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Introduction: Telemedicine is an increasingly common form of healthcare delivery in the United States. It is unclear how there are differences in clinical performance in early learners between in-person and telemedicine encounters. Materials & Methods: The authors conducted a single-site retrospective cohort study of 241 second-year medical students to compare performance between in-person and telemedicine standardized patient (SP) encounters. One hundred and twenty medical students in the 2020 academic year participated in a telemedicine encounter, and 121 medical students in the 2022 academic year participated in an in-person encounter. SPs completed a multi-domain performance checklist following the encounter, and the authors performed statistical analyses to compare student performance between groups. Results: Students who completed in-person encounters had higher mean scores in overall performance (75.2 vs. 69.7, p < 0.001). They had higher scores in physical exam (83.3 vs. 50, p < 0.001) and interpersonal communication domains (95 vs. 85, p < 0.001) and lower scores in obtaining a history (73.3 vs. 80, p = 0.0025). There was no significant difference in assessment and plan scores (50 vs. 50, p = 0.96) or likelihood of appropriately promoting antibiotic stewardship (41.3% vs. 45.8%, p = 0.48). Conclusion: The authors identified significant differences in clinical performance between in-person and telemedicine SP encounters, indicating that educational needs may differ between clinical environments. [ABSTRACT FROM AUTHOR]

Background: There are limited studies that explored the preparation and challenges faced by standardized patients (SPs) in portraying characters in difficult communication scenarios, and the strategies used to overcome these challenges. The purpose of this study was to understand the experience of SPs in interpreting difficult communication situations and the learning needs of performing similar scenarios. And it allows the researchers to explore the meaning, beliefs, values, and aspiration associated with their role as SPs. The findings could shade light on the significance of their experiences and provide valuable insights for the development of future SP training programs. Methods: The design of this study is framed by a narrative inquiry, using semi-structured guidelines to conduct in-depth interviews with 11 SPs who have participated in the performances of difficult communication situations. Research data were analyzed by Polkinghorne narrative analysis, and Riessman's four criteria were used to establish rigor. Results: Analysis revealed the following five themes: scenarios to real life connections, process of preparing for a performance, methods to detach from character, obtaining unexpected rewards, and needs for performance training. There are two to three subthemes that are subsumed under each theme. Conclusions: To strengthen training in difficult communication for healthcare professionals, the use of SPs to interpret challenging difficult communication scenarios will continue to increase. Educators need to ensure that SPs are fully prepared physically and emotionally before, during and after their performance. Offering of continuing education and training in feedback techniques are crucial to extend the tenure of SPs, reduce their frustration, prevent attrition, and ultimately, reduce training costs. In the future, SP training should also include detachment and feedback techniques to alleviate SPs' stress. [ABSTRACT FROM AUTHOR]

This systematic review aims to evaluate the effectiveness of simulation in enhancing the knowledge and skills required for preventing, managing, and treating pressure injuries (PIs) among nursing students. A systematic review of English articles published between January 1, 2014, and March 31, 2024, was conducted to determine the effectiveness of simulation in PI education. PubMed, Cochrane Library, Medline (OVID), Scopus, Web of Science, CINAHL, and Science Direct databases were searched using the keywords "simulation", "pressure ulcer", "pressure injury", "nursing", and "nursing education". The study data were analyzed using the content analysis method. Of the 101 articles retrieved from the databases, 5 met the eligibility criteria. The study found that simulation in PI prevention and management education increased students' knowledge and skill levels, enhanced their satisfaction and communication skills, and was more effective than traditional didactic education. This systematic review supports the use of simulation as an educational tool for nursing students in preventing, implementing protective interventions, and managing PI. Furthermore, it encourages further research to explore the role and effectiveness of different formats of simulation, particularly high-fidelity simulation, in PI management education and their impact on student achievement and clinical practice. [ABSTRACT FROM AUTHOR]

