Lights, Camera, Action…
The Effective Use of Standardized Patients
in Health Professions Education
Maria Wamsley, MD
Sharon Youmans, Pharm.D., MPH
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Workshop Objectives
By the end of the workshop…
• Discuss the rationale for the use of standardized
patients (SPs) in health professions education.
• Describe the use of (SPs) in health professions
education for learner skill assessment.
• Explain the process for developing an
standardized patient (SP) case.
• Create an outline for a SP case for formative
(teaching) or summative (assessment) purposes.
Workshop Agenda
•
•
•
•
•
•
Introductions
Overview of SP use
Process of writing SP case
Developing case outline (breakout)
Next steps
Wrap-up
Workshop Agenda
•
•
•
•
•
•
Introductions
Overview of SP use
Process of writing SP case
Developing case outline (breakout)
Next steps
Wrap-up
Millers Pyramid of Assessment
Does
Direct observation,
unannounced
standardized patients
Shows
Knows How
Knows
Miller G. Acad Med 1990
Simulation,
Standardized
patients
Case
presentations,
essays
MCQs
OSCE
• Series of timed stations
• Each station focused on a
different task
• 8-10 stations to achieve
reliability
• Checklist of specific
behaviors
• Ex: U.S. Medical Licensing
Exam, Canadian Pharmacy
Licensing Exam
Reznick RK Acad Med 1993
Reliability Estimate of OSCE
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
1 hour
2 hours
3 hours
van der Vleuten CPM and Schuwirth L. Med Educ 2005.
4 hours
SP Assessments
• 80% of all medical schools use
SPs to assess learners
• 30% of all pharmacy schools
• ACGME recommends SPs to
assess resident competencies
– Interviewing
– Communication skills
– Counseling
Brownell Teach Learn Med 1994
Sturpe, AJPE 2010
Using SPs for Teaching Purposes
• Practicing communication
skills
– Breaking bad news
– Handling challenging
patient interaction
– Addressing unprofessional
behavior of colleagues
• Interprofessional
standardized patient
exercise
• Global health simulation
Global Health Simulation
Goal: Prepare trainees to face the ethical
challenges of global health fieldwork
Format: Simulation based curriculum
comprising 5 scenarios that focus on
ethically challenging scenarios in resourcepoor settings.
Scenario
You are assisting an HIV outreach team in rural
Malawi. The team visits remote villages to do rapid
HIV tests on pregnant women. It is known that the
majority of pregnant women in these areas do not
receive prenatal care or HIV treatment. Women
who test positive are offered treatment for free, but
the patient must go to the nearest clinic (5 hours
walk) monthly to get check ups and their HIV
medications. Women are assured that test results
and treatment will be kept confidential. You arrive
to discuss positive HIV test results with Blessings,
who is in her third-trimester of her pregnancy.
Global Health Clip
Hybrid (Patient-Focused) Simulations
• Combines SPs with inanimate
models
• Used in procedural or surgical
skills teaching
• Adds the patient perspective
to the simulation
Ex: SP plays a pregnant woman
but a plastic pelvis/mannequin
simulates the actual birthing
process
Nestel D and Kneebone R. Acad Med 2010.
Multiple Mini Interviews (MMI)
• Interview format to assess
applicant skills
– Ethics
– Communication
– Professionalism
– Interpersonal relationships
– Ability to collaborate
• Series of short stations
Beyond Standardized Patients
• Standardized caregivers
• Standardized colleagues
• Standardized students
Workshop Agenda
•
•
•
•
•
•
Introductions
Overview of SP use
Process of writing SP case
Developing case outline (breakout)
Next steps
Wrap-up
What makes a case?
CASE OBJECTIVES
STUDENT INSTRUCTIONS
SP DEMOGRAPHICS
INTERSTATION EXERCISE
TRAINING MATERIALS
TEST RESULTS
CHECKLIST
GUIDE TO THE CHECKLIST
FEEDBACK INSTRUCTIONS
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Elements of a SP Case
• Decide if case for teaching (formative) or
assessment (summative).
• Choose the objectives of the case.
• What is the level of the learner? (e.g. 1st year, 4th
year, resident)
• What is the context? (e.g. circumstances,
background, setting)
Elements of a SP Case
• Develop checklist
– Checklist: YES or No answers
– Checklist: Global ratings
– Number of checklist items
– Which one is better?
Cunnington, Adv Health Sci Edu, 1997
Ostergarrd, Med Teach, 2003
UCSF SOP MMI
Scenario:
You are a volunteer at a local free health clinic
for people who cannot otherwise afford
healthcare. Pat is new to the clinic and has been
asked to fill out a basic information sheet to
keep on file at the clinic. You have been asked
by the staff to greet Pat and review this basic
information. (Pat is waiting inside the room.)
UCSF SOP MMI VIDEO
Vera Lyons case
• Assess medical students’ skill in
communicating with an interprofessional
colleague (nurse)
• Assess medical students’ ability to evaluate
and manage a hospitalized patient with an
acute complaint
Vera Lyons
• A 55 year old woman hospitalized with
cellulitis who develops new chest pain
• Nurse is unable to reach Vera’s physicians;
student on the team enters the room and is
charged with evaluating the chest pain,
coming up with a diagnostic and treatment
plan, communicating with patient and nurse
Vera Lyons clip
Elements of a SP Case
• Who completes the checklist?
– Faculty?
– SP?
• How do learners receive feedback?
Small Group Breakout
Developing a SP Case Outline
Workshop Agenda
•
•
•
•
•
•
Introductions
Overview of SP use
Process of writing SP case
Developing case outline (breakout)
Next steps
Wrap-up
Guide to the Checklist
• Essential to good inter-rater reliability
• Allows multiple actors to understand
your criteria for them to…
 Reveal or withhold specific information
 Give the learner credit for an item when
there are multiple ways to ask the patient
for the information
29
Guide to the Checklist
Example:
Do you smoke?
• YES: Student must ask: IF you smoke, HOW
MUCH you smoke and HOW LONG have you
smoked to get credit for this answer
• Your response: “Yes.” “Two packs a day.” “30
years.”
30
Inter-station exercise
• Assess clinical reasoning
• Assess ability to integrate history and PE findings
• Can use:





SOAP note
Questions related to the case
Simulations
Heart sounds
Lung x-ray
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Next steps…
Case
review by
experts
Revisions
Revisions
Pilot case
SP
training
Revisions
Wrap-Up/Evaluations
Additional Resources
Hodges B, Hanson M, McNaughton BA, Regehr G. Creating, Monitoring, and
Improving a Psychiatry OSCE. A Guide for Faculty, Academic Psychiatry,
26:3, Fall 2002
Coaching standardized patients : for use in the assessment of clinical
competence (sample training materials, Checklist Guide, Feedback
Instructions)
Peggy Wallace, Ph.D., (UCSD)
Imprint New York : Springer Pub., c2007
UCSF Call # RT71 .W35 2007
Association of Standardized Patient Educators
aspe@aspeducators.org
MedEdPortal
https://www.mededportal.org/
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