Search

Introduction With a growing Hispanic population in the United States, medical education is adapting to provide the necessary language skills and cultural competence for effective health care. However, the incorporation of gender-affirming care in the context of medical education for Hispanic populations requires further emphasis. Methods This curriculum presented a 3-week medical Spanish endocrine system module designed for first-year medical students. The module aimed to enhance students’ ability to communicate effectively with Spanish-speaking patients about endocrine health while integrating principles of gender-affirming care. It included classroom sessions, standardized patient practice, and clinical practice with peer tutors. Pre- and postmodule surveys and assessments were conducted to evaluate the module's effectiveness. Results Out of 76 participants, 72 completed the postmodule evaluation. Survey results indicated significant increases in confidence levels across various aspects of patient interaction in Spanish, with statistically significant gains observed in all assessed areas. Knowledge test outcomes revealed enhanced proficiency in Spanish terminology related to the endocrine system, with scores increasing from an average of 22.3 premodule to 25.7 postmodule (p = .002), as measured by the paired t test. Additionally, students performed well in the diabetic consultation objective structured clinical examination station, with a high mean score of 86%, surpassing the satisfactory threshold. Discussion This curriculum highlights the success of a comprehensive educational approach in expanding medical students’ language proficiency and ability to provide gender-affirming care to address health care disparities and improve patient outcomes among diverse populations.

Introduction Medical misinformation, which contributes to vaccine hesitancy, poses challenges to health professionals. Health professions students, while capable of addressing and advocating for vaccination, may lack the confidence to engage with vaccine-hesitant individuals influenced by medical misinformation. Methods An interprofessional in-person simulation activity (90 minutes) using standardized patients was developed and instituted for students in medicine, nursing, pharmacy, and public health programs. Student volunteers were recruited from classes approximately halfway through their respective degree programs (i.e., second or third year of a 4-year program). Online simulation was used as a method to prepare for in-person simulation. Impact on students was assessed primarily through a postprogram student self-assessment. Results A total of 220 students participated in the program; 206 (94%) had paired data available to analyze. Following program participation, self-assessed abilities increased from pre to post, from 2.8 out of 5 (good) to 3.9 out of 5 (very good; p < .001). Ninety-eight percent of students felt that their ability to address medical misinformation was somewhat/much better after the activity, compared to before, and that their ability to address vaccine hesitancy was somewhat/much better. The overall program was rated highly, with mean scores for each program evaluation item >4 out of 5 (very good). Discussion An interprofessional cohort of students demonstrated improvement in self-assessed skills to participate in a conversation with an individual with hesitancy to receive vaccines and/or beliefs informed by misinformation. Students felt that this program was relevant and important to their professional development.

Introduction Verbal de-escalation is an essential skill for physicians across specialties and is the first-line intervention for patients who present with agitation. Training in verbal de-escalation for medical students is less robust compared to other health care disciplines. We describe the creation and evaluation of a novel verbal de-escalation curriculum for third- and fourth-year medical students on their psychiatry clerkship rotation. Method We developed a simulation using standardized patient (SP) methodology and a dedicated reflection session, implementing it in the third-year psychiatry clerkship. Participants in the scenario received targeted feedback from their peers and SPs. The sessions were video recorded, and a random sample was selected and reviewed to identify key observations and themes from student performance. Results A total of 139 students participated in the encounter. One hundred twenty-two of 125 students (82%) stated the activity met the learning objectives, with 108 (86%) assigning the letter grade A to the activity. Written feedback indicated that the majority of students believed the activity to be realistic, instructive, and helpful but felt the SPs de-escalated too quickly. Video review of the encounters found that while the students effectively used the skills, many jumped to a quick fix, and some offered inappropriate choices to end the encounter. Discussion This SP activity was effective in allowing students to practice skills in a safe setting and was valued by students. In the future, adding another workshop in the fourth year could facilitate higher retention and practice of skills.

Introduction For future success in the modern health care environment, health professions students require effective interprofessional education experiences to develop their perceptions of other professionals on the health care team. The Interprofessional Standardized Patient Experience (ISPE) is an interprofessional education activity for prelicensure health professional students in nursing, pharmacy, physical therapy, medicine, social work, and occupational therapy. Methods The ISPE involved collaboration among students to conduct a subjective interview. Students from six health care professions individually interviewed a simulated patient while being observed by students from other professions. A structured faculty-guided debriefing session followed the comprehensive interview process. Students completed a voluntary pre- and post-ISPE survey with interprofessional questions and feedback on the activity. Descriptive statistics were used to analyze individual responses. Differences in student opinions by student profession and by the number of professions present were examined using chi-square tests. Results Over 4 consecutive academic years, 1,265 students completed the ISPE, and 1,028 completed the pre- and post-ISPE surveys. Analysis of the survey responses indicated that the ISPE enhanced student awareness of the functions of an interprofessional team and increased student knowledge of the roles of different health care professions. Students rated the ISPE as a valuable experience. Differences were noted in some of the measures by profession and group size. Discussion A single ISPE had a significant impact on prelicensure students’ perceptions. The ISPE is a novel and effective approach to interprofessional education that students appreciate.

Introduction The COVID-19 pandemic has necessitated the rapid expansion of telemedicine. However, there has been minimal coverage of telemedicine in traditional undergraduate medicine curricula. Telemedicine presents specific challenges in the geriatric population, including unfamiliarity with technology, cognitive and sensory barriers, inclusion of family and/or caregivers, multimorbidity, and a high degree of medical complexity. Methods We developed a workshop to allow rising third-year medical students to practice a telemedicine patient encounter while developing skills for assessing and communicating with geriatric patients. This 90-minute workshop consisted of an introductory didactic presentation and a standardized patient activity for small groups of two to five students. Students’ level of comfort with telemedicine for assessment of geriatric patients was evaluated with a pre- and postsurvey. Results Fifty-eight students participated in the workshop and completed the surveys (presurvey = 58, postsurvey = 40), with roughly half (52%) reporting prior experience with telemedicine. A 5-point Likert-type scale (1 = very uncomfortable, 5 = very comfortable) was used. Students reported statistically significant increases in comfort using telemedicine (presurvey = 3.1, postsurvey = 3.9, p < .001) and using telemedicine for patients ≥65 years (presurvey = 2.8, postsurvey = 3.9, p < .001) after completing the workshop. Discussion Medical students’ comfort levels using telemedicine and caring for patients ages 65 and older with a telehealth visit improved after participating in this workshop. To help prepare students for telehealth practice in their future careers, educators should provide them with opportunities to practice and develop this critical skill set.

Introduction Opioid pain management is complex and requires a collaborative approach. To prepare health professions students to care for patients who have chronic pain, we developed an interprofessional education (IPE) session for delivery using a virtual platform that featured a standardized patient (SP) interaction. Methods The SP case highlighted a patient on opioids for chronic low back pain resulting from a car accident. Despite no improvement in pain or function, the patient continued taking opioids and developed behaviors that could represent opioid misuse. During the synchronous, online session, interprofessional teams of students interviewed an SP and collaborated to develop a holistic care plan to address the patient's pain and potential opioid misuse. The session evaluation included pre- and postsession surveys. Results Over 750 students from medicine, pharmacy, nursing, and social work programs participated in the virtual IPE sessions during a single year. Students rated the session positively. Matched survey responses suggested improved confidence in knowledge and skills, and learning through Zoom was rated favorably. Discussion We successfully implemented a synchronous online IPE session involving SP interactions that allowed students to practice team-based care of a patient with chronic pain who was taking opioids. Based on the success of this IPE session, including the success of the online delivery model, future IPE sessions will continue virtually.

