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Objective: Evaluate medical students' communication skills with a standardized patient (SP) requesting a low value test and describe challenges students identify in addressing the request.Methods: In this mixed-methods study, third-year students from two medical schools obtained a history, performed a physical examination, and counseled an SP presenting with uncomplicated low back pain who requests an MRI which is not indicated. SP raters evaluated student communication skills using a 14-item checklist. Post-encounter, students reported whether they ordered an MRI and challenges faced.Results: Students who discussed practice guidelines and risks of unnecessary testing with the SP were less likely to order an MRI. Students cited several challenges in responding to the SP request including patient characteristics and circumstances, lack of knowledge about MRI indications and alternatives, and lack of communication skills to address the patient request.Conclusions: Most students did not order an MRI for uncomplicated LBP, but only a small number of students educated the patient about the evidence to avoid unnecessary imaging or the harm of unnecessary testing.Practice Implications: Knowledge about unnecessary imaging in uncomplicated LBP may be insufficient to adhere to best practices and longitudinal training in challenging conversations is needed. [ABSTRACT FROM AUTHOR]

Objective: In current objective structured clinical examinations (OSCEs), simulated encounters lacking realism reduce authenticity of assessment as students can take the OSCEs with a search-and-scan approach and trained empathy. Accordingly, patient-centeredness, the fundamental goal of OSCE, is not well assessed. This study evaluated the effect of a change in the OSCE scenario and checklist with respect to detecting students' patient-centeredness.Methods: A scenario script for valid representation of a real clinical encounter was developed and defined as authenticated scenario. The OSCE scores and the measure of patient-centered communication (MPCC) scores of 79 medical students were compared between the two OSCE stations, one using the traditional scenario and another using the authenticated scenario.Results: The MPCC total score was higher in the OSCE station using the authenticated scenario than that of the traditional scenario (p < 0.001). For the OSCE scores, the patient satisfaction score and the patient-physician interaction score were higher in the station using the authenticated scenario than the traditional one (p < 0.001).Conclusion: The OSCE station using the authenticated scenario better detected medical student level of patient-centeredness.Practice Implications: Strengthening the authenticity of the OSCE scenario is critical for detecting the medical students' levels of patient-centeredness. [ABSTRACT FROM AUTHOR]

Objective: Good physician communication skills increase patient satisfaction and improve healing processes. Although physicians and patients appear to value communicative competencies differently, students are often evaluated solely by physicians. This study examines whether additional assessment of students by 'standardized patients' (SPs) is useful.Methods: During their Objective Structured Clinical Examination (OSCE) 238 medical students were additionally rated by SPs at 9 stations according to two items that defined the 'physician-patient relationship' and 'communication'. SPs were informed that their assessment was for research purposes only, with no impact on the assessment of the students. SPs also had the opportunity to comment on their rating of the students.Results: The SPs rated the communicative competencies of students differently than physicians. The two parts of the SP rating are closely related. Inclusion of SP rating in the OSCE would provide higher measurement precision, with more students failing. SPs considered five factors relevant in their rating: 'human connection', 'information flow', 'professionalism', 'competence', and 'exam situation'.Conclusion: Our study suggests inclusion of SP rating as additional assessment of student communication skills.Practice Implications: Addition of SP rating in assessments is worthwhile, as it appears to complete the picture of the student performance in their OSCEs. [ABSTRACT FROM AUTHOR]