Background: Sufficient knowledge of end-of-life care, positive attitudes, and emotions regarding death and dying are essential criteria for showcasing favorable palliative care educational results to undergraduate nursing students. However, nursing students have negative attitudes toward end-of-life care and know little about it. Aim: This study aimed to examine the effect of a repeated standardized patient-based training program (intervention) on nursing students' knowledge, attitudes, and emotions about end-of-life patients. Method: This study adopted a pretest-posttest quasi-experimental research design. The sample consisted of 50 fourth-year nursing students divided into intervention (n = 25) and control (n = 25) groups. All participants attended the intervention. The intervention group attended the intervention twice, while the control group attended it only once. Data were collected using a personal information form, the Frommelt Attitudes Toward Care of the Dying Scale, the Positive and Negative Affect Schedule, and the End-of-Life Care Nursing Questionnaire. The data were analyzed using descriptive statistics, Pearson's Chi-square test, dependent groups t test, Pearson-Spearman, Mann-Whitney test, Wilcoxon test, and Friedman test. Results: The intervention helped participants learn more about end-of-life care (χ2 = 27.167, P =.000; F = 42.725, P =.000) and develop more positive attitudes toward end-of-life patients (F = 13.279, P =.000; F = 6.934, P =.000). The intervention also helped participants develop communication skills. Conclusion: Universities should integrate repeated standardized patient-based into nursing curricula. [ABSTRACT FROM AUTHOR]

Abstract Background Given the increasing frequency of disasters globally, it is critical that healthcare systems are prepared for these mass casualty events. The Saudi health system’s preparedness for mass casualty incidents needs to be more robust, potentially due to limited disaster drills and inadequate standardized patient (SP) simulation training. This study aims to (i) assess the performance of front-line hospital staff in Saudi Arabia through a functional drill and (ii) evaluate the drill’s effectiveness using SP and MAC-SIM cards, providing detailed insights into its design and execution. Methods A functional drill was conducted at a government hospital in Riyadh, Saudi Arabia, on December 19, 2022, using a cross-sectional approach with two phases. 141 healthcare receivers served as subjects, while 23 volunteers acted as SPs. The scenario simulated a building collapse to assess the emergency department (ED) response, interdepartmental communication, and surge capacity. Data were collected through direct observation of healthcare practitioners’ interactions with the SPs, analysis of SP data, and participant feedback. Quantitative data were analyzed descriptively, while qualitative data were examined for patterns and themes related to simulation performance and effectiveness. Results The hospital receivers’ performances demonstrated accurate triage categories. The ED team assessed most patients (67%) in less than 5 min. For patients requiring definitive care, such as intensive care unit, 95% spent less than 2.5 h in the ED. Most patients (65%) required ‘other treatments’. Communication was efficient in the triage zone and the yellow treatment area. Participants’ feedback on using MAC-SIM cards during the simulation was overwhelmingly positive with 82.61% reporting that MAC-SIM use helped them respond better. Experienced SPs (paramedics) with prior disaster knowledge and experience outperformed inexperienced SPs (nurses) in the functional exercise. Conclusion This groundbreaking study is the first in the Arabic Gulf region to use SPs with MAC-SIM cards in functional drills. The findings highlight the potential of simulation exercises to improve hospital team knowledge and performance when responding to disasters. Multiple evaluation techniques can effectively identify participant strengths and weaknesses, informing future disaster improvement plans. This information is a valuable resource for Arabic and middle-income countries where disaster medicine is still developing.

Abstract Background History-taking is an essential clinical competency for qualified doctors. The limitations of the standardized patient (SP) in taking history can be addressed by the virtual standardized patient (VSP). This paper investigates the accuracy of virtual standardized patient simulators and evaluates the applicability of the improved system’s accuracy for diagnostic teaching support and performance assessment. Methods Data from the application of VSP to medical residents and students were gathered for this prospective study. In a human–machine collaboration mode, students completed exams involving taking SP histories while VSP provided real-time scoring. Every participant had VSP and SP scores. Lastly, using the voice and text records as a guide, the technicians will adjust the system’s intention recognition accuracy and speech recognition accuracy. Results The research revealed significant differences in scoring across several iterations of VSP and SP (p

