as only slightly more challenging (means of 7.83 and 7.17, respectively) than attendings (mean of 6.63 out of 10). DISCUSSION Despite the challenges of scenario complexity, evaluation results indicate that this resource supports the observation and analysis of diagnostic and management reasoning of diverse specialties from interns through attendings.
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Affiliation(s)
- Megan Ohmer
- Research Assistant, Department of Medicine, Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences
| | - Steven J. Durning
- Professor, Department of Medicine and Pathology, Uniformed Services University of the Health Sciences
- Director, Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences
| | - Walter Kucera
- Resident, Department of Surgery, Walter Reed National Military Medical Center
| | - Matthew Nealeigh
- Resident, Department of Surgery, Walter Reed National Military Medical Center
| | - Sarah Ordway
- Fellow, Department of Internal Medicine, Division of Gastroenterology, Walter Reed National Military Medical Center
| | - Thomas Mellor
- Fellow, Department of Internal Medicine, Division of Gastroenterology, Naval Medical Center San Diego
| | - Jeffery Mikita
- Chief, Department of Simulation, Walter Reed National Military Medical Center
- Program Director, Department of Internal Medicine, Division of Pulmonology and Critical Care Medicine, Walter Reed National Military Medical Center
- Associate Professor, Department of Medicine, Uniformed Services University of the Health Sciences
| | - Anna Howle
- Simulation Educator, Department of Simulation, Walter Reed National Military Medical Center
| | - Sarah Krajnik
- Simulation Educator, Department of Simulation, Walter Reed National Military Medical Center
| | - Abigail Konopasky
- Assistant Professor, Department of Medicine, Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences
| | - Divya Ramani
- Research Assistant, Department of Medicine, Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences
| | - Alexis Battista
- Assistant Professor, Department of Medicine, Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences
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Turner-Lawrence D, Hang BS, Shah P, Levasseur K. An Emergency Medicine Milestone-Based Simulation Curriculum: Acute Ischemic Stroke. MedEdPORTAL 2019; 15:10829. [PMID: 31294077 PMCID: PMC6597876 DOI: 10.15766/mep_2374-8265.10829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 04/11/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The emergency medicine (EM) resident's ability to make independent decisions in the setting of acute ischemic stroke has been reduced as a result of the involvement of multidisciplinary teams. This simulation was created to give EM residents the opportunity to independently manage the early stages of ischemic stroke and its complications. METHODS A solo learner was presented with a 55-year-old male with complaints consistent with an acute stroke. The resident had to calculate stroke severity; coordinate hospital resources; discuss risks, benefits, and alternatives to thrombolysis; and deal with subsequent complications. The learner had to keep a broad differential for sudden change in mental status and consider alternative interventions. Strategies to decrease intracranial pressure needed to be implemented while obtaining neurosurgical consultation. Debriefing included discussion of expected actions in the context of the Accreditation Council for Graduate Medical Education (ACGME) milestones. Residents' review of their video performance added additional self-reflection. RESULTS A total of 69 PGY 3 EM residents independently participated in this simulation over a 5-year period. Thirty-two completed a postsimulation evaluation. Nearly all learners felt that this case reflected an actual patient encounter and increased their confidence in managing stroke. The milestone-based feedback tool was completed with all learners. Anticipated actions linked to Level 1 and 2 milestones were regularly achieved while acquisition of Level 3 and 4 actions varied. DISCUSSION Case actions were uniquely characterized by the ACGME milestones, which helped to delineate learners' knowledge gaps and provided concrete areas for improvement.
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Affiliation(s)
- Danielle Turner-Lawrence
- Associate Professor, Department of Emergency Medicine, Oakland University William Beaumont School of Medicine
- Emergency Medicine Program Director, Beaumont Hospital
| | - Bophal Sarha Hang
- Assistant Professor, Department of Emergency Medicine, Oakland University William Beaumont School of Medicine
- Director of Emergency Medicine Simulation, Beaumont Hospital
| | - Payal Shah
- Assistant Professor, Department of Emergency Medicine, Oakland University William Beaumont School of Medicine
- Associate Emergency Medicine Program Director, Beaumont Hospital
| | - Kelly Levasseur
- Associate Professor, Department of Emergency Medicine, Oakland University William Beaumont School of Medicine
- Pediatric Emergency Center Division Chief, Beaumont Hospital
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Pinto Taylor E, Mulenos A, Chatterjee A, Talwalkar JS. Partnering With Interpreter Services: Standardized Patient Cases to Improve Communication With Limited English Proficiency Patients. MedEdPORTAL 2019; 15:10826. [PMID: 31161138 PMCID: PMC6543860 DOI: 10.15766/mep_2374-8265.10826] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/08/2019] [Indexed: 05/29/2023]
Abstract
INTRODUCTION As the number of patients with limited English proficiency grows, there is increasing awareness in the medical community about disparities in health outcomes for this population. The proper use of professional medical interpreters improves communication between physicians and patients with limited English proficiency. Typically, however, little curricular time in medical training is devoted to this competency. METHODS We developed a two-station objective structured clinical examination (OSCE) in which learners worked with interpreters to conduct medical interviews with Spanish-speaking standardized patients (SPs). Cases were designed for use with residents from any medical specialty and to have personal and emotional richness in keeping with the real-life circumstances of many patients. Twelve residents from six medical specialties completed a session evaluation and were assessed by faculty, SPs, and interpreters using existing validated instruments and case-specific checklists. RESULTS All residents reported that the cases mimicked real patient encounters. The checklists were well received and easy to use. While scores varied between residents, deficiencies were identified in basic communication skills for interacting with a non-English-speaking SP through an interpreter, including maintaining proper eye contact and open body posture with patients and introducing and clearly articulating the role of the interpreter. DISCUSSION A two-station OSCE utilizing professional medical interpreters and Spanish-speaking SPs was well received by all participants. Residents' scores helped identify common skill gaps in their work with interpreters. Based on the success of the pilot deployment, we plan to target educational interventions at these common deficiencies and offer the OSCE to more trainees.