Introduction It is estimated that at least 700,000 individuals in the United States identify as transgender or gender expansive. Many have confronted marginalization within the health care system, leading to suboptimal care and inequitable health outcomes. Health sciences trainees do not receive adequate training in gender-affirming care. The authors therefore created, piloted, and evaluated a formative standardized patient case for gender-affirming care for family medicine resident learners that could be given with limited resources in primary care and health professional education. Methods The curriculum for the case was developed with patient input and with family medicine physicians skilled in education, simulation, and gender-affirming care. The first case was held for 20 residents in a 4-year family medicine program in the Pacific Northwest. Nineteen participants completed pre/post case surveys delineating knowledge, awareness, attitudes, and intended behavior regarding providing gender-affirming care. Results Self-reported knowledge and awareness increased after standardized patient case participation in multiple skill areas related to providing gender-affirming care. Faculty observers informally reported that the session increased their knowledge and comfort as well. Discussion Implementation of this gender-affirming standardized patient case inclusive of community input was associated with successful improvements in self-reported measurements of resident knowledge and awareness of providing gender-affirming care. Additional institutions should consider such training to improve health care equity for this population.

Introduction Firearm injuries are a major public health concern. Safe firearm storage is recommended by multiple medical organizations. However, rates of firearm safety counseling are particularly low among trauma providers. Educational initiatives for other provider groups have proven to be effective. We hypothesized that educating trauma providers to offer safety counseling would be similarly effective. Methods We developed a didactic session around safe firearm storage counseling for trauma providers consisting of a lecture followed by an interactive session with standardized patients. Session participants completed pre- and postsurveys evaluating their knowledge about firearm storage, self-efficacy in providing firearm storage counseling, and attitudes towards firearm safety. We compared differences between pre- and postsurvey data using chi-square tests. Results The didactic session was delivered to target trauma providers: three trauma nurse practitioners, 42 general surgery residents, and 26 emergency medicine residents. After the session, participants were more likely to know the optimal way to safely store a firearm and to be confident in effectively counseling patients about safe firearm storage. Learners were not more likely to believe that providers have a responsibility to counsel patients on firearm safety. Discussion A didactic session on safe firearm storage counseling was associated with increased rates of knowledge and self-efficacy. The session did not change attitudes among trauma providers, although, prior to the session, most providers already believed they had a responsibility to counsel patients on safe firearm storage. Similar curricula should be piloted at other trauma centers.

Introduction Transgender and gender-diverse (TGD) patients experience health disparities and bias in health care settings. To improve care for TGD patients, medical trainees can practice gender-affirming care skills such as inclusive communication and discussing hormone therapy through patient simulation. Systematically evaluating these simulation outcomes also helps educators improve training on gender-affirming care. Methods A standardized patient case with a patient establishing primary care was developed for rising third-year medical students. The case featured multiple patient iterations to portray individuals with the same health history but a different gender identity and/or sex assigned at birth. Each student was randomly assigned to one patient encounter. Gender-affirming care skills were assessed through standardized patient checklists, postencounter notes, and preventive care recommendations. Results Over 2 years, 286 students participated in the simulation. Transgender men and women, cisgender men and women, and genderqueer patients were portrayed. Performance gaps such as misgendering patients and incorrect cancer screening recommendations based on perceived gender identity (rather than sex assigned at birth) were documented. Ninety-eight percent of students agreed that the encounter helped them practice clinical skills needed to see actual patients, and students described the case as challenging but important. Discussion This case served dual roles for medical training: (1) Students working with TGD patients practiced skills for gender-affirming care, and (2) portraying TGD patients along with cisgender patients allowed educators to identify biased recommendations that necessitated additional training. The outcomes further highlighted the importance of students routinely practicing gender-inclusive communication with all patients during simulation.

Introduction The overdose crisis remains a critical public health problem, creating an urgent need to train physicians in the treatment and management of opioid use disorder (OUD). Our medicine clerkship module aimed to close this gap by training and assessing students’ motivational interviewing skills, harm reduction knowledge, and use of nonstigmatizing language in the treatment of patients with OUD. Methods We evaluated the impact of a small-group, case-based activity and patient panel on the clinical documentation skills of students in a medicine clerkship. Clinical documentation was based on an observed structured clinical examination of a standardized patient with OUD and was evaluated using a grading rubric that followed the module learning objectives. Students also submitted reflections on the curriculum. Results Qualitative responses (n = 40) from students evaluating the small-group activity and patient panel exercise revealed overall student satisfaction with the patient panel and exposure to patients living with OUD. Three themes emerged from student reflections: (1) humanity, (2) different paths to recovery, and (3) using nonstigmatizing language. For the quantitative test, students’ (n = 39) mean clinical documentation scores before and after the small-group activity and patient panel increased from 10.1 to 11.3 out of 13.5 possible points. There was a significant difference between mean pretest and posttest scores (p < .001). Discussion The medicine clerkship provided an acceptable and feasible opportunity for implementing a multifaceted educational experience for students with significant immediate impact on their evaluation of patients with OUD.

Introduction Pharmacology is an important learning topic in preclinical medical education. Simulated patient encounters allow students to apply basic science knowledge in a clinical setting and have been useful in previous studies of pharmacology education. We developed a standardized patient (SP) encounter to reinforce antiviral pharmacology content for first-year medical students. Methods Students were instructed to recommend a medication for shingles during an SP encounter and to answer questions from the SP on mechanism of action and adverse effects. Students then attended a large-group debrief session. Following the activity, students evaluated the exercise through a voluntary survey. For knowledge assessment, students were randomized into two groups to complete three multiple-choice questions either before or after the learning activity. Results In 2020 and 2021, 144 and 145 students, respectively, participated. In 2020, there was no significant difference in the proportion of correct answers between the pre- and postsimulation groups (p > .05). In 2021, the postsimulation group significantly outperformed the presimulation group in knowledge of mechanism of action (p < .01) and adverse effects (p < .01), but no difference was seen between the groups regarding medication selection (p = .27). Most learners assessed the instructional design as effective for the tasks assigned. Discussion This SP activity provided an opportunity for early medical students to practice integrating antiviral pharmacology knowledge into a patient encounter and was well received by learners. The instructional method offers a clinically relevant approach for reinforcing pharmacology knowledge for preclinical medical students.

Introduction Virtual urgent care (VUC) provides real-time evaluation, triage, and treatment of low-acuity medical problems; however, VUC physicians have varying levels of telemedicine training. We created a workplace-based experiential onboarding program that deployed standardized patients (SPs) into a VUC clinic to evaluate and deliver feedback to independently practicing physicians, providing quality assurance and identifying areas for improvement. Methods We simulated evaluation of an adult with upper respiratory symptoms. To replicate a real-life encounter, we developed a mock electronic medical entry with demographic and medical information and scheduled SPs into the clinic's actual patient queue. SPs provided seamless, realistic training within the real-world virtual clinic environment. Using an adapted assessment tool anchored to not done, partly done, or well done, SPs evaluated communication, disease-specific, and telemedicine skills by observing behaviors. We surveyed participants to evaluate the program. Results Twenty-one physicians participated. All performed well in core communication and disease management domains. Ninety-three percent of behaviors (SD = 11%) were rated well done within the information gathering domain, 90% (SD = 8%) within relationship development, and 95% (SD = 5%) within disease management. Physicians struggled with telemedicine-specific skills—55% (SD = 38%) well done—and education and counseling—32% (SD = 34%) well done—highlighting specific behaviors most ripe for improvement. All queried participants indicated that this simulation improved communication and telemedicine skills. Discussion This workplace-based experiential onboarding program uncovered knowledge gaps within telemedicine skills and patient education domains. Identification of these gaps can help drive new virtual care curricula.

Introduction Efforts to improve pain education and knowledge about prescription opioid misuse and opioid/substance use disorder in undergraduate medical education continue to be inadequate. To advance educational practices and address training needs to counter the opioid epidemic, we created a longitudinal pain and addiction curriculum that includes three patient vignettes in which the patient requests an early refill of opioid medication. The goal was to introduce students to the potential impact of personal biases on health care delivery and medical decision-making with patients who have pain and/or substance use disorders. Methods Three clinical vignettes were presented to early matriculating medical students (MS 1s) using a progressive case disclosure approach in the format of a PowerPoint presentation with embedded audio interactions and follow-up audience response system questions. The same vignettes were converted into OSCEs for early clinical clerkship students (MS 3s). Results A total of 180 MS 1s participated in the case presentations, and 124 MS 3s participated in the OSCE session. There was a significant difference between students' level of comfort and individual patient requests for early prescription refills in both student cohorts. MS 1s were significantly more likely to provide the early refill to the elderly female patient compared to the two middle-age male patients, whereas a majority of MS 3s wanted more information. Discussion This module can be presented to medical students who have little clinical exposure and to health care trainees at other levels of clinical exposure.