Objective: To investigate the reliability and validity of the Chinese version of VR-CoDES.Methods: The VR-CoDES was translated into Chinese, and a focus group was held to discuss its cultural adaptation. Video consultations between 75 fourth-year medical students and 2 standardized patients (SPs) were coded by two raters with the Chinese VR-CoDES. Inter-rater reliability was tested by using ICC. To obtain validity, the SPs reviewed the video consultations to confirm the cues and concerns.Results: ICC was 0.79. Specificity and sensitivity were 0.99 and 0.96 respectively. The SPs expressed considerably more cues (mean = 7.00) than concerns (mean = 0.32). Half of the responses of medical students were explicit reducing space. Focus group participants raised some cultural considerations, and some interactions were difficult to code due to cultural differences.Conclusion: The Chinese VR-CoDES obtained good reliability and validity. Due to differences in the expression of emotions and other differences such as different medical systems between China and Western countries, the Chinese VR-CoDES needs further cultural adaptation.Practice Implication: More consultations in real clinical settings need to be gathered to further support the Chinese VR-CoDES both on validation and cultural adaptation. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Students are rarely taught communication skills in the context of clinical reasoning training. The purpose of this project was to combine the teaching of communication skills using SPs with clinical reasoning exercises in a Group Objective Structured Clinical Experience (GOSCE) to study feasibility of the approach, the effect on learners’ self-efficacy and attitude toward learning communication skills, and the effect of providing multiple sources of immediate, collaborative feedback. Methods: GOSCE sessions were piloted in Pediatrics and Medicine clerkships with students assessing their own performance and receiving formative feedback on communication skills from peers, standardized patients (SPs), and faculty. The sessions were evaluated using a retrospective pre/post-training questionnaire rating changes in self-efficacy and attitudes, and the value of the feedback. Results: Results indicate a positive impact on attitudes toward learning communication skills and self-efficacy regarding communication in the clinical setting. Also, learners considered feedback by peers, SPs, and faculty valuable in each GOSCE. Conclusion: The GOSCE is an efficient and learner-centered method to attend to multiple goals of teaching communication skills, clinical reasoning, self-assessment, and giving feedback in a formative setting. Practice implications: The GOSCE is a low-resource, feasible strategy for experiential learning in communication skills and clinical reasoning. [Copyright &y& Elsevier]

Abstract: Objectives: Considering the expense of standardized patients (SP) for training communication skills and the convenience of peer role playing (RP) there is a surprising lack of studies directly comparing the two methods. Methods: Fifth year medical students (N =103) were assigned to three groups receiving a training in counseling parents of sick children with RP (N =34) or SP (N =35) or to a control group (CG, N =34). We assessed self-efficacy, as well as objective performance in parent–physician communication using questionnaires and the Calgary-Cambridge-Observation-Guide Checklist in a six-station OSCE, respectively. Results: The training led to an increase in self-efficacy ratings and in the post-intervention OSCE score after RP (p <.021 and p <.001 respectively) and SP-training (p <.007 and p <.006 respectively) compared to controls. Surprisingly, this benefit was higher after RP than after SP-training (p <.021) due to significantly higher performance in the domain understanding of parents’perspective (p <.001). Conclusion: Both RP and SP are valuable tools for training specific communication skills. RP offer a methodological advantage in fostering empathy for patient perspectives. Practice implications: Both peer-role-play and standardized patients hold specific benefits for communication training. Peer-role-play seems to foster a more empathic approach towards patients’ concerns justifying its prominent role in medical curricula. [Copyright &y& Elsevier]

Objective: To explore the accuracy and consistency of standardized patient (SP) performance in the context of routine genetic counseling, focusing on elements beyond scripted case items including general communication style and affective demeanor.Methods: One hundred seventy-seven genetic counselors were randomly assigned to counsel one of six SPs. Videotapes and transcripts of the sessions were analyzed to assess consistency of performance across four dimensions.Results: Accuracy of script item presentation was high; 91% and 89% in the prenatal and cancer cases. However, there were statistically significant differences among SPs in the accuracy of presentation, general communication style, and some aspects of affective presentation. All SPs were rated as presenting with similarly high levels of realism. SP performance over time was generally consistent, with some small but statistically significant differences.Conclusion and Practice Implications: These findings demonstrate that well-trained SPs can not only perform the factual elements of a case with high degrees of accuracy and realism; but they can also maintain sufficient levels of uniformity in general communication style and affective demeanor over time to support their use in even the demanding context of genetic counseling. Results indicate a need for an additional focus in training on consistency between different SPs. [ABSTRACT FROM AUTHOR]