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Affiliation(s)
- Emily Pinto Taylor
- Resident Physician, Department of Internal Medicine, Yale School of Medicine
- Resident Physician, Department of Pediatrics, Yale School of Medicine
| | - Arielle Mulenos
- Postgraduate Research Associate, Department of Internal Medicine, Yale School of Medicine
| | - Avik Chatterjee
- Physician, Boston Health Care for the Homeless Program
- Instructor, Harvard Medical School
- Associate Epidemiologist, Division of Global Health Equity, Department of Internal Medicine, Brigham and Women's Hospital
| | - Jaideep S. Talwalkar
- Associate Professor, Department of Internal Medicine, Yale School of Medicine
- Associate Professor, Department of Pediatrics, Yale School of Medicine
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Cannone D, Atlas M, Fornari A, Barilla-LaBarca ML, Hoffman M. Delivering Challenging News: An Illness-Trajectory Communication Curriculum for Multispecialty Oncology Residents and Fellows. MedEdPORTAL 2019; 15:10819. [PMID: 31139738 PMCID: PMC6507920 DOI: 10.15766/mep_2374-8265.10819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/07/2019] [Indexed: 05/17/2023]
Abstract
Introduction Published curricula to teach communication skills for postgraduate fellows in oncology are few in number despite the fact that oncologists conduct many difficult discussions with their patients and their families. Such discussions may include disclosing initial diagnosis or relapse of a patient's cancer or relaying a poor prognosis or change to palliative care. Methods An eight-module course on communication in oncology practice was delivered over 2 months for palliative and oncology fellows and radiation oncology residents. Learners were given a precourse survey in which they were asked to rate their proficiency in various communication tasks. Each learner then participated in a videotaped precourse objective structured clinical exam (OSCE) on breaking bad news with standardized patients (SPs). The course took place over 8 weeks with weekly didactics and role-play. At the end of the course, a second OSCE took place. After the course was completed, the fellows again filled out a proficiency survey. Results Twenty-two learners participated over 2 years of this course. Participants reported a significant increase in perceived competence in all areas on the postcourse survey. SP feedback on OSCEs pre- and postcourse indicated improvement in skills for learners. Pre- and postcourse OSCE video assessment revealed a significant improvement in global communication skills. Discussion Initial data show that this course successfully improved communication skills and increased fellows' comfort level across several domains of communication. Future directions include validating our assessment tool, expanding the topic base, and investigating the impact on practice after course completion.