Introduction Standardized patient (SP) methodology has been used in health professional education to help students develop communication, deeper diagnostic reasoning, and critical thinking skills. Few examples demonstrate the use of SPs to practice difficult conversations with pediatric caregivers in the pediatric dentistry literature. The objective of this educational activity was to describe the implementation of three SPs in a pediatric dentistry course for second-year dental students. Methods We developed three SP encounters covering interactions with caregivers of an infant with severe early childhood caries, an adolescent on the path to gender affirmation, and a child with autism and dental caries whose caregiver was resistant to fluoride- and silver-containing dental materials. We describe the case design process, rubric construction and calibration, student debriefing, and pandemic modifications. We evaluated the effectiveness of the implementation by thematic analysis of student reflections following each encounter using a qualitative descriptive framework. Results Eighty-three students completed each encounter. Qualitative analysis showed that students preferred a more realistic encounter by having a child or other distraction present. Students relied on different elements of motivational interviewing depending on the objective of each encounter and the age of the patient. Overall, the SP encounters were well received by students and faculty as an alternative or supplement to traditional student evaluation methods. Discussion We noted a number of lessons learned about implementing SP methodology in pediatric dental education. With these experiences now in place, future evaluations should measure student performance in the SP encounters against student performance during clinical care.

Introduction Increasingly, use of the electronic health record (EHR) is interwoven into even the most basic patient care tasks. Accordingly, learning how to utilize the EHR during patient encounters is important for medical students as they develop their clinical skills. Existing EHR curricula have focused primarily on doctor-patient relationship skills. We developed a session for our preclinical students on EHR-related doctor-patient relationship skills as well as on using the EHR to verify data and focus one's history taking. Methods We developed student notes, three training videos, four standardized patient (SP) cases, and a simplified, simulated EHR based on these cases. Students reviewed the notes and videos prior to class. During class, students practiced EHR-related communication and data-collection strategies by interviewing an SP while interacting with the simulated EHR. Following each encounter, students received feedback from a small group of peers and faculty. Results Two-hundred eighty-nine second-year medical students participated this session in 2019 and 2020, and 27 (19%, 2019) and 40 (28%, 2020) students, respectively, completed the postsession evaluation. Most respondents rated the SP activity as extremely or quite effective for practicing doctor-patient relationship strategies while interacting with the EHR (89%, 2019; 83%, 2020) and for practicing verification of EHR data during a patient encounter (81%, 2019; 86%, 2020). Discussion This training session was effective for introducing preclinical medical students to fundamental concepts and skills related to incorporating the EHR into patient encounters and offers a low-cost approach to teaching early medical students these important skills.

Introduction The differential diagnosis for abnormal uterine bleeding (AUB) among reproductive-age women is broad and includes common and life-threatening conditions. Recognition and accurate diagnosis of AUB are important but can be challenging for medical students. We developed a standardized patient (SP) encounter for medical students during their OB/GYN clerkship. Methods We implemented two SP encounters, on AUB and dyspareunia, that included a postencounter note and SP evaluations. Here, we describe the implementation of the SP encounter on AUB. Students received formative feedback on their interpersonal and history-taking skills, differential diagnosis, and management plan from the SP as well as OB/GYN residents and faculty. Student cumulative feedback was obtained mid-clerkship and following the clerkship. Summary statistics and qualitative data for students’ experiences are reported. Results SP cases were implemented at the Duke University School of Medicine with 101 second-year medical students who completed the encounter from September 2018 to July 2019. Regarding the AUB case, SPs identified students as adequate history takers, with a mean evaluation score of 3.45 (SD = 0.15) out of 5. Most students (94%) correctly identified at least one diagnosis and provided evidence. Endometrial cancer/hyperplasia (63%) and uterine leiomyoma (60%) were most likely to be identified. Regarding both SP encounters, of the 82 students (81%) completing the end-of-clerkship survey, 57% indicated that the experience enhanced their overall learning at least adequately well or better. Discussion The AUB case provided students with the opportunity to exercise their diagnostic and management skills.

Introduction Documenting a clinical encounter is a core skill for entering residency, but medical students often receive scant dedicated documentation training, leading to a high rate of inadequate information. Utilizing adult experiential learning theory, we created and implemented an educational resource to train medical students on how to proficiently document an emergency department (ED) patient encounter. Methods One hundred and five third- and fourth-year medical students participating in an emergency medicine clerkship took part in a brief orientation day documentation curriculum that included a group didactic, a review of reference materials, a standardized patient activity, a sample patient note writing assignment with individualized feedback, and supervising faculty physician feedback on real patient notes. Students were subsequently entrusted with primary documentation responsibility for all ED patients whose care they participated in. Results After completing this curriculum, students’ self-rated comfort with writing a high-quality note increased from 4.1 to 5.9 (p < .001) and knowledge about billing and coding increased from 2.9 to 5.5 (p < .001) on a 7-point scale. Among faculty physicians, 93% found student notes to always, usually, or frequently be clinically useful, and 86% reported that student notes always, usually, or frequently contained enough information for billing and coding. Discussion This curriculum was effective at training medical students on proficient patient care documentation in emergency medicine. The relatively short amount of synchronous learning time required could aid in implementation, and the allowance of medical student notes to count for billing purposes could facilitate student and faculty buy-in.

Introduction Adverse childhood experiences (ACEs) and trauma are common and can negatively impact children's health. Standardized patient (SP) learning may provide trainees with knowledge and skills to screen for and manage ACEs, apply trauma-informed care approaches, and teach resilience strategies. Methods With content experts, we developed three SP cases based on common clinical encounters, as well as didactic and debriefing materials. Case 1 focused on somatic symptoms in an adolescent with ACEs, case 2 focused on an ACE disclosure by a parent, and case 3 focused on de-escalation. The workshop required facilitators, SPs, simulation exam room and meeting space, and audiovisual equipment. It lasted 4 hours and included an orientation (1 hour), the three SP cases (totaling 2 hours), and group debriefing (1 hour). Results We conducted five identical workshops with 22 pediatric residents. Participants responded favorably to case fidelity and applicability to their clinical work. Resident mean self-assessment scores improved significantly from baseline. Specifically, we assessed comfort with inquiring about and discussing ACEs, explaining the health impacts of trauma, identifying protective factors, resilience counseling, and de-escalation. Over 90% of responses indicated that residents were likely to apply what they had learned to their clinical practice. Discussion These findings demonstrate that our SP cases were well received and suggest that such curricula can help pediatric residents feel more prepared to address trauma and promote resilience. Future work will assess these outcomes, as well as behavior change, in a larger sample to further substantiate these promising findings.

Introduction Medical students often lack training in advanced communication skills encompassing emotionally fraught situations and those in which an intense emotional response is expected. Such skills are required for clinical situations encountered during residency. We created and evaluated an advanced communication skills workshop (ACSW) using standardized patients for senior medical students. The workshop emphasized communication skills for four scenarios—strong emotion, goals of care, medical error, and palliative care assessment—and utilized formative peer assessment and feedback. Methods We created the four ACSW cases with case-specific communication behavior checklists and a common modified Master Interview Rating Scale in a Capstone Course for senior medical students. In groups of three, students rotated through three of four stations. Each student conducted one of the interviews while the other two completed the checklists and provided verbal feedback. We performed one-way analyses of variance on Likert responses and content analysis on open responses on a post-ACSW survey. Results Ninety-one students completed the ACSW and survey. Students assigned high value to all four ACSW student roles: interviewer, observer, feedback recipient, and feedback provider. Students rated the experience above average to excellent on nearly all survey items. Open-response themes included “liked the opportunity to give or receive peer feedback” (46%) and “found the checklists helpful” (45%). Discussion Feasible and well received by senior medical students, our ACSW offers an opportunity to practice and observe advanced communication skills and peer feedback. A peer-assisted, formative learning model, the ACSW efficiently addresses a key aspect of residency preparation.