Background: Given the increasing frequency of disasters globally, it is critical that healthcare systems are prepared for these mass casualty events. The Saudi health system's preparedness for mass casualty incidents needs to be more robust, potentially due to limited disaster drills and inadequate standardized patient (SP) simulation training. This study aims to (i) assess the performance of front-line hospital staff in Saudi Arabia through a functional drill and (ii) evaluate the drill's effectiveness using SP and MAC-SIM cards, providing detailed insights into its design and execution. Methods: A functional drill was conducted at a government hospital in Riyadh, Saudi Arabia, on December 19, 2022, using a cross-sectional approach with two phases. 141 healthcare receivers served as subjects, while 23 volunteers acted as SPs. The scenario simulated a building collapse to assess the emergency department (ED) response, interdepartmental communication, and surge capacity. Data were collected through direct observation of healthcare practitioners' interactions with the SPs, analysis of SP data, and participant feedback. Quantitative data were analyzed descriptively, while qualitative data were examined for patterns and themes related to simulation performance and effectiveness. Results: The hospital receivers' performances demonstrated accurate triage categories. The ED team assessed most patients (67%) in less than 5 min. For patients requiring definitive care, such as intensive care unit, 95% spent less than 2.5 h in the ED. Most patients (65%) required 'other treatments'. Communication was efficient in the triage zone and the yellow treatment area. Participants' feedback on using MAC-SIM cards during the simulation was overwhelmingly positive with 82.61% reporting that MAC-SIM use helped them respond better. Experienced SPs (paramedics) with prior disaster knowledge and experience outperformed inexperienced SPs (nurses) in the functional exercise. Conclusion: This groundbreaking study is the first in the Arabic Gulf region to use SPs with MAC-SIM cards in functional drills. The findings highlight the potential of simulation exercises to improve hospital team knowledge and performance when responding to disasters. Multiple evaluation techniques can effectively identify participant strengths and weaknesses, informing future disaster improvement plans. This information is a valuable resource for Arabic and middle-income countries where disaster medicine is still developing. [ABSTRACT FROM AUTHOR]

OBJECTIVE: It is crucial that teaching faculties determine and remain informed of medical school learners' clinical reasoning competence. We created an innovative assessment method for fourth-year medical students to identify deficiencies in various components of their clinical reasoning ability. METHODS: This was a cross-sectional observational study of fourth-year medical students' reasoning assessments from 2019 to 2022. Teams of four–five trainees questioned standardized patients in clinical scenarios, including fever, abdominal pain, and weight loss. They then individually documented key information to reflect comprehension of patient problems. Trainees were tasked with differentiating diagnoses and associated statuses and reaching the most likely diagnosis along with two tentative diagnoses. The correlations observed between 2020 and 2022 for abdominal pain were analyzed using student t -tests. RESULTS: A total of 177 students participated in this study. Across the scenarios, there was no significant difference in key information representation scores (56%–58%). Reasoning ability scores were 49% for fever, 57% for abdominal pain, and 61% for weight loss. A comparison between 2020 and 2022 revealed a significant improvement in the objective structured clinical examination scores and differential diagnoses (P <.01). Shortcomings included brief chief complaint duration, lack of detailed presentation, and insufficient description of negative information. Differential diagnosis and diagnostic justification were inadequate for acute and chronic conditions, and disease location clarity within the organ system was lacking. On average, students presented two correct diagnoses. CONCLUSIONS: Fourth-year medical students exhibited inadequate reasoning abilities, particularly in fever and abdominal pain scenarios, with deficiencies in hypothesis generation and differential diagnosis. Group history-taking with individual reasoning assessment identified students' shortcomings and provided faculty feedback to improve their teaching strategies. [ABSTRACT FROM AUTHOR]

Background: History-taking is an essential clinical competency for qualified doctors. The limitations of the standardized patient (SP) in taking history can be addressed by the virtual standardized patient (VSP). This paper investigates the accuracy of virtual standardized patient simulators and evaluates the applicability of the improved system's accuracy for diagnostic teaching support and performance assessment. Methods: Data from the application of VSP to medical residents and students were gathered for this prospective study. In a human–machine collaboration mode, students completed exams involving taking SP histories while VSP provided real-time scoring. Every participant had VSP and SP scores. Lastly, using the voice and text records as a guide, the technicians will adjust the system's intention recognition accuracy and speech recognition accuracy. Results: The research revealed significant differences in scoring across several iterations of VSP and SP (p < 0.001). Across various clinical cases, there were differences in application accuracy for different versions of VSP (p < 0.001). Among training groups, the diarrhea case showed significant differences in speech recognition accuracy (Z = -2.719, p = 0.007) and intent recognition accuracy (Z = -2.406, p = 0.016). Scoring and intent recognition accuracy improved significantly after system upgrades. Conclusion: VSP has a comprehensive and detailed scoring system and demonstrates good scoring accuracy, which can be a valuable tool for history-taking training. [ABSTRACT FROM AUTHOR]