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Affiliation(s)
- Daniel Cannone
- Fellow, Division of Pediatric Hospice and Palliative Medicine, University of Tennessee Health Science Center
| | - Mark Atlas
- Attending Physician, Cohen Children's Medical Center; Program Director, Division of Pediatric Hematology/Oncology and Stem Cell Transplantation, Cohen Children's Medical Center
- Associate Professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
| | - Alice Fornari
- Associate Dean for Educational Skills Development, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
- Professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
| | - Maria-Louise Barilla-LaBarca
- Associate Professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
- Attending Physician, Division of Rheumatology, Allergy, and Clinical Immunology, Long Island Jewish Medical Center
| | - Mark Hoffman
- Associate Professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
- Attending Physician, Division of Hematology/Oncology, Monter Cancer Center
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Patel RA, Mohl L, Paetow G, Maiser S. Acute Neuromuscular Respiratory Weakness Due to Acute Inflammatory Demyelinating Polyneuropathy (AIDP): A Simulation Scenario for Neurology Providers. MedEdPORTAL 2019; 15:10811. [PMID: 30931390 PMCID: PMC6415011 DOI: 10.15766/mep_2374-8265.10811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 01/25/2019] [Indexed: 06/09/2023]
Abstract
Introduction Acute neuromuscular respiratory failure is a source of morbidity and mortality in neurological diseases, including acute inflammatory demyelinating polyneuropathy (AIDP), also known as Guillain-Barré syndrome. It is important for health care providers to recognize this condition and provide early ventilatory support. In this simulation, learners must assess and treat a standardized patient with acute respiratory complications related to AIDP. Methods This is a single-session simulation that can be run in a standard simulation center using a live standardized patient. The simulation scenario is followed by a facilitated debriefing session. Details about the simulation scenario, critical action checklist, environment preparation, actors/roles, and debriefing session are outlined. Results A total of 14 neurology residents participated in this simulation. A postsimulation survey revealed that participants thought the simulation achieved its stated objectives, was useful, and would impact their future practice. Discussion We designed this simulation to assess a learner's ability to identify acute neuromuscular respiratory weakness in a patient with AIDP and initiate treatment with ventilatory support. This simulation can easily be incorporated into an existing curriculum for neurology residents or for trainees in other specialties.
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Affiliation(s)
- Roshni Abee Patel
- Neurology Resident, Department of Neurology, University of Minnesota Medical School
| | - Leighton Mohl
- Neurology Resident, Department of Neurology, University of Minnesota Medical School
| | - Glenn Paetow
- Medical Education & Simulation Fellow, Department of Emergency Medicine, Hennepin Healthcare
| | - Samuel Maiser
- Assistant Professor of Neurology, Department of Neurology, University of Minnesota
- Assistant Professor of Neurology, Department of Neurology, Hennepin Healthcare
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Battista A, Konopasky A, Ramani D, Ohmer M, Mikita J, Howle A, Krajnik S, Torre D, Durning SJ. Clinical Reasoning in the Primary Care Setting: Two Scenario-Based Simulations for Residents and Attendings. MedEdPORTAL 2018; 14:10773. [PMID: 30800973 PMCID: PMC6346281 DOI: 10.15766/mep_2374-8265.10773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 10/12/2018] [Indexed: 06/09/2023]
Abstract
Introduction We describe the development and implementation of tools medical educators or researchers can use for developing or analyzing residents' through attending physicians' clinical reasoning in an outpatient clinic setting. The resource includes two scenario-based simulations (i.e., diabetes, angina), implementation support materials, an open-ended postencounter form, and a think-aloud reflection protocol. Method We designed two scenarios with potential case ambiguity and contextual factors to add complexity for studying clinical reasoning. The scenarios are designed to be used prior to an open-ended written exercise and a think-aloud reflection to elicit reasoning and reflection. We report on their implementation in a research context but developed them to be used in both educational and research settings. Results Twelve physicians (five interns, three residents, and four attendings) considered between three and six differential diagnoses (M = 4.0) for the diabetes scenario and between three and nine differentials (M = 4.3) for angina. In think-aloud reflections, participants reconsidered their thinking between zero and 14 times (M = 3.5) for diabetes and zero and 11 times (M = 3.3) for angina. Cognitive load scores ranged from 4 to 8 (out of 10; M = 6.2) for diabetes and 5 to 8 (M = 6.6) for angina. Participants rated scenario authenticity between 4 and 5 (out of 5). Discussion The potential case content ambiguity, along with the contextual factors (e.g., patient suggesting alternative diagnoses), provides a complex environment in which to explore or teach clinical reasoning.
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Affiliation(s)
- Alexis Battista
- Assistant Professor, Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences
| | - Abigail Konopasky
- Assistant Professor, Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences
| | - Divya Ramani
- Research Associate, Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences
| | - Megan Ohmer
- Research Associate, Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences
| | - Jeffrey Mikita
- Chief, Department of Simulation, Walter Reed National Military Medical Center
| | - Anna Howle
- Simulation Educator, Department of Medical Simulation, Walter Reed National Military Medical Center
| | - Sarah Krajnik
- Nurse Educator, Department of Simulation, Walter Reed National Military Medical Center
| | - Dario Torre
- Associate Director, Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences
| | - Steven J. Durning
- Director, Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences
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Rivera J, de Lisser R, Dhruva A, Fitzsimmons A, Hyde S, Reddy S, Tsourounis C, Adler SR. Integrative Health: An Interprofessional Standardized Patient Case for Prelicensure Learners. MedEdPORTAL 2018; 14:10715. [PMID: 30800915 PMCID: PMC6342396 DOI: 10.15766/mep_2374-8265.10715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/15/2018] [Indexed: 05/21/2023]
Abstract
Introduction Integrative health care and complementary medicine are widely used by the U.S. population, yet health professions learners are typically inadequately educated to counsel patients on the use of these approaches. This interprofessional standardized patient exercise (ISPE) provides learners the opportunity to discuss various health care professionals' roles in caring for a patient interested in integrative health strategies, and to collaborate on a care plan. Utilizing this ISPE format aligns with the principles of integrative health as it requires interprofessional collaboration to address the multifaceted needs of patients. Methods The ISPE is approximately three hours in duration, and required of all UCSF, third-year dentistry, physical therapy, and medical students; second-year nurse practitioner students, and fourth-year pharmacy students. Social work, nutrition, and chaplain trainees also participated. Working in interprofessional teams of 4-5 learners, team members discuss case information, interview the standardized patient (SP) individually, jointly formulate a care plan, and, discuss the plan with the SP. The experience is debriefed with a facilitator. Results In 2016-17, 520 learners participated in the ISPE. They agreed that they learned about the roles of other health care professionals (M = 5.24 on a six-point scale, SD = 1.27), and that they would recommend the ISPE to fellow students in their profession (M = 5.25, SD = 1.30). Discussion Students appreciated the ability to observe learners from other health professions interacting with the SP, and how different perspectives and expertise were integrated to create a comprehensive care plan. The exercise can be adapted to accommodate local health professions learners.