Introduction The opioid epidemic impacts all ages, yet few published medical education curricula exist to train physicians on how to care for opioid use disorder (OUD) in adolescents, a developmental stage where confidentiality protection is appropriate and contributes to quality health care. We developed a simulation-based educational intervention to increase addiction medicine and addiction psychiatry trainees’ confidence in managing adolescents with OUD. Methods Trainees completed a confidence survey and viewed an educational video covering state-specific confidentiality laws pertinent to treating adolescents with OUD. One week later, trainees participated in a simulated encounter where they described the scope of confidentiality to a trained actor, used the Clinical Opiate Withdrawal Scale to assess symptoms of opioid withdrawal, and explained adolescent-specific OUD medication treatment options. Immediately afterward, trainees completed a self-reflection and satisfaction survey and participated in a debriefing session with a faculty member where they identified learning goals. One month later, they completed the confidence survey to quantify changes in confidence. Results Thirty-five fellows (21 male, 14 female) completed the simulation-based educational intervention between 2016 and 2019. When asked to answer yes or no, 96% of participants described the exercise as effective and 100% (n = 26) would recommend it to peers. In addition, learners identified future learning goals, including researching specific topics and seeking out additional opportunities to evaluate adolescents with OUD. Discussion Based on our participants’ report, this simulation-based educational intervention is an effective teaching method for increasing trainee confidence in managing adolescents with OUD.

Introduction Although menopause is a common condition, trainees still express high levels of discomfort with managing climacteric symptoms. Trainees also receive little preparation for conducting telemedicine visits, which have become increasingly important in clinical care. We present a formative standardized patient (SP) encounter to introduce medical students to the diagnosis and treatment of menopausal symptoms and the process of conducting a telemedicine visit. Methods We designed a virtual telemedicine encounter with an SP for medical students. Students received feedback via a post-encounter note on history taking, differential diagnosis, and diagnostics/management and an SP debrief. We collected student input on the experience at the midpoint and end of clerkship and analyzed it for recurring themes. We calculated summary statistics from student post-encounter notes. Results Thirty-two OB/GYN students completed the menopause telemedicine SP encounter between April and June 2020. Students scored a median of 20 out of 45 (interquartile range: 18, 22) on the post-encounter note. All students correctly provided a diagnosis of perimenopause/menopause; however, 50% did not offer any strategy for counseling or managing menopausal symptoms. Students expressed discomfort with using a telehealth format (78%) but found it a useful skill to practice (47%). A majority (66%) found the educational encounter to be of excellent or above-average educational value. Discussion While medical students demonstrated discomfort with both managing menopause and utilizing a telemedicine format, this SP case provided an opportunity for them to practice both skills in a safe learning environment. The majority of participants rated the learning experience highly.

Introduction Climate change presents unprecedented health threats. It is imperative that medical trainees understand the implications of climate change/planetary health on the physical and mental health and well-being of their patients. Medical professionals generally are not trained to consider climate change impacts in patient encounters. Hence, there is a need to train climate-aware providers who will be at the forefront of patient care in managing these current and emerging health impacts. Methods We created a standardized patient (SP) case enhanced with details of risks and health impacts due to exposure to wildfire smoke. This session was deployed to 11 internal medicine clerkship students as part of a standard OSCE already included in our curriculum to evaluate core clinical and communication skills. Two cohorts, a group activity, and a one-on-one encounter were deployed and followed with a faculty debrief and learner assessments. Results Students had increased awareness and knowledge of health impacts of climate change and potential actions for adaptation and mitigation. The improvements were statistically significant for the one-on-one cohort (p = .006). Postsimulation comments were favorable; students were more inclined to consider health impacts, risks, and vulnerabilities exacerbated by climate change. Discussion Students had an increased recognition of climate change as a force impacting their patients' health which should be considered in patient care. This format allowed retention of well established curricular content, but also the inclusion of other crucial emerging issues that will impact public health locally and globally and foster the development of climate-aware health care providers.

Introduction The ability to utilize the electronic health record (EHR) without compromising the doctor-patient relationship (DPR) is an essential skill of all physicians and trainees, yet little time is spent on educating or assessing learners on needed techniques. To address this gap, we developed a conventional OSCE station coupled with a simulated patient chart within the Epic program in order to assess our students' skills utilizing the EHR during a patient encounter. Methods Of third-year medical students, 119 were given full access to the patient's simulated chart 24 hours in advance of their OSCE to review clinical data. During an in-person OSCE with a standardized patient (SP), students performed a focused history and physical, using the EHR to verify allergies and medications. Students completed an electronic patient note graded by faculty. SPs evaluated the students on communication and interpersonal skills with specific rubric elements. Faculty graded the students' notes to evaluate their expression of clinical reasoning in the assessment and plan. Results Training SPs and faculty to assess students on EHR skills was feasible. After implementation of a comprehensive curriculum focused on EHR and DPR, there was a significant difference on EHR-related communication skills (M = 76.4, SD = 17.6) versus (M = 37, SD = 28.9) before curriculum enhancement t (117.9) = −12.4, p

Introduction Learning to elicit a sexual history and counsel patients on sexual pain aligns with the Association of Professors of Gynecology and Obstetrics clerkship objectives. This topic can be challenging to cover due to lack of exposure in clinical encounters and inadequate coverage in preclinical studies. Methods Second-year medical students in the OB/GYN clerkship participated in a standardized patient (SP) encounter on dyspareunia, receiving formative feedback on sexual history taking, differential diagnosis and management plan, and their SP's comfort during the encounter. Student feedback was obtained mid- and postclerkship. Summary statistics and regression models comparing SP encounter scores with shelf exam and clerkship scores are reported. Results From September 2018 through July 2019, 101 students completed the encounter. Students asked an average of 3.9 of 13 sexual history questions. Sixty-six percent of students identified a correct diagnosis; 48% provided a management plan. The majority of students were very good or excellent at creating a safe environment. Most reported the encounter enhanced their learning (62%) and identified knowledge gaps (72%). SP encounter score was not associated with shelf exam score or clerkship letter grade but was associated with final clerkship score (unadjusted ß = 0.2, p = .009; adjusted ß = 0.1, p = .2). A summary didactic session was developed following student feedback. Discussion This SP encounter and summary didactic session allowed students to improve their sexual history taking and may be associated with clerkship performance. These skills are necessary to advocate for patients with sensitive complaints across specialties.

Introduction Cognitive integration is required to perform clinical decision-making tasks, even in the preclinical curriculum of medical school. Simulation supports students' cognitive integration by providing practical application of basic science knowledge in a relevant clinical context. To address the need for integrative activities in our curriculum, we implemented a simulated clinic exercise with cases representing gastrointestinal diseases for first-year medical students. Methods Basic science and clinical skills course directors collaborated to design this simulated clinic event, during which student small groups rotated through a series of standardized patient encounters. During each encounter, one student performed the history and physical exam, following which the small group collaboratively developed a prioritized differential diagnosis. Afterwards, the gastroenterology course director debriefed students to highlight key learning points. We collected learner evaluation data following the event. Results Two hundred eighty first-year medical students participated in the simulated clinic in 2018 and 2019. Students rated these events as effective for learning about clinical features of the diseases presented and for reinforcing skills learned in the clinical skills course. Students agreed that the small-group format, pace, and duration were appropriate and that the problem-solving aspect was intellectually stimulating. The most effective aspects were opportunities to solidify illness scripts, apply knowledge to solve a problem, and encounter diseases in a realistic clinical context. Discussion This simulated clinic model effectively supported preclinical students' basic and clinical science integration to complete diagnostic reasoning tasks for gastrointestinal gastrointestinal conditions and was evaluated favorably by learners.

Introduction Telemedicine is a growing practice with minimal training in US medical schools. Telemedicine OSCE (TeleOSCE) simulations allow students to practice this type of patient interaction in a standardized way. Methods The Insomnia–Rural TeleOSCE was implemented as part of a required clinical clerkship for students in their second, third, or fourth year of medical school. This case addressed a patient with depression in a medically underserved area. Students performed it as a formative experience and received immediate feedback. They then completed a survey to evaluate the experience. Results Students (n = 287) rated the quality of the experience 7.59 out of 10. Comments showed that 61 learners thought the TeleOSCE was a positive experience, 35 wanted more teaching about telemedicine, 28 improved their understanding of barriers to care, 25 expressed concern over minimal other training, 23 found the TeleOSCE important and challenging, 16 appreciated the differences between in-person and remote visits, and 15 wanted fewer distractions. Eight students worried about how they would be judged, five learned from the technical limitations, five requested more time, five were skeptical of the utility, and five saw telemedicine as triage. Discussion The TeleOSCE allows learners to gain exposure to telemedicine in a safe simulated teaching environment and assesses learner competencies. The TeleOSCE also improves students’ understanding of barriers to care and the utility of telemedicine. It logistically allows faculty to directly assess distance students on their clinical reasoning and patient communication skills.