Objective: Standardized or simulated patients are widely used in medical training, however, little is known about these individuals and their work experience. The current study was designed to describe the SP workforce and gain insight into the routine tasks, challenges and rewards associated with their work. Methods: Using the full 2005 membership list (n =450) of Association of Standardized Patient Educators (ASPE), one SP educator for each medical school across all states was identified, representing a total of 87 different medical schools. Fifty-seven (65%) of the SP educators approached agreed to participate in the study and distribute surveys to 10 SPs in each program. Results: 255 (45%) of the distributed surveys were returned representing the experience of SPs in 57 medical schools across all 6 ASPE geographic regions. Specifics in regard to work scheduling and compensation are reported with some regional differences noted in pay. On the whole, SPs were highly satisfied with their work, but roughly half reported some difficulty with elements of case mastery and providing feedback to learners. Conclusion: SP satisfaction is high but challenges in case mastery and feedback tasks are evident. Practice implications: Meeting training needs can enhance the utility and effectiveness of this workforce. [Copyright &y& Elsevier]

Objective: We sought to evaluate a year 3 motivational interviewing (MI) curriculum using a standardized patient case. Methods: The 2-h small group MI curriculum included a didactic presentation followed by interactive role plays. During a clinical skills assessment at the end of year 3 the MI skills of 80 students who had participated in the curriculum were compared with those of 19 students who had not participated. Results: The standardized patient reliably rated the students on their performance of 8 items. Students who had participated in the MI curriculum were significantly more proficient than nonparticipating students in the performance of 2 strategic MI skills, importance and confidence rulers (ps<.006). The groups did not differ in their use of patient-centered counseling skills or collaborative change planning commonly used in MI. Conclusions: Third year medical students can learn to use MI skills that specifically aim to enhance patients’ motivations for change. Practice implications: Medical schools should consider providing students with MI training and MI skill assessments using standardized patient cases to help students prepare to counsel patients for behavior change. [Copyright &y& Elsevier]

Objectives: To evaluate the impact that role-playing two pre/post standardized patient scenarios within a tobacco cessation training program had on pharmacists’ counseling skills. Second, to analyze the validity of the observation coding tool used to evaluate pharmacist's role-play performance. Methods: Pharmacists performed two role-playing scenarios which incorporated national guidelines, the 5A's counseling process, and the “preparation” and “action” phases of the transtheoretical model. Pharmacists’ performance was evaluated with an observation coding tool. Results: Pharmacists’ (n =25) counseling performance improved significantly post-training (p <0.02: Action Scenario; p <0.004: Preparation Scenario). More than 50% of pharmacists provided patient-directed tobacco consultation services in the one year following training. The observation tool score for the “action phase” scenario was highly associated with pharmacists’ subsequent delivery of tobacco cessation services in community practice. Conclusion: Role-playing facilitated pharmacists’ skill development. The evaluation tool and Action Scenario may be powerful for predicting pharmacists’ delivery of tobacco cessation services. Practice implications: Incorporating role-playing and structured tools for performance evaluation can help enhance pharmacist performance during training and predict service delivery in community practice. Together they could facilitate tailored feedback to help pharmacists struggling with the difficult task of extending cognitive service roles in practice. [Copyright &y& Elsevier]

Abstract: Objective: Physicians often overlook important contextual clues that patients give during an encounter. The objective of our study was to increase medical students’ knowledge and skills in identifying contextual issues. Methods: Six consecutive learning experiences, including a standardized patient (SP) encounter and activities designed to trigger reflection, were implemented within a first-year Introduction to Clinical Medicine course. Evaluation of the intervention was measured through self-confidence, attitudes, SP history checklist, and student and small group facilitator evaluations. Results: Standardized patient encounters, coupled with activities designed to trigger reflection, can help students identify patients’ contextual clues. Students’ confidence in eliciting patient clues significantly increased after the intervention. Our results suggest that some contextual clues were more difficult for students to elicit. Conclusion: Multi-faceted approaches that include activities to trigger reflection are effective in teaching students to recognize and respond to contextual clues, however, more research is needed. Practice Implications: While students elicited most clues in this study, they struggled with identifying some clues. These results suggest the need for additional research and educational development in this area. [Copyright &y& Elsevier]