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Affiliation(s)
- Josette Rivera
- Associate Professor, Department of Medicine, University of California, San Francisco, School of Medicine
| | - Rosalind de Lisser
- Associate Professor, School of Nursing, University of California, San Francisco
| | - Anand Dhruva
- Associate Professor, Department of Medicine, University of California, San Francisco, School of Medicine
| | - Amber Fitzsimmons
- Assistant Professor, Department of Physical Therapy & Rehabilitative Sciences, University of California, San Francisco, School of Medicine
| | - Susan Hyde
- Associate Professor, Department of Preventive and Restorative Dental Sciences, University of California, San Francisco School of Dentistry
| | - Sanjay Reddy
- Associate Professor, Department of Medicine, University of California, San Francisco, School of Medicine
| | - Candy Tsourounis
- Professor of Clinical Pharmacy, Department of Clinical Pharmacy, School of Pharmacy at the University of California San Francisco
| | - Shelley R. Adler
- Professor, Department of Family & Community Medicine University of California, San Francisco Osher Center
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Karpa K, Pinto C, Possanza A, Dos Santos J, Snyder M, Salvadia A, Panchik D, Myers R, Fink M, Dunlap A. Stroke Simulation Activity: A Standardized Patient Case for Interprofessional Student Learning. MedEdPORTAL 2018; 14:10698. [PMID: 30800898 PMCID: PMC6342397 DOI: 10.15766/mep_2374-8265.10698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 02/25/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Integration of interprofessional education (IPE) activities into health professions curricula aims to promote collaborative practice with a goal of improving patient care. METHODS Through intercollegiate collaborations involving four different educational organizations and an academic health center, an interprofessional stroke simulation involving standardized patients was developed and instituted for IPE-naive student learners from medicine, nursing, physician assistant, occupational therapy, and physical therapy programs with additional involvement from pharmacy and social work learners. Herein, we describe the design of the IPE simulation and examine its impact on students' interprofessional development as assessed by students' completion of a validated IPE competency self-assessment tool and written reflective comments after the simulation. RESULTS Self-assessed interprofessional interaction and values domains were evaluated before and after the activity using the shortened 16-question Interprofessional Education Collaborative Competency Self-Assessment tool; data revealed significant changes in both the values and interaction domains of the tool from pre- to postsimulation experience (p < .0001). The qualitative student reflections revealed new student realizations around the concepts of collaboration, leadership, roles of different professions, and the importance of communication after participating in the simulation. DISCUSSION Quantitative data coupled with qualitative reflections from learners support the effectiveness of this activity for facilitating development of interprofessional competencies among health professions students.
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Affiliation(s)
- Kelly Karpa
- Professor, Department of Pharmacology, Pennsylvania State University College of Medicine
| | - Casey Pinto
- Assistant Professor, Public Health Sciences, Pennsylvania State University College of Medicine
| | | | - Jason Dos Santos
- Physician Assistant, Emergency Department, Pinnacle Health System
| | - Melissa Snyder
- Associate Teaching Professor, Pennsylvania State University College of Nursing
| | - Angela Salvadia
- Lecturer, Department of Occupational Therapy, Elizabethtown College
| | - Daniel Panchik
- Associate Professor, Department of Occupational Therapy, Elizabethtown College
| | - Robin Myers
- Clinical Associate Professor, Department of Physical Therapy, Lebanon Valley College
| | - Michael Fink
- Associate Professor, Department of Physical Therapy, Lebanon Valley College
| | - Andrew Dunlap
- Associate Professor, Department of Social Work, Elizabethtown College
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