Introduction Given the aging population and the benefits of comprehensive geriatric assessment to this subset of patients, an interprofessional education training approach may be advantageous for learners from a number of different health professions. Methods Through intercollegiate collaborations involving seven different colleges, an interprofessional simulation using standardized patients was developed and instituted for learners in medicine, nursing, pharmacy, occupational therapy, physical therapy, dental hygiene, and dietitian programs. Herein, we describe the design of the simulation experience and examine its impact on students, as assessed primarily via written reflective comments provided via exit slips at the conclusion of the activity. Results Of the 340 student participants, 83% submitted exit slips describing something gained from the interprofessional session that would not have occurred if students had completed the activity with only students from their own discipline. Three key themes were identified from these reflections: new understanding of roles and responsibilities of other disciplines, new knowledge or skills pertaining to geriatric assessments, and the value of teamwork. Discussion Reflective comments from students regarding the interprofessional experience are evidence of this initiative's benefits, which include increasing knowledge of geriatric medical and allied health-provided care and attainment of interprofessional competencies.

Introduction There is a need for educational resources supporting the practice and assessment of the complex processes of clinical reasoning in the inpatient setting along a continuum of physician experience levels. Methods Using participatory design, we created a scenario-based simulation integrating diagnostic ambiguity, contextual factors, and rising patient acuity to increase complexity. Resources include an open-ended written exercise and think-aloud reflection protocol to elicit diagnostic and management reasoning and reflection on that reasoning. Descriptive statistics were used to analyze the initial implementation evaluation results. Results Twenty physicians from multiple training stages and specialties (interns, residents, attendings, family physicians, internists, surgeons) underwent the simulated scenario. Participants engaged in clinical reasoning processes consistent with the design, considering a total of 19 differential diagnoses. Ten participants provided the correct leading diagnosis, tension pneumothorax, with an additional eight providing pneumothorax and all participants offering relevant supporting evidence. There was also good evidence of management reasoning, with all participants either performing an intervention or calling for assistance and reflecting on management plans in the think-aloud. The scenario was a reasonable approximation of clinical practice, with a mean authenticity rating of 4.15 out of 5. Finally, the scenario presented adequate challenge, with interns and residents rating it as only slightly more challenging (means of 7.83 and 7.17, respectively) than attendings (mean of 6.63 out of 10). Discussion Despite the challenges of scenario complexity, evaluation results indicate that this resource supports the observation and analysis of diagnostic and management reasoning of diverse specialties from interns through attendings.

Introduction The emergency medicine (EM) resident's ability to make independent decisions in the setting of acute ischemic stroke has been reduced as a result of the involvement of multidisciplinary teams. This simulation was created to give EM residents the opportunity to independently manage the early stages of ischemic stroke and its complications. Methods A solo learner was presented with a 55-year-old male with complaints consistent with an acute stroke. The resident had to calculate stroke severity; coordinate hospital resources; discuss risks, benefits, and alternatives to thrombolysis; and deal with subsequent complications. The learner had to keep a broad differential for sudden change in mental status and consider alternative interventions. Strategies to decrease intracranial pressure needed to be implemented while obtaining neurosurgical consultation. Debriefing included discussion of expected actions in the context of the Accreditation Council for Graduate Medical Education (ACGME) milestones. Residents' review of their video performance added additional self-reflection. Results A total of 69 PGY 3 EM residents independently participated in this simulation over a 5-year period. Thirty-two completed a postsimulation evaluation. Nearly all learners felt that this case reflected an actual patient encounter and increased their confidence in managing stroke. The milestone-based feedback tool was completed with all learners. Anticipated actions linked to Level 1 and 2 milestones were regularly achieved while acquisition of Level 3 and 4 actions varied. Discussion Case actions were uniquely characterized by the ACGME milestones, which helped to delineate learners' knowledge gaps and provided concrete areas for improvement.

Introduction As the number of patients with limited English proficiency grows, there is increasing awareness in the medical community about disparities in health outcomes for this population. The proper use of professional medical interpreters improves communication between physicians and patients with limited English proficiency. Typically, however, little curricular time in medical training is devoted to this competency. Methods We developed a two-station objective structured clinical examination (OSCE) in which learners worked with interpreters to conduct medical interviews with Spanish-speaking standardized patients (SPs). Cases were designed for use with residents from any medical specialty and to have personal and emotional richness in keeping with the real-life circumstances of many patients. Twelve residents from six medical specialties completed a session evaluation and were assessed by faculty, SPs, and interpreters using existing validated instruments and case-specific checklists. Results All residents reported that the cases mimicked real patient encounters. The checklists were well received and easy to use. While scores varied between residents, deficiencies were identified in basic communication skills for interacting with a non-English-speaking SP through an interpreter, including maintaining proper eye contact and open body posture with patients and introducing and clearly articulating the role of the interpreter. Discussion A two-station OSCE utilizing professional medical interpreters and Spanish-speaking SPs was well received by all participants. Residents’ scores helped identify common skill gaps in their work with interpreters. Based on the success of the pilot deployment, we plan to target educational interventions at these common deficiencies and offer the OSCE to more trainees.

Introduction Published curricula to teach communication skills for postgraduate fellows in oncology are few in number despite the fact that oncologists conduct many difficult discussions with their patients and their families. Such discussions may include disclosing initial diagnosis or relapse of a patient's cancer or relaying a poor prognosis or change to palliative care. Methods An eight-module course on communication in oncology practice was delivered over 2 months for palliative and oncology fellows and radiation oncology residents. Learners were given a precourse survey in which they were asked to rate their proficiency in various communication tasks. Each learner then participated in a videotaped precourse objective structured clinical exam (OSCE) on breaking bad news with standardized patients (SPs). The course took place over 8 weeks with weekly didactics and role-play. At the end of the course, a second OSCE took place. After the course was completed, the fellows again filled out a proficiency survey. Results Twenty-two learners participated over 2 years of this course. Participants reported a significant increase in perceived competence in all areas on the postcourse survey. SP feedback on OSCEs pre- and postcourse indicated improvement in skills for learners. Pre- and postcourse OSCE video assessment revealed a significant improvement in global communication skills. Discussion Initial data show that this course successfully improved communication skills and increased fellows' comfort level across several domains of communication. Future directions include validating our assessment tool, expanding the topic base, and investigating the impact on practice after course completion.

Introduction Acute neuromuscular respiratory failure is a source of morbidity and mortality in neurological diseases, including acute inflammatory demyelinating polyneuropathy (AIDP), also known as Guillain-Barré syndrome. It is important for health care providers to recognize this condition and provide early ventilatory support. In this simulation, learners must assess and treat a standardized patient with acute respiratory complications related to AIDP. Methods This is a single-session simulation that can be run in a standard simulation center using a live standardized patient. The simulation scenario is followed by a facilitated debriefing session. Details about the simulation scenario, critical action checklist, environment preparation, actors/roles, and debriefing session are outlined. Results A total of 14 neurology residents participated in this simulation. A postsimulation survey revealed that participants thought the simulation achieved its stated objectives, was useful, and would impact their future practice. Discussion We designed this simulation to assess a learner's ability to identify acute neuromuscular respiratory weakness in a patient with AIDP and initiate treatment with ventilatory support. This simulation can easily be incorporated into an existing curriculum for neurology residents or for trainees in other specialties.

