Gayle Gliva-McConvey

Children as standardized patients: Initial assessment of effects

In this exploratory study, we examined the effects of simulating experienced by children who are standardized patients (SPs). In 1993, a random sample of children in the McMaster University SP pool were invited to attend a focus group. The data were transcribed, content analyzed, and reviewed by participants to ensure that they were trustworthy. All(N = 7) of the child SPs (age 6–18) who were invited to the focus group attended, except those who had moved away. The children reported that they acquired important skills and information through simulating. Developmental differences were observed in the nature of the effects reported. The teenagers reported sophisticated learning about communication, their behavior, adults, and life in general. Our results suggest care should be taken in selecting children as SPs and their SP roles to ensure that this experience benefits them. Further exploration of the effects of being an SP on children is advocated.

Assessment of patient management skills and clinical skills of practising doctors using computer‐based case simulations and standardised patients

Context  Standardised assessments of practising doctors are receiving growing support, but theoretical and logistical issues pose serious obstacles.

Characteristics of simulation activities at North American medical schools and teaching hospitals: an AAMC-SSH-ASPE-AACN collaboration.

Summary Statement In September 2011, the Association of American Medical Colleges released the results of a survey conducted in 2010 on simulation activities at its member medical schools and teaching hospitals. In this commentary, we offer a synthesis of data and conclude that (1) simulation is used broadly at Association of American Medical Colleges member institutions, for many types of learners, including other health care professionals; (2) it addresses core training competencies and has many educational purposes; (3) its use in learner assessment is more prevalent at medical schools but is still significant at teaching hospitals; and (4) it requires a considerable investment of money, space, personnel, and time. These data confirm general perceptions about the state of simulation in North America for physician training. Future endeavors should include a more granular examination of how simulation is integrated into curricula, a similar survey of other health care–related institutions and professions, and a periodic assessment to characterize trends over time.

The advantages and challenges of unannounced standardized patient methodology to assess healthcare communication

OBJECTIVE This paper provides an overview of the implementation of using unannounced standardized patients (USPs) to conduct health communication research in clinical settings. METHODS Certain types of health communication situations are difficult to capture because of their rarity or unpredictable nature. In primary care the real reasons for a visit are frequently unknown until the consultation is well under way. Therefore, it is logistically difficult for communication studies to capture many real-time communications between patients and their physicians. Although the USP methodology is ideal for capturing these communication behaviors, challenges to using this method include developing collaborative relationships with clinical practices, logistical issues such as safeguarding the identity of the USP, training USPs and creating their identities, maintaining fidelity to the role, and analyzing the resultant data. RESULTS This paper discusses the challenges and solutions to USP implementation. We provide an example of how to implement a USP study using an on-going study being conducted in primary care practices. CONCLUSION This paper explores the advantages and challenges as well as strategies to overcome obstacles to implementing a USP study. PRACTICE IMPLICATIONS Despite the challenges, USP methodology can contribute much to our understanding of health communication and practice.

The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP)

In this paper, we define the Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP) for those working with human role players who interact with learners in a wide range of experiential learning and assessment contexts. These human role players are variously described by such terms as standardized/simulated patients or simulated participants (SP or SPs). ASPE is a global organization whose mission is to share advances in SP-based pedagogy, assessment, research, and scholarship as well as support the professional development of its members. The SOBP are intended to be used in conjunction with the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice: SimulationSM, which address broader simulation practices. We begin by providing a rationale for the creation of the ASPE SOBP, noting that with the increasing use of simulation in healthcare training, it is incumbent on ASPE to establish SOBP that ensure the growth, integrity, and safe application of SP-based educational endeavors. We then describe the three and a half year process through which these standards were developed by a consensus of international experts in the field. Key terms used throughout the document are defined. Five underlying values inform the SOBP: safety, quality, professionalism, accountability, and collaboration. Finally, we describe five domains of best practice: safe work environment; case development; SP training for role portrayal, feedback, and completion of assessment instruments; program management; and professional development. Each domain is divided into principles with accompanying key practices that provide clear and practical guidelines for achieving desired outcomes and creating simulations that are safe for all stakeholders. Failure to follow the ASPE SOBP could compromise the safety of participants and the effectiveness of a simulation session. Care has been taken to make these guidelines precise yet flexible enough to address the diversity of varying contexts of SP practice. As a living document, these SOBP will be reviewed and modified periodically under the direction of the ASPE Standards of Practice Committee as SP methodology grows and adapts to evolving simulation practices.

The cognitive demands of standardized patients: understanding limitations in attention and working memory with the decoding of nonverbal behavior during improvisations.

Introduction This study was designed to look at the challenges of standardized patients while in role and to use the findings to enhance training methods. The study investigated the effect of improvisations and multiple-task performance on the ability of standardized patients to observe and evaluate another’s communication behaviors and its associated mental workload. Method Twenty standardized patients participated in a 2 types of interview (with and without improvisations)–by–2 types of observation (passive and active) within-groups design. Results The results indicated that both active observations and improvisations had a negative effect on the standardized patients’ ability to observe the learner, missing more than 75% of nonverbal behaviors during active improvisational encounters. Moreover, standardized patients experienced the highest mental demand during active improvisational encounters. Conclusions The findings suggest that the need to simultaneously portray a character and assess a learner may negatively affect the ability of standardized patients to provide accurate evaluations of a learner, particularly when they are required to improvise responses, underscoring the need for specific and targeted training.

