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Flanagan OL, Cummings KM. Standardized Patients in Medical Education: A Review of the Literature. Cureus 2023; 15:e42027. [PMID: 37593270 PMCID: PMC10431693 DOI: 10.7759/cureus.42027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/19/2023] Open
Abstract
The concept of standardized patients (SPs) was first introduced in the 1960s by Dr. Howard Barrows of the University of Southern California and has been applied in medical school education since that time. This practice has allowed medical students to practice skills on live persons who are teachers rather than on real patients, who may be endangered by their emerging skills. Previous studies supported the use of SPs but did not measure whether they improved clinical competence or students' confidence in their skills. This literature review evaluated whether current medical education literature supports or refutes the use of SPs compared to other modalities such as simulated patients (SiPs) and virtual reality (VR) in the improvement of student confidence, clinical performance, and interpersonal communication skills. The research questions posed for this review were as follows: do medical students in their first two years of education who have practiced skills using SPs have more self-confidence in their ability to perform skills on real patients than those students who did not use SPs, do medical students in their third and fourth years of medical school have higher clinical competency with sensitive patient examinations after using SPs in their first two years of medical education than those students who did not use SPs, and do medical students who have used SPs for discussing sensitive issues have better interpersonal skills when they encounter real patients in the clinical setting than those who have not used SPs? The methodology for this descriptive, systematic review of the literature was organized using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart to describe how articles were collected and synthesized to evaluate the variables under study. The results of this study revealed that students learned the most when SPs were used because they were able to teach students the skills that they needed in a safe learning environment. Medical students performing sensitive patient examinations with SPs learned not only how to perform the examinations but also how to improve their communication with patients. Students and residents reported increased confidence and clinical competence when performing new skills with SPs rather than with peer practice, virtual reality, or real patients in a clinical setting. Although the utilization of SPs has been studied in multiple ways and found to be a powerful tool in the education of undergraduate medical students and interns, there is still much study to be done to address the human needs of real patients. Gaps in this literature included small sample sizes, a lack of standardized assessment tools, and the need to include a multidisciplinary approach that addresses cultural awareness and appreciation. The authors found limited studies analyzing the effect the coronavirus disease 2019 (COVID-19) pandemic had on the use of SPs in medical school education. Continued scientific inquiry in post-pandemic medical education is an essential component for dissemination as most schools have reintroduced the use of SPs, which strengthens the concept that their use is superior to the other simulation methods used when SPs were not available.
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Affiliation(s)
- Octavia L Flanagan
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine (LECOM), Elmira, USA
| | - Kristina M Cummings
- Department of Family Medicine, Lake Erie College of Osteopathic Medicine (LECOM), Elmira, USA
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Lawes-Wickwar S, Lovat E, Alao A, Hamer-Hunt J, Yurtoglu N, Jensen C, Clarke N, Roberts N, Park S. Digital undergraduate medical education and patient and carer involvement: a rapid systematic review of current practice. BMC MEDICAL EDUCATION 2023; 23:335. [PMID: 37193974 DOI: 10.1186/s12909-023-04218-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/31/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Involving patients and carers in medical students' learning aims to centralise the perspective of healthcare users and supports our future medical workforce in the development of key skills. Medical schools are increasingly using digital technology for teaching and it is timely to understand how to maintain patient and carer involvement in this context. METHODS Ovid MEDLINE, Ovid EMBASE and medRxiv were searched in October 2020 and reference lists of key articles were hand searched. Eligible studies reported authentic patient or carer involvement in undergraduate medical education where technology was also used. Study quality was assessed by the Mixed Methods Appraisal Tool (MMAT). Levels of patient or carer involvement were assessed using Towle et al.'s (2010) taxonomy, from Level 1 (lowest level) to Level 6 (highest level). RESULTS Twenty studies were included in this systematic review. In 70% of studies, patients and carers featured in video or web-based case scenarios with no interaction between healthcare users and students. The remaining 30% of studies reported real-time interactions between students and patients via remote clinical encounters. Digital teaching sessions involving patients or carers were perceived to be valuable by students and educators, and increased student engagement, patient-centred attitudes, clinical knowledge, and communication skills. No studies reported the perspective of patients or carers. DISCUSSION Digital technology has not yet driven higher levels of patient and carer involvement in medical training. "Live" interactions between students and patients are becoming more common but challenges need addressing to ensure positive experiences for all involved. Future teaching should enhance the role of patients and carers in medical education and support them to overcome any potential barriers to doing so remotely.