Introduction We describe the development and implementation of tools medical educators or researchers can use for developing or analyzing residents' through attending physicians' clinical reasoning in an outpatient clinic setting. The resource includes two scenario-based simulations (i.e., diabetes, angina), implementation support materials, an open-ended postencounter form, and a think-aloud reflection protocol. Method We designed two scenarios with potential case ambiguity and contextual factors to add complexity for studying clinical reasoning. The scenarios are designed to be used prior to an open-ended written exercise and a think-aloud reflection to elicit reasoning and reflection. We report on their implementation in a research context but developed them to be used in both educational and research settings. Results Twelve physicians (five interns, three residents, and four attendings) considered between three and six differential diagnoses (M = 4.0) for the diabetes scenario and between three and nine differentials (M = 4.3) for angina. In think-aloud reflections, participants reconsidered their thinking between zero and 14 times (M = 3.5) for diabetes and zero and 11 times (M = 3.3) for angina. Cognitive load scores ranged from 4 to 8 (out of 10; M = 6.2) for diabetes and 5 to 8 (M = 6.6) for angina. Participants rated scenario authenticity between 4 and 5 (out of 5). Discussion The potential case content ambiguity, along with the contextual factors (e.g., patient suggesting alternative diagnoses), provides a complex environment in which to explore or teach clinical reasoning.

Introduction Integrative health care and complementary medicine are widely used by the U.S. population, yet health professions learners are typically inadequately educated to counsel patients on the use of these approaches. This interprofessional standardized patient exercise (ISPE) provides learners the opportunity to discuss various health care professionals' roles in caring for a patient interested in integrative health strategies, and to collaborate on a care plan. Utilizing this ISPE format aligns with the principles of integrative health as it requires interprofessional collaboration to address the multifaceted needs of patients. Methods The ISPE is approximately three hours in duration, and required of all UCSF, third-year dentistry, physical therapy, and medical students; second-year nurse practitioner students, and fourth-year pharmacy students. Social work, nutrition, and chaplain trainees also participated. Working in interprofessional teams of 4–5 learners, team members discuss case information, interview the standardized patient (SP) individually, jointly formulate a care plan, and, discuss the plan with the SP. The experience is debriefed with a facilitator. Results In 2016–17, 520 learners participated in the ISPE. They agreed that they learned about the roles of other health care professionals (M = 5.24 on a six-point scale, SD = 1.27), and that they would recommend the ISPE to fellow students in their profession (M = 5.25, SD = 1.30). Discussion Students appreciated the ability to observe learners from other health professions interacting with the SP, and how different perspectives and expertise were integrated to create a comprehensive care plan. The exercise can be adapted to accommodate local health professions learners.

Introduction Integration of interprofessional education (IPE) activities into health professions curricula aims to promote collaborative practice with a goal of improving patient care. Methods Through intercollegiate collaborations involving four different educational organizations and an academic health center, an interprofessional stroke simulation involving standardized patients was developed and instituted for IPE-naive student learners from medicine, nursing, physician assistant, occupational therapy, and physical therapy programs with additional involvement from pharmacy and social work learners. Herein, we describe the design of the IPE simulation and examine its impact on students' interprofessional development as assessed by students' completion of a validated IPE competency self-assessment tool and written reflective comments after the simulation. Results Self-assessed interprofessional interaction and values domains were evaluated before and after the activity using the shortened 16-question Interprofessional Education Collaborative Competency Self-Assessment tool; data revealed significant changes in both the values and interaction domains of the tool from pre- to postsimulation experience (p < .0001). The qualitative student reflections revealed new student realizations around the concepts of collaboration, leadership, roles of different professions, and the importance of communication after participating in the simulation. Discussion Quantitative data coupled with qualitative reflections from learners support the effectiveness of this activity for facilitating development of interprofessional competencies among health professions students.

Introduction This standardized-patient-based module prepares medical students to take inclusive, comprehensive sexual histories from patients of all sexual orientations and gender identities. Health disparities faced by lesbian, gay, bisexual, transgender, and queer (LGBTQ) people are at least partially the result of inadequate access to health care and insufficient provider training. This module incorporates implicit bias activities to emphasize the important role providers can play in mitigating these disparities through compassionate, competent care. Furthermore, two of the three included cases highlight the negative impact sexual dysfunction can have on emotional well-being. Methods Over 3 hours, students participate in a 30-minute large-group lecture and three 40-minute small-group standardized patient encounters with debrief. Prework consists of a short video on sexual history taking, assigned readings, and an implicit bias activity. These materials are included in this resource, along with lecture slides, facilitator guide, and standardized patient cases. Though the cases are adaptable to all levels of medical education, this module is designed for second-year and early third-year medical students. Results Qualitative student evaluations were positive, and postparticipation surveys revealed statistically significant improvement in comfort with their ability to take a sexual history in general, and take one from patients with a differing sexual orientation. Deployed in the second year of our Doctoring curriculum, this module continues to receive positive evaluations. Discussion Introducing these skills begins to address the curricular deficiencies seen across medical education and lays the foundation for a more competent health care workforce to address the needs of LGBTQ patients.

Introduction The purpose of this resource is to introduce first- and second-year medical students to the psychiatric concerns of military veterans. The number of veterans receiving care outside of the Veterans Health Administration (VHA) results in many nonVHA medical doctors treating military veterans; thus, it is important that medical students have exposure to military veterans and their unique issues during medical training. A noncombat veteran with posttraumatic stress disorder (PTSD) was specifically chosen for this training to highlight the fact that PTSD can result from a number of different traumatic events that one may experience during military service. Methods The student learners were presented with an hour-long didactic on PTSD, depression, and suicide in military veterans. They subsequently engaged in an hour-long simulation with a standardized patient who was trained in the symptom presentation of PTSD. Each student in the class had an opportunity to complete a medical interview with the standardized patient (SP) and receive feedback from both their peers and the SP. The student learners then evaluated the learning experience. Results Feedback for the course was overwhelmingly positive. The average response to the quality of the presentation question was 4.83 out of 5 (with 1 = poor; 5 = outstanding). Discussion The results indicate that using SPs is a valuable learning modality for teaching medical students about psychiatric concerns in the veteran population.

Introduction Errors that harm patients often have many contributing factors and ideally should be disclosed by a team rather than an individual provider. However, most health professions students learn about errors and error disclosure in a single-profession class. Methods We developed a 2-hour small-group session in which our students practice discussing and disclosing a medical error that involves several professions, following a communication map. As they practice, students gain an understanding of the roles, skills, and perspectives of the other professions represented in the group. Results Over the last 5 years, student evaluations have been very positive. In 2016, our students strongly agreed that “The small group skills practice was a useful and interesting learning opportunity,” “Learning with other professional students was valuable,” and “Thinking about error disclosure from a team perspective was helpful.” Student comments consistently indicated that they learned both about disclosing medical errors as well as other professionals' roles and perspectives. Discussion This activity has met both of our major goals. The first was to bring health professions students together to learn with, from, and about each other. The second was to practice a critical and challenging communication skill. This activity has been successfully implemented at other institutions, and can be adapted to fit other groups of students.

Introduction Delivering unexpected news to families can lead to emotionally charged conversations that cause discomfort and feelings of ineffectiveness in pediatric postgraduate trainees. Although prenatal screening exists, over 80% of trisomy 21 diagnoses continue to be made postnatally to unsuspecting parents who report a desire for better communication from health care professionals when they first receive the news of their child's diagnosis. Recognizing this area for improvement as reported in the literature, as well as the expressed desire from fellows in the University of Ottawa neonatal-perinatal medicine program for additional protected time to preemptively practice such disclosures, this trisomy 21 Scenario-Oriented Learning in Ethics workshop was developed. Methods During the workshop, trainees are introduced to an evidence-based communication framework that provides them with strategies to facilitate clear knowledge translation and promote rapport with families for this specific clinical scenario. Participants are divided into small groups and practice disclosing a trisomy 21 diagnosis to a standardized patient in the role of a new mother. Each small group is supported by two trained facilitators who are experts in delivering life-altering news. Results The pilot workshop was completed by 21 postgraduate trainees from the University of Ottawa. Qualitative evaluations were overwhelmingly positive, with feedback indicating high levels of perceived usefulness for the workshop. Discussion By preemptively practicing evidence-based communication, we hope to increase trainee confidence and preparation for trisomy 21 disclosures and improve parents' feelings regarding the quality of communication and support provided while receiving real-life trisomy 21 diagnoses.