Using a computer simulation for teaching communication skills: A blinded multisite mixed methods randomized controlled trial.

OBJECTIVES To assess advanced communication skills among second-year medical students exposed either to a computer simulation (MPathic-VR) featuring virtual humans, or to a multimedia computer-based learning module, and to understand each groups experiences and learning preferences. METHODS A single-blinded, mixed methods, randomized, multisite trial compared MPathic-VR (N=210) to computer-based learning (N=211). Primary outcomes: communication scores during repeat interactions with MPathic-VRs intercultural and interprofessional communication scenarios and scores on a subsequent advanced communication skills objective structured clinical examination (OSCE). Multivariate analysis of variance was used to compare outcomes. SECONDARY OUTCOMES student attitude surveys and qualitative assessments of their experiences with MPathic-VR or computer-based learning. RESULTS MPathic-VR-trained students improved their intercultural and interprofessional communication performance between their first and second interactions with each scenario. They also achieved significantly higher composite scores on the OSCE than computer-based learning-trained students. Attitudes and experiences were more positive among students trained with MPathic-VR, who valued its providing immediate feedback, teaching nonverbal communication skills, and preparing them for emotion-charged patient encounters. CONCLUSIONS MPathic-VR was effective in training advanced communication skills and in enabling knowledge transfer into a more realistic clinical situation. PRACTICE IMPLICATIONS MPathic-VRs virtual human simulation offers an effective and engaging means of advanced communication training.

Standardized Patient Encounters: Periodic Versus Postencounter Evaluation of Nontechnical Clinical Performance.

Introduction Standardized patients are a beneficial component of modern healthcare education and training, but few studies have explored cognitive factors potentially impacting clinical skills assessment during standardized patient encounters. This study examined the impact of a periodic (vs. traditional postencounter) evaluation approach and the appearance of critical verbal and nonverbal behaviors throughout a standardized patient encounter on scoring accuracy in a video-based scenario. Methods Forty-nine standardized patients scored either periodically or at only 1 point in time (postencounter) a healthcare provider’s verbal and nonverbal clinical performance during a videotaped standardized patient encounter. The healthcare provider portrayed in this study was actually a standardized patient delivering carefully scripted verbal and nonverbal behaviors in their portrayal of an actual physician. The encounter itself was subdivided into 3 distinct segments for the purpose of supporting periodic evaluation, with the expectation that both verbal and nonverbal cues occurring in the middle segment would be more challenging to accurately report for participants in the postscenario evaluation group as a result of working memory decay. Results Periodic evaluators correctly identified a significantly greater number of critical verbal cues midscenario than postencounter evaluators (P < 0.01) and correctly identified a significantly greater number of critical nonverbal cues than their postscenario counterparts across all 3 scenario segments (P < 0.001). Further, postscenario evaluations exhibited a performance decrement in terms of midscenario correct identifications that periodic evaluators did not (P < 0.01). Also, periodic evaluators exhibited fewer verbal cue false-positives during the first segment of the scenario than postscenario evaluators (P < 0.001), but this effect did not extend to other segments regardless of the cue type (ie, verbal or nonverbal). Discussion Pausing lengthier standardized patient encounters periodically to allow for more frequent scoring may result in better reporting accuracy for certain clinical behavioral cues. This could enable educators to provide more specific formative feedback to individual learners at the session’s conclusion. The most effective encounter design will ultimately depend on the specific goals and training objectives of the exercise itself.

Attentional and Mental Workload Demands in Nonverbal Communication

The present study applied assumptions of attention and working memory theories to tasks involving nonverbal (NV) communication. Thirty-six undergraduates interviewed for a job. Both type of interview (rote and improvisational) and type of observation (passive and active) were manipulated within groups. Participants were expected to observe fewer NV behaviors and indicate greater workload after active improvisational interviews. The results showed that participants detected fewer NV behaviors and reported higher mental workload when required to simultaneously participate in an interview and observe the interviewer, and particularly when they needed to improvise responses. These findings suggest that the ability to observe and possibly assess another’s NV behaviors may be compromised when engaged in an active conversation.

Evaluating Physician-to-Patient Communication: The Effects of Concurrent and Retrospective Assessment on Verbal and Nonverbal Recall

Research has established that human patient simulators (i.e., standardized patients) are a highly beneficial component of modern medical education and training, but few studies have explored the cognitive factors that affect the ability of standardized patients to make clinical skills assessments during simulated patient encounters. This study examines the impact of multiple scenario evaluation points (as opposed to a single, postscenario evaluation) and serial position effects on the accuracy of verbal and nonverbal clinical performance evaluations. Results suggest that concurrent recall may result in better verbal and nonverbal recall accuracy for clinical skills assessment than the traditional retrospective framework. For formative clinical skills assessment, in which specificity for the purpose of professional development is critical, concurrent evaluation could be considered as a potential alternative to retrospective approaches.