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An Overview and Discussion of the Literature
2010 Publications Involving Standardized Patients
My apologies to Best Buy…
Educational Scholarship
• Clear Goals
• Adequate Preparation
• Appropriate Methods
• Significant Results
• Effective Presentation
• Reflective Critique
Glassick
Objectives
• Provide a guided discussion of the published literature from 2010 involving SPs
• Discuss the unique applications of SPs in teaching, assessment and research
• Guide participants through discussion on the potential application of findings to their own program
• Stimulate ideas for studies involving standardized patients.
Clear goals
Thinking ‘both this…
• Review Medline capabilities
• Decisions on limitations
• Skills in literature search
Adequate Preparation
Methods
Medline search
• MeSH descriptors:–Standardized patient(s)
–Simulated patient(s)
–OSCE
–Objective structured clinical examination
Limited to English language, 2010
Appropriate Methods
Results
• Initial result: – 427 papers– Titles scanned – Irrelevant papers discarded.
• Left with 423 articles • Reviewed all abstracts
Result was 154 articles
Significant Results
Which Journals? N=91
Medical Education
Medicine Osteopathic Med
Nursing Pharmacy
Allied Health Dentistry
Psychology Pastoral Care
Medical Informatics Nutrition
Location of Author
• Australia• Belgium• Brazil• Canada• Chile• France• Germany• India
• Iran• Israel• Italy• Japan• Korea• Malaysia• Netherlands• Nepal
• Pakistan• South Africa• Sweden• Switzerland• Taiwan• UK• USA
Questions to Ponder
• Unique aspect of the use of standardized patients is presented in the article
• Consider ways that the use of findings from current literature can enhance your program
• Do the papers presented offer ideas for further research?
Effective Presentation
Organizing the Chaos
• What do we do?
• Where do we do it?
• When do we do it?
• With whom do we do it?
• Why do we do it?
• How do we do it?
• What can we learn from the experience?
Categories
• Teaching / Assessment
• Communication skills / Feedback
• Logistics
• Impact of the SP experience
• Really Cool Stuff
Teaching vs Assessment
• Primary skills– Interview – Physical examination (neuro, MSK)– Specialized exams (GTA)– Skills (ultrasound)
• Special Concepts– Populations (geriatrics, pt with disability)– Topics (palliative care)– Situations (transitions of care, student to resident)– Delivery: by SP vs other
Academic Medicine
• Brown R, Graham C, Richerson N et al
• Evaluation of Medical Student Performance on Objective Structured Clinical Exams with Standardized Patients with and without Disabilities
Use of Assessment with SPs
• Outcome measures– Comparison of curricula– Comparison of training sites
• Special topics – Demonstration of knowledge– Critical thinking skills– Patient context– Challenging patient situations (say “no”)– Self assessment
Medical Education
• Yudkowsky R, Otaki J, Lowenstien T et al.
• A hypothesis-driven physical examination learning and assessment procedure for medical students: initial validity evidence
Communication Skills
• Motivational interviewing• Behavior change• Palliative care• Elderly with altered mental status• Persons with mental health issues (suicide)• Organ procurement • Bad news delivery• Adherence to medication
Behavioral and Cognitive Psychotherapy
• Hartzler B, Beadnell B, Rosengren D et al
• Deconstructing Proficiency in Motivational Interviewing: Mechanics of Skilful Practitioner Delivery During Brief Simulated Encounters
Communication Skills
• Nonverbal communication
• Patient centered communication
• Professionalism
• Empathy
Patient Education and Counseling
• Thompson B, Teal C, Scott S et al
• Following the clues: Teaching Medical students to explore patient contexts
Annals of Internal Medicine
• Weiner S, Schwartz A, Weaver F et al
• Contextual Errors and Failures in Individualized Patient Care
JAMA
• Schwartz A, Weiner S, Harris I, Binns-Calvey A.
• An Educational Intervention for Contextualizing Patient Care and Medical students’ Abilities to Probe for Contextual Issues in Simulated Patients
Academic Medicine
• Blatt B, LeLacheur S, Galinsky A
• Does Perspective-Taking Increase Patient Satisfaction in Medical Encounters?
Feedback
• Not much in 2010 on – Who should give it– How to give it – When to give it – Why to give it
Logistics
• Description of OSCE experience
• Build an OSCE
• Prepare for an OSCE
• Prepare a hybrid simulation
Logistics
• Validity studies
• Checklist development
• Comparison of scoring methods
• Repeat use of cases
• Post encounter scoring
• The “who” in scoring
• Gender issues
Medical Teacher
• Pell G, Fuller R, Homer M. Roberts T.
• How to Measure the Quality of the OSCE: A review of metrics – AMEE guide no. 49
Just Read This
Medical Education
• Durning S, Artino A, Boulet J, et al
Making Use of Contrasting Participant Views of the Same Encounter
Medical Education
• Hettinga A, Denessen E, Postma C
Checking the Checklist: a content analysis of expert- and evidence-based case-specific checklist items.
Academic Medicine
• Swygert K, Muller E, Scott C, Swanson D
• The Relationship Between USMLE Step 2 CS Patient Note Ratings and Time Spent on the Note: So Examinees Who Spend More Time Write Better Notes?
Impact of SP experience
• Impact of experience on students
• Still not much on the SPs themselves– Can they?
• SP vs faculty
– Should they?• Role play vs SP• SP vs actual patients
– Guides for SPs
Academic Medicine
• Bokken L, Rethans JJ, Jobsis Q et al
Instructiveness of Real Patients and Simulated Patients in Undergraduate Medical Education: A Randomized Experiment
Simulation in Healthcare
• Nestel D, Clark S, Tabak D, et al
Defining Responsibilities of Simulated Patients in Medical Education
International Journal of Psychophysiology
• Hulsman R, Pranger S, Koot S et al
How stressful it doctor-patient communication? Physiological and psychological stress of medical students in simulated history taking and bad-news consultations
Really Cool Stuff
• Faculty Development– Skills as raters– Development of skills – Reentry to practice
American Journal of Gastroenterology
• Alevi D, Baiocco PJ, Chokhavatia S et al.
• Teaching the competencies: using observed structured clinical examinations for faculty development
Academic Medicine
• Kogan J, Hess B, Conforti L, Holmboe E
• What Drives Faculty Ratings of Residents’ Clinical Skills? The Impact of Faculty’s Own Clinical Skills
It’s a depth of field issue….
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Reflective Critique
BIBLIOGRAPHY
www.utmb.edu/oed
• Once you open the OED home page, go to “standardized patient “ section.
• Go to subheading “bibliography”