Introduction Drug-induced nephrotoxicity is a common yet preventable cause of acute renal failure. With the upward trend of prescription and over-the-counter medication use, it has become increasingly important for health care professionals to not only be able to identify acute renal failure precipitated by medications, but also to recognize medications that are eliminated by the kidneys and adjust dosages accordingly to prevent further damage. Methods In this activity, third-year clerkship medical students are presented with a standardized patient portraying an acute medical problem in which students must ascertain the underlying cause of the problem and draw from their knowledge of pharmacology, pharmacokinetic principles, and clinical therapeutics to develop a plan to address the patient's medical concerns. Results We found that few students were able to identify the underlying cause of the patient's acute condition, and none were successful at applying pharmacokinetic principles appropriately. Discussion Implementing this case with third-year medical students has identified the need to revisit pharmacokinetic principles in an applied setting. As a result, this topic is being added to a course that highlights the relevance of basic sciences in clinical contexts for clerkship students.

Introduction In 2003, the Institute of Medicine recommended that interprofessional education be incorporated into the training programs of health care professionals. However, many logistical challenges hinder formal interprofessional learning in health care profession programs. Methods This resource is a 3-hour interprofessional small-group session designed for health professions student teams to engage in a standardized patient encounter, each team member contributing a profession-specific perspective to create a collaborative care plan across five discharge decisions. The activity includes a simulated standardized patient encounter and debrief session wherein students discuss the role of bias and communication and create a collaborative care plan. Results Following the activity, participants were surveyed about the value of the educational experience. Over 12 months, 106 students (81 medicine, nine nursing, 16 pharmacy) participated in the interprofessional activity. Eighty-four students responded to the postevent survey (79% response rate). Students were confident that the experience helped them integrate profession-specific knowledge, create a shared care plan, and understand how interprofessional collaboration contributes to quality care. The debriefing session and interprofessional interaction were an integral component of the experience. Discussion This resource is a feasible interprofessional small-group activity that has been implemented without excessive faculty time or institutional resources. It is adaptable to institutional needs, local resources, level of trainee, and professions. The session provides interprofessional students the opportunity to engage with one another and with the patient in a collaborative decision-making activity focused around a critical transition of care.

Abstract Introduction Transgender patients experience poor health outcomes and often avoid seeking medical care because of negative encounters with providers. Despite growing awareness of the health disparities transgender patients face, there is very little curricular time in medical schools to improve medical students’ knowledge and skills for caring for transgender patients. This standardized patient (SP) case was developed for use in a communication challenges workshop for advanced clerkship students in order to address working with transgender patients. Methods This formative SP encounter takes place in a classroom as part of a half-day workshop on communication challenges with patients. We developed the case to focus specifically on skills related to obtaining patients’ preferred names and pronouns, as well as taking an appropriate patient history. Materials for SP recruitment, SP training, and case implementation are included within this publication. Results In preliminary uses of the case, 80% of students (N = 64) agreed or strongly agreed that it had increased their skills for working with transgender patients. Observational data from the debrief discussions also revealed that medical students perceived gaps in their medical training regarding LGBT health and expressed interest in their program incorporating more information on transgender health. Discussion This case adds to a growing number of curricular interventions to address medical students’ knowledge and skills with regard to lesbian, gay, bisexual, and transgender (LGBT) patients and, as a result, aims to address health disparities in LGBT patient populations.

Abstract Introduction From the first day of residency, residents may be required to consent patients for interventions, procedures, or tests. The ability to perform an informed consent is considered one of the Association of American Medical College's Core Entrustable Professional Activities for entering residency. This case provides learners with the opportunity to obtain informed consent for a lumbar puncture procedure and to receive immediate structured feedback on their performance. This is a formative assessment, which has been used with both senior medical students and first-year residents at our institution. Methods The case involves a standardized patient with a history of leukemia who presents to the emergency department with a headache, fever, and lethargy. The learner is charged with the task of compassionately, honestly, and confidently explaining the process of a lumbar puncture in order to appropriately obtain informed consent. Results This case was well received, with the vast majority of learners rating the instructions as clear and the tasks of the station as appropriate for the level of learner. Comments provided by the learners regarding the standardized patients’ feedback indicate that this is a useful exercise to assist with the development of the crucial skill of obtaining informed consent. Discussion Overall, learners are able to perform this task and find it a meaningful exercise. We are able to measure both content and communication skills. In our cohort, learners are able to perform above the targeted passing score. This provides some evidence of competency in terms of both content and communication skills.

Abstract Introduction Standardized patient simulation has become an essential tool for undergraduate and graduate medical education for both training and assessment of learners. It has been less consistently used for more advanced learners, including infectious diseases fellowship trainees. Methods Four standardized clinical scenarios were developed to provide an opportunity to observe infectious diseases fellows in a standardized clinical environment in order to evaluate history-taking, physical exam, diagnostic, and counseling skills. Case topics were chosen to emulate key encounters related to infectious diseases care. Full case descriptions, standardized encounter tools, and assessment rubrics were developed and implemented in concert with simulation experts and standardized patients from the Vanderbilt Center for Experiential Learning and Assessment. A faculty member observed each learner simulation, provided qualitative verbal and written feedback, and assessed learner performance utilizing assessment rubrics based on 5-point Likert scales. Results Between 2012 and 2015, 18 first- and second-year infectious diseases fellows were evaluated using the simulation, which was well accepted as an educational tool by both fellows and faculty. Implementation of these tools helped identify individual learner opportunities for improvement as well as common educational gaps that subsequently led to systemic program interventions. Discussion Standardized patient simulation provides an additional tool for fellow assessments as well as infectious diseases fellowship program evaluations. These cases may be used in other institutions to assess fellows or other learners, unify assessment across programs, or provide a template for alternative assessments.

Abstract Introduction Faculty development programs are standards of practice in medical education to develop teaching skills of faculty. Programs that involve direct faculty feedback from a trained observer are more effective in impacting behaviors. An observed structured teaching encounter (OSTE) uses standardized trainees in scripted cases to assess teaching skills. The goal of the OSTE assessment can be program evaluation or specific teaching and feedback skills used in medical education with trainees. The OSTE allows practice followed by immediate feedback on performance. Methods In this OSTE, faculty development was provided to psychiatry preceptors. Their role was to precept two to three second-year medical students during a psychiatric patient encounter. The goal was to conduct a complete history and mental status exam on the patient. Using a standardized patient in the role of a psychiatric patient and fourth-year medical students in the role of second-year students, a simulated interaction was conducted in a small group. This role-play mimicked the preceptor, student, and patient encounter. The focus was on patient interviewing skills in addition to keeping all three students, who were observers, engaged in the interaction and learning. This was followed by a small-group discussion focusing on teachable moments. Results We used the evaluation by the second-year students, who completed a required initial clinical experience (ICE) in psychiatry, as evidence that this faculty development was effective. The psychiatry ICE data from 2014–2015 (N = 77) had 12 evaluation questions with a mean score of 3.9 out of 4.0. The one question that directly related to the faculty development OSTE (“Directly observes my clinical skills when interacting with patients”) scored 4.0 out of 4.0. Discussion To engage preceptors who are required to participate as preceptors in an early clinical experience, it is important to consider faculty development strategies beyond introductory letters, how-to manuals, videos, and PowerPoints. The OSTE framework permits enactment of the desired education strategy and reinforces what we expect from clinical teachers as well as expectations from students during a teaching encounter. It also unveils gaps that can be addressed in future faculty developments to assure learning for our students is consistent and on target.