The use of standardized patients in nursing education provides many advantages such as providing students with realistic learning opportunities, defining patient needs, reducing anxiety, and stress while caring for real patients in clinical practice, and increasing clinical performance, theoretical knowledge, and self-confidence. This study aimed to examine the effect of repeated standardized patient simulations in family planning counseling on the anxiety levels, communication, and counseling skills of nursing students. This is a quasi-experimental study with single group pretest-posttest. The study sample consisted of 44 nursing students. Student sociodemographic form, State anxiety inventory, Communication skills inventory, and Family planning counseling skill learning guides were used as data collection tools. The median of the State anxiety inventory before the first standard patient simulation was 43.0, and the median of the State anxiety inventory before the repeated simulation was 38.5. A significant difference was found between after the first standard patient simulation and repeated simulations to students' median scores of State anxiety inventory, Communication skills inventory, and Family planning counseling skills (p < 0.05). Repeated simulations with standardized patients has contributed positively to reducing anxiety among students and increasing students' family planning counseling and communication skills. [ABSTRACT FROM AUTHOR]

Introduction Telemedicine is an increasingly common form of healthcare delivery in the United States. It is unclear how there are differences in clinical performance in early learners between in-person and telemedicine encounters.Materials & Methods The authors conducted a single-site retrospective cohort study of 241 second-year medical students to compare performance between in-person and telemedicine standardized patient (SP) encounters. One hundred and twenty medical students in the 2020 academic year participated in a telemedicine encounter, and 121 medical students in the 2022 academic year participated in an in-person encounter. SPs completed a multi-domain performance checklist following the encounter, and the authors performed statistical analyses to compare student performance between groups.Results Students who completed in-person encounters had higher mean scores in overall performance (75.2 vs. 69.7, p

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.

Background: The use of standardized patient simulation in psychiatric nursing education addresses the unique challenges presented by mental healthcare settings. Students’ attitudes toward clinical simulation remain predominantly favorable, with many expressing enthusiasm for the opportunities it provides in terms of embracing challenges, enhancing realism, and promoting critical thinking through problem solving, decision-making, and adaptability. Methods: This quantitative study used a cross-sectional, descriptive, correlation design to investigate the effectiveness of standardized patient simulation as a teaching method in the Psychiatric and Mental Health nursing course in a university setting. A total of 84 nursing students were recruited for the convenience sample. Data were collected using a three-part questionnaire survey which included the following: a demographic data sheet, the Student Satisfaction and Self-confidence in Learning Scale, and a narrative open-ended question asking the participants to write the advantages and disadvantages of their simulation experience. Data were analyzed using the statistical software JMP pro17. Results: The total satisfaction with learning subscale score ranged between 5 and 25 with a mean score of 19.36 ± 6.32. The total self-confidence subscale score ranged between 8 and 40 with a mean score of 30.87 ± 9.1. Pearson’s correlation coefficient r revealed a statistically significant positive relationship between the participants’ satisfaction with the learning experience and their self-confidence (t = 0.923, p < 0.0001). Approximately 91.7% of the students recommended using simulation. The results confirmed the students’ recommendations of simulation use in teaching psychiatric and mental health courses; furthermore, the results showed a statistically significant positive correlation with the total SSLS (p = 0.01) and satisfaction with learning subscale (0.003). Participants reported that authentic, practical, comfortable, and safe learning environments contributed to an enriched learning experience. Additionally, factors such as timesaving, access to information, cost-effectiveness, standardized teaching, varied exposure, skill development, and immediate feedback also enhanced the learning experience through patient simulation in psychiatric and mental health nursing. Conclusion: Simulations can contribute efficiently and positively to psychiatric and mental health nursing education in a manner that optimizes the learning experience while ensuring the consistency of student learning in a safe learning environment.

Abstract Background Low- and middle-income countries face a disproportionate impact of sexual health problems compared to high-income countries. To address this situation proper interpersonal communication skills are essential for clinician to gather necessary information during medical history-taking related to sexual health. This study aimed to evaluate the interrater reliability of ratings on sexual health-related interpersonal communication and medical history-taking between SPs and trained HCP faculty for health care professional students. Methods We conducted a cross-sectional comparative study to evaluate the interrater reliability of ratings for sexual health-related interpersonal communication and medical history-taking. The data were collected from medical and nursing students at Muhimbili University of Health and Allied Sciences, who interviewed 12 Standardized Patients (SPs) presenting with sexual health issues. The video-recorded interviews rated by SPs, were compared to the one rated by 5 trained Health Care Professional (HCP) faculty members. Inter-rater reliability was evaluated using percent agreement (PA) and kappa statistics (κ). Results A total of 412 students (mean age 24) were enrolled in the study to conduct interviews with two SPs presenting with sexual health concerns. For interpersonal communication (IC), the overall median agreement between raters was slight (κ2 0.0095; PA 48.9%) while the overall median agreement for medical sexual history-taking was deemed fair (κ2 0.139; PA 75.02%). Conclusion The use of SPs for training and evaluating medical and nursing students in Tanzania is feasible only if they undergo proper training and have sufficient time for practice sessions, along with providing feedback to the students.