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Affiliation(s)
- Sadie Lawes-Wickwar
- Department of Primary Care & Population Health, University College London, London, UK.
| | - Eitan Lovat
- Department of Primary Care & Population Health, University College London, London, UK
| | - Adedoyin Alao
- School of Medical Education, Newcastle University Medical School, Newcastle Upon Tyne, UK
| | | | - Nesrin Yurtoglu
- Department of Primary Care & Population Health, University College London, London, UK
| | - Cherise Jensen
- School of Medical Education, Newcastle University Medical School, Newcastle Upon Tyne, UK
| | - Nicola Clarke
- Department of Primary Care & Population Health, University College London, London, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, Medical Sciences, University of Oxford, Oxford, UK
| | - Sophie Park
- Department of Primary Care & Population Health, University College London, London, UK
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Erici S, Lindqvist D, Lindström MB, Gummesson C. Three perspectives on learning in a simulated patient scenario: a qualitative interview study with student, simulated patient, and teacher. Adv Simul (Lond) 2023; 8:10. [PMID: 36941693 PMCID: PMC10029280 DOI: 10.1186/s41077-023-00249-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 03/01/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Patient simulation can be useful for medical students in developing communication skills for vulnerable situations. Three participants are primarily involved in the patient simulation activities: the student, the simulated patient (SP), and the teacher. We here aimed to explore these participants' perceptions of learning in a patient simulation scenario. METHODS We conducted individual interviews with eight students, three teachers, and one SP at a psychiatry placement of a Medical Doctor Program (5th year). During the interviews we asked the participants to watch a video of their participation in a patient simulation session. Thus, we obtained three perspectives on each of the eight recordings. We analysed our data with qualitative content analysis. RESULTS Three themes were generated: identity formation, collaborative learning, and learning intentions. This highly emotional scenario forced students out of their comfort zone, to the intersection of their roles as private person and professional. The SP perceived the collaborative creation of the scenario as significant learning. The teacher took a professional position and perceived the learning in the perspective of a future colleague. CONCLUSIONS The mutually created emotionally loaded scenario was found to be important from all three perspectives, forcing the students to identify unexpected ways of communicating. This possibly enhanced their professional identity development. Implications for future research can be to explore the process of skills transfer.
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Affiliation(s)
- Sten Erici
- Centre for Teaching and Learning, Faculty of Medicine, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
| | - Daniel Lindqvist
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Lund, Sweden
| | - Mats B Lindström
- Department of Clinical Sciences Malmö, Psychiatry, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Christina Gummesson
- Faculty of Medicine, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Fluet A, Essakow J, Ju M. Standardized Patients' Perspectives on Bias in Student Encounters. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:S29-S34. [PMID: 35947468 DOI: 10.1097/acm.0000000000004925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Standardized patient (SP) encounters are widely used in health professional education to evaluate trainees' clinical skills. Prior literature suggests that bias can influence the evaluations of student learners in SP-student encounters. Understanding how SPs perceive bias in their work and how they view their role in mitigating or perpetuating bias in simulation is an important first step in addressing bias in the SP-student encounter. METHOD Researchers designed a qualitative interview study and conducted 16 semistructured interviews with SPs at the University of California, San Francisco Kanbar Simulation Center from July through September of 2020. Participants were selected using purposive sampling. The interviews were transcribed and analyzed by researchers using inductive thematic analysis. Researchers met iteratively to reconcile codes and identify themes. RESULTS SPs identified bias occurring in multiple directions: SP-to-student, student-to-SP, student-to-character, and SP-to-character. SPs were hesitant to label their own biases and instead used words such as "comfort" or "preference." SPs reported little bias from students, because students were being evaluated and therefore behaving carefully. Additionally, SPs perceived bias in the implementation of health care simulation, which manifests as underrepresentation of certain groups amongst actors and character descriptions. Most SPs felt that they should play a role in mitigating bias in SP-student encounters, including addressing bias that occurs, challenging stereotypes, teaching about cultural differences, and/or being conscious of bias in their assessments of learners. CONCLUSIONS In the SP-student encounter, bias can occur on many levels and between many individuals, including between the SP and the character they are portraying. Identifying the areas in which bias can exist can help simulation educators mitigate bias.