Abstract The use of standardized patients (SPs) in an objective structured clinical examination (OSCE) format is well documented as a successful means of training students in the basics of clinical skills since it provides a rehearsal for students to practice in a safe environment. These five neurological-based SP cases were developed at the Morehouse School of Medicine. They include cluster headache, multiple sclerosis, neurologic exam for preemployment, Parkinson disease, and lateral femoral cutaneous nerve entrapment. All five cases were constructed to be all summative, all formative, and/or a combination of both types of assessments depending on the availability of faculty preceptors for direct feedback. In addition, most cases were written such that slight modifications could easily accommodate an SP of the opposite gender. The Morehouse School of Medicine has used these neurology cases for over 2 years. The first year, the five neurology cases were used as a summative OSCE. The following years, we made two of the cases direct feedback for formative evaluation. The learners appreciated the direct feedback much more than a pure summative assessment. The limitation with having a formative was that faculty members had to be available at each OSCE in order to provide the direct feedback. Future plans include implementing evaluations to gather data demonstrating impact of the OSCE (i.e., if the learners' comfort levels have increased as pertains to the neurological exams). Also, OSCE evaluations from learners, SPs, and/or preceptors could help correct deficiencies in any portion of the process. We feel that the use of SPs in the OSCE setting has translated to increased diagnostic and physical examination acumen in real practice with neurological patients. However, this is our perception and is not yet supported by data.

Abstract Introduction This standardized patient case introduces the unique needs of lesbian, gay, bisexual, and transgendered (LGBT) youth during an outpatient visit. This workshop was developed by clinician educators as part of a small-group curriculum for preclinical medical students. This case was developed by an internal medicine physician and vetted through pediatricians and clinicians with an interest in LGBT health. The session is intended to be used with preclinical or early clinical learners to give students practice in obtaining a complete history while simultaneously recognizing the added psychosocial stressors on LGBT youth, and how these stressors may manifest as physical complaints. Methods The session was run in a small-group setting, with a faculty facilitator. Students interviewed standardized patients in their weekly small-group session (12 students and one facilitator per group). The case pertained to a 15− to 25-year-old patient with chief complaint of headache. In delving deeper into social history, the students encountered the scenario of a patient with conflicted views on his/her sexual orientation and family pressures. Results The case and session have been used to train about 560 medical students. A subset (n = 95) of students was randomly selected to evaluate the small-group session. Eighty-seven percent of students rated the session as excellent or good, 12% as fair, and 2% as poor. During the 2013-14 and 2014-15 academic years, 88% of facilitators (n = 17) agreed or strongly agreed that the “content of the session was at the appropriate level for the students' level of learning.” Additional comments were generally positive, including “content was excellent and ‘real’” and “students did a great job discussion LGBT content.” Areas for improvement included suggestions that “more time” be allowed for discussion and reflections stating that “addressing both adolescent and LBGT in one session was challenging.” Discussion This standardized patient case introduces the unique needs of an LGBT youth during an outpatient visit, and has been used to train medical students to recognize the unique needs for a patient-centered, compassionate environment when treating adolescents who self-identify as LGBT.

Abstract Introduction The Liaison Committee on Medical Education's new accreditation standards recommend that medical education must prepare medical students to learn to collaborate with other healthcare professions. This post-traumatic stress disorder (PTSD) standardized patient (SP) case answers this call to collaborate with health care professions to better prepare new graduate nurses to enter multidisciplinary professional practice. Methods This resource provides an SP case specifically about PTSD, which includes a flashback in response to stimuli during the encounter, thus allowing students the opportunity to recognize an impending PTSD attack and offer ways to interrupt an impending attack. A simulated hospital suite was modified to mimic an inpatient clinic room. The encounter was digitally recorded for review in debrief. Each SP simulation was allowed to run a maximum of 20 minutes with a warning announcement being delivered at the 15-minute mark to cue the students to close the encounter. Faculty or students could end the scenario before the full 20 minutes if the learning objectives were successfully achieved. At the end of the scenario, the SP had a maximum of 15 minutes to come out of character, review the guidelines for debrief, and collect his relevant thoughts for feedback comments. Once this was completed, the SP joined the nursing students and faculty in debrief and engaged in guided reflection on the encounter by giving positive and meaningful feedback to the students. At the end of the debrief session, nursing students completed a web-based evaluation of the SP encounter. Results Results were overwhelmingly positive, with the majority of the undergraduate nurse students (n = 40) agreeing or strongly agreeing the SP encounter was an effective learning experience. Students' comments indicated that the interaction with the SP rewarded caring relationship strategies, helped them to develop a therapeutic relationship with the patient, and gave them an opportunity to demonstrate empathy for a patient with PTSD. Discussion This resource adds to MedEdPORTAL's collection of interprofessional teaching/learning strategies, while focusing on veterans' health, which is a national healthcare concern and a priority for nursing education. During the case, the SP's PTSD characteristics escalate and/or de-escalate based on establishment of a caring relationship by the student. This dynamic interaction is more effective than a lecture or reading, as illustrated by the learner and SP comments.

Abstract Introduction The pelvic exam is by nature a challenging procedure to perform well, as it requires a provider to establish with a patient a level of trust high enough to permit inspection and palpation of one of the most private and intimate parts of the body. Unfortunately, data suggest that providers have not mastered the art of performing a sensitive and tolerable pelvic exam. Levels of distress have been shown to be especially high among certain groups, including patients with sexual and gender minority status, disabilities, obesity, and a history of trauma. Individuals who experience exam-related pain or discomfort are less likely to return for future care; accordingly, disparities in cervical cancer screening have been documented in each of the aforementioned populations. This resource includes all of the materials needed to run an OSCE station focused on providing formative feedback to primary care residents regarding their ability to perform a sensitive and technically proficient pelvic exam/Pap test for a standardized patient who identifies as lesbian and has a history of trauma. Methods For the past 3 years we have implemented (and continue to use) this OSCE as an integral component of a multistation OSCE designed to provide formative feedback to residents enrolled in the HIV Primary Care Track of the 3-year BIDMC internal medicine residency program. After completion of each year of training, residents rotate through four sequential OSCE stations; this OSCE is one of these stations administered at the end of the PGY2 year. Results To date, 12 PGY2 residents (four per year) enrolled in the HIV Primary Care Track have participated in this OSCE station. Total performance, encompassing history, exam, and counseling skills, as rated by faculty checklists was 23.5 out of 30. Communication performance (i.e., patient centered communication, interpersonal skills, and global rating), available for eight of the residents, as rated by standardized patients, was 78.3/90. Discussion The pelvic exam is by nature a challenging procedure to perform well. Unfortunately, data suggest that providers have not mastered the art of performing a sensitive and tolerable pelvic exam. This OSCE includes all the materials to run a station focused on providing formative feedback to residents regarding their ability to perform a sensitive and technically proficient pelvic exam. With minor adaptations, the case can be adapted to feature a patient on the female-to-male transgender spectrum. Use of the case may also be appropriate for other health professions trainees.

Abstract Introduction Delivering a death disclosure is a routine but high-stakes part of the practice of an emergency physician. However, this is a skill that is conducted with a wide range of competence by both residents and faculty and one that can be improved through practice. This is a standardized patient (SP) scenario created to teach emergency medicine interns how to deliver a death disclosure in the case of an adult. This case was created as part of a hands-on session for emergency medicine interns to increase their comfort and competence with death disclosures. Methods A 1-hour didactic session on death disclosure for the interns precedes the SP encounter. The learners then participate in the SP scenario regarding the delivery of a death disclosure to the spouse of a patient. During the scenario, the learners were observed by the SP, the faculty rater, and a peer, all of whom delivered feedback. The faculty rater completes the direct observation tool which was created using language which maps to the emergency medicine milestones. Debriefing following the session takes place with the faculty, the resident, a peer, and the SP all present. The discussion focuses on the emotional toll of this conversation on both the learner and the SP, as well as the intern's ability to utilize the format presented in the didactic session. Results Following implementation, feedback from interns was positive in that most enjoyed the experience and found it to be a valuable use of resources. In addition, most were able to utilize the death disclosure construct that was taught in the morning didactic session. The session length was appropriate for the case and debriefing. Early experience and outcomes with the curriculum have been previously published and demonstrated a perceived increase in the number of interns confident they could perform death disclosure from 29% (prescenario) to 67% (postscenario). Discussion This SP scenario was created to teach emergency medicine interns how to deliver a death disclosure in the case of an adult. Communication skills necessary for such a conversation are a focus of the ACGME milestones in emergency medicine. Over time, we have modified the assessment tool to reflect the use of these milestones in resident assessment. We also had to expand the resources expended on this curriculum to accommodate growing class sizes. Finally, we have eliminated discussion of bad news delivery, focusing instead on death disclosure exclusively due to time constraints.