Abstract Background Nurses around the world are expected to demonstrate competence in performing mental status evaluation. However, there is a gap between what is taught in class and what is practiced for patients with mental illness among nursing students during MSE performance. It is believed that proper pedagogics may enhance this competence. A longitudinal controlled quasi-experimental study design was used to evaluate the effect of using standardized patient simulation-based pedagogics embedded with a lecture in enhancing mental status evaluation cognition among nursing students in Tanzania. Methods A longitudinal controlled quasi-experimental study design with pre-and post-test design studied 311 nursing students in the Tanga and Dodoma regions. The Standardized Patient Simulation-Based Pedagogy (SPSP) package was administered to the intervention group. Both groups underwent baseline and post-test assessments using a Interviewer-adminstered structured questionnaire as the primary data collection tool, which was benchmarked from previous studies. The effectiveness of the intervention was assessed using both descriptive and inferential statistics, specifically the Difference in Difference linear mixed model, and the t-test was carried out using IBM Statistical Package for Social Science (SPSS) software, version 25. Results The participant’s mean age was 21 years ± 2.69 with 68.81% of the students being female. Following the training Students in the intervention group demonstrated a significant increase in MSE cognition post-test, with an overall mean score of (M ± SD = 22.15 ± 4.42;p =

Abstract Objectives In middle-income countries, poor physician-patient communication remains a recognized barrier to enhancing healthcare quality and patient satisfaction. This study investigates the influence of provider-patient communication skills on healthcare quality and patient satisfaction in the rural primary healthcare setting in China. Methods Data were collected from 504 interactions across 348 rural primary healthcare facilities spanning 21 counties in three provinces. Using the Standardized Patient method, this study measured physician-patient communication behaviors, healthcare quality, and patient satisfaction. Communication skills were assessed using the SEGUE questionnaire framework. Multivariate linear regression models and multivariate logistic regression models, accounting for fixed effects, were employed to evaluate the impact of physicians’ communication skills on healthcare quality and patient satisfaction. Results The findings indicated generally low provider-patient communication skills, with an average total score of 12.2 ± 2.8 (out of 24). Multivariate regression models, which accounted for physicians’ knowledge and other factors, demonstrated positive associations between physicians’ communication skills and healthcare quality, as well as patient satisfaction (P

Background: Low- and middle-income countries face a disproportionate impact of sexual health problems compared to high-income countries. To address this situation proper interpersonal communication skills are essential for clinician to gather necessary information during medical history-taking related to sexual health. This study aimed to evaluate the interrater reliability of ratings on sexual health-related interpersonal communication and medical history-taking between SPs and trained HCP faculty for health care professional students. Methods: We conducted a cross-sectional comparative study to evaluate the interrater reliability of ratings for sexual health-related interpersonal communication and medical history-taking. The data were collected from medical and nursing students at Muhimbili University of Health and Allied Sciences, who interviewed 12 Standardized Patients (SPs) presenting with sexual health issues. The video-recorded interviews rated by SPs, were compared to the one rated by 5 trained Health Care Professional (HCP) faculty members. Inter-rater reliability was evaluated using percent agreement (PA) and kappa statistics (κ). Results: A total of 412 students (mean age 24) were enrolled in the study to conduct interviews with two SPs presenting with sexual health concerns. For interpersonal communication (IC), the overall median agreement between raters was slight (κ2 0.0095; PA 48.9%) while the overall median agreement for medical sexual history-taking was deemed fair (κ2 0.139; PA 75.02%). Conclusion: The use of SPs for training and evaluating medical and nursing students in Tanzania is feasible only if they undergo proper training and have sufficient time for practice sessions, along with providing feedback to the students. [ABSTRACT FROM AUTHOR]

Objective: In this study, it was aimed for third-year medical school students to improve their knowledge, examination skills and attitudes about breast cancer, and to experience the skills of taking a disease history, communicating effectively and giving bad news. Methods: The present study was carried out with 406 3rd-year medical faculty students from Akdeniz University and a semi-experimental method was employed. The content of implementation consists of improving the students' skills