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Affiliation(s)
- Angelina Fluet
- A. Fluet is a medical student, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Jenna Essakow
- J. Essakow is a clinical fellow, Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Mindy Ju
- M. Ju is assistant clinical professor, Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of California, San Francisco, and associate education director, University of California, San Francisco Kanbar Center for Simulation, San Francisco, California
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Fong SFT, Sakai DH, D’Eon M, Trinder K. The effect of case nodes in problem-based learning on the length and quality of discussion: a 2x2 factorial study. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:75-80. [PMID: 35291456 PMCID: PMC8909818 DOI: 10.36834/cmej.71812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Problem-based learning (PBL) relies heavily on case structure for their success. To make more meaningful cases, faculty introduced a "case node" that requires students to make a group decision on the action they will take at a given point in the case. The purpose of this study was to determine whether case nodes enhance PBL discussions. METHODS Two PBL cases were designed with and without a node. In 2011, 2012, and 2015, first-year medical students were assigned one PBL case with a node and one without a node. In total, 26 groups processed cases with a node while 27 groups processed the same cases without the node. All sessions were audio recorded and analyzed to determine the length and quality of discussions. RESULTS Groups with a node, regardless of case (M = 25.62, SD = 12.25) spent significantly more time in discussion on the node topic than those without a node (M = 16.54, SD = 10.33, p=.005, d = .80). Groups with a node, regardless of case (M = 14.38, SD = 8.04) expressed an opinion significantly more frequently than those without a node (M = 6.07, SD = 5.80, p < .001, d = 1.19). CONCLUSIONS Case nodes increased both the length and depth of discussion on a topic and may be an effective way to enhance case-based instruction.
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Affiliation(s)
- Sheri FT Fong
- Office of Medical Education, John A. Burns School of Medicine, University of Hawaii at Manoa, Hawaii. USA
| | - Damon H Sakai
- Office of Medical Education, John A. Burns School of Medicine, University of Hawaii at Manoa, Hawaii. USA
| | - Marcel D’Eon
- Medical College of Georgia, Augusta University, Georgia, USA
- College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Krista Trinder
- College of Medicine, University of Saskatchewan, Saskatchewan, Canada
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Farahani S, Farahani I, Burckhardt BB, Monser K, Laeer S. The Development of an Educational Video on Blood Pressure Measurement for Pharmacy Students. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:655-663. [PMID: 34163281 PMCID: PMC8215688 DOI: 10.2147/amep.s302728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/30/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION High blood pressure is an important worldwide health issue. Pharmacists can perform multifaceted tasks in hypertension management such as measuring blood pressure. In a time where the use of educational videos in health professions education has increased, an educational video might be an option for teaching blood pressure measurement skills to pharmacy students. This project aimed to develop an educational video tailored to pharmacy students on oscillometric blood pressure measurement in a community pharmacy setting that can be used as a self-instruction video. METHODS The video was created with support from the university's multimedia center. The video development was roughly divided into pre-production, production, and post-production. Students' satisfaction with and perception of the video was surveyed. RESULTS An 11-minute 33-second self-instruction video in the German language on proper oscillometric blood pressure measurement tailored for pharmacy students was created. Along with descriptive slides, the video delineates the necessary steps of blood pressure measurement in a community pharmacy setting in a role-play, to support students in communication with the patient. Results of a survey on the satisfaction and perception of the video from thirty-seven pharmacy students were included in the analysis and revealed that the video was well accepted by pharmacy students. Moreover, approximately 95% responded that instructional videos should be included in future pharmacy education. CONCLUSION We successfully developed an educational video on oscillometric blood pressure measurement for a community pharmacy setting. This work is a valuable form of support for faculty members, who intend to develop educational videos. This might be of interest especially during the coronavirus disease 2019 (COVID-19) pandemic, where distance learning has become highly relevant.
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Affiliation(s)
- Samieh Farahani
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Imaneh Farahani
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Bjoern B Burckhardt
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Karin Monser
- Multimedia Center, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Stephanie Laeer
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
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Noverati N, R. Naro G, J. Fischer R, M. Thompson B. Using Video and Virtual Patients in Problem-Based Learning: a Scoping Review. MEDICAL SCIENCE EDUCATOR 2020; 30:1685-1691. [PMID: 34457832 PMCID: PMC8368294 DOI: 10.1007/s40670-020-01108-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 06/07/2023]
Abstract
Problem presentation in problem-based learning can include the use of videos and interactive virtual patients. This review scopes the literature for this variation and what benefits or pitfalls there may be to their use. Themes indicate that videos and virtual patients may better prepare students for future difficult clinical interactions, while also increasing authenticity and memorability of cases. Findings are more inconsistent in determining whether they lead to clear knowledge or critical thinking gains. Despite inconsistent data, in an age where the use of technology is inevitable, the findings of this scoping review can inform future practice and guide innovation.
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Affiliation(s)
| | - Gillian R. Naro
- Pennsylvania State University College of Medicine, Hershey, PA USA
| | - Ryan J. Fischer
- Pennsylvania State University College of Medicine, Hershey, PA USA
| | - Britta M. Thompson
- Department of Medicine and Woodward Center for Excellence in Health Sciences Education, Hershey, PA USA
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Farahani S, Farahani I, Burckhardt BB, Schwender H, Laeer S. Self-Instruction Video Versus Face-to-Face Instruction of Pharmacy Students' Skills in Blood Pressure Measurement. PHARMACY 2020; 8:pharmacy8040217. [PMID: 33207585 PMCID: PMC7711835 DOI: 10.3390/pharmacy8040217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/07/2020] [Accepted: 11/13/2020] [Indexed: 02/06/2023] Open
Abstract
A modern approach to clinical skill education is the use of educational videos, yet there is a shortage of literature investigating the effect of self-instruction videos (SIVs) in pharmacy students. Therefore, our objective was to investigate whether an SIV is non-inferior compared to face-to-face instruction (FTFI) in acquiring blood pressure measurement skills. The participants in this randomized controlled study were pharmacy students. The control group was taught by FTFI, while the intervention group watched an SIV. Before and after the instruction, the participants' performance was assessed by an objective structured clinical examination (OSCE). The participants completed a self-assessment survey before each OSCE session. Moreover, the participants' perception and satisfaction were assessed using another survey. The OSCE score and self-assessment score increased significantly from pre- to post-instruction in both groups. The SIV was non-inferior compared to FTFI in terms of the OSCE score, considering a predefined non-inferiority margin of -10%. The participants' self-assessment yielded inconclusive results for non-inferiority. Both instructional approaches were well received. Considering our findings, SIVs might be a valuable option for teaching pharmacy students' blood pressure measurement skills. However, depending on the skill intended to be taught, a combination of an instructional video with instructor-led teaching may be necessary.
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Affiliation(s)
- Samieh Farahani
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany; (I.F.); (B.B.B.); (S.L.)
- Correspondence:
| | - Imaneh Farahani
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany; (I.F.); (B.B.B.); (S.L.)
| | - Bjoern B. Burckhardt
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany; (I.F.); (B.B.B.); (S.L.)
| | - Holger Schwender
- Mathematical Institute, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany;
| | - Stephanie Laeer
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany; (I.F.); (B.B.B.); (S.L.)
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Chang CC, Lirng JF, Wang PN, Wang SJ, Chen CH, Yang LY, Huang WJ, Huang HC. A pilot study of integrating standardized patients in problem-based learning tutorial in Taiwan. J Chin Med Assoc 2019; 82:464-468. [PMID: 31008811 DOI: 10.1097/jcma.0000000000000109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Problem-based learning (PBL) has been widely adopted in medical education; however, its application has been questioned due to the lack of interaction with a real patient. Standardized patients (SPs) might solve this problem. Herein, we tested the impact of integrating SPs in a PBL tutorial. METHODS In 2017, a total of 313 students, 66 facilitators, and 36 SPs were enrolled at National Yang-Ming University, Taiwan. The SPs presented the symptoms/signs of the cases then the students interviewed them to obtain the detail history. All students, facilitators, and SPs were invited to complete the questionnaires before and after this program. RESULTS Most SPs considered that both the second-year dental medical student and third-year medical students participated actively and were competent enough but students and facilitators considered that the fourth-year medical students might be more prepared. Overall, the students thought highly of the interactions with the SPs. Only about one-fifth felt that this design caused unnecessary pressure among the students and facilitators. They agreed that this program significantly inspired the student's learning motivation (pre- vs post-course: 4.1 ± 0.7 vs 4.3 ± 0.7, p < 0.001), increased their confidence level in interviewing patients (4.0 ± 0.8 vs 4.2 ± 0.7, p < 0.001), and encouraging critical thinking (4.0 ± 0.7 vs 4.2 ± 0.7, p < 0.001). CONCLUSION The SPs, facilitators, and students had different viewpoints with regards to integrating SPs in the PBL tutorial. However, a majority agreed that this design enhanced the motivation of students and supported such an application in PBL tutorials.
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Affiliation(s)
- Ching-Chih Chang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Jiing-Feng Lirng
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pei-Ning Wang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shuu-Jiun Wang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chen-Huan Chen
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Ling-Yu Yang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - William J Huang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hui-Chun Huang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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