1. 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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3. 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.

4. Workshop Agenda Introductions Overview of SP use Process of writing SP case Developing case outline (breakout) Next steps Wrap-up

5. Workshop Agenda Introductions Overview of SP use Process of writing SP case Developing case outline (breakout) Next steps Wrap-up

6. Millers Pyramid of Assessment Does Shows Knows How Knows Direct observation, unannounced standardized patients Simulation, Standardized patients MCQs Case presentations, essays Miller G. Acad Med 1990

7. 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

8. Reliability Estimate of OSCE van der Vleuten CPM and Schuwirth L. Med Educ 2005.

9. SP Assessments 80% of all medical schools use SPs to assess learners 50-60% of all pharmacy schools ACGME recommends SPs to assess resident competencies – Interviewing – Communication skills – Counseling Brownell Teach Learn Med 1994 Sturpe, AJPE 2010

10. 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

11. 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 resource- poor settings.

12. 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.

13. Global Health Clip

14. 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.

15. Multiple Mini Interviews (MMI) Interview format to assess applicant skills – Ethics – Communication – Professionalism – Interpersonal relationships – Ability to collaborate Series of short stations

16. Beyond Standardized Patients Standardized caregivers Standardized colleagues Standardized students

17. Workshop Agenda Introductions Overview of SP use Process of writing SP case Developing case outline (breakout) Next steps Wrap-up

18. What makes a case? 18

19. 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. 1 st year, 4 th year, resident) What is the context? (e.g. circumstances, background, setting)

20. Elements of a SP Case Develop checklist – Checklist: YES or No answers – Checklist: Global ratings – Number of checklist items Cunnington, Adv Health Sci Edu, 1997 Ostergarrd, Med Teach, 2003

21. 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

22. 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

23. Vera Lyons clip

24. Elements of a SP Case Who completes the checklist? – Faculty? – SP? How do learners receive feedback?

25. Small Group Breakout Developing a SP Case Outline Break into Groups of 3-4 Spend no more than 3-5 minutes sharing your ideas for an SP case and then choose one idea to develop further in your small group Complete the SP case development worksheet https://ucsf.co1.qualtrics.com/SE/?SID=SV_9XgPu Bwr8jF2Qsd or on paper https://ucsf.co1.qualtrics.com/SE/?SID=SV_9XgPu Bwr8jF2Qsd 15 minutes on case objectives (first half of Part 1) and what you will assess (Part 2) 10 minutes on the outline of the case (second half of Part 1).

26. Debrief

27. Workshop Agenda Introductions Overview of SP use Process of writing SP case Developing case outline (breakout) Next steps Wrap-up

28. 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 Guide to the Checklist 28

29. 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.” Guide to the Checklist 29

30. 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 Inter-station exercise 30

31. Next steps… Case review by experts Revisions SP training RevisionsPilot caseRevisions

32. The Future?

33. Wrap-Up/Evaluations Please complete your evaluations using the following link: Please complete your evaluations using the following link: http://tinyurl.com/UseofSPs

34. 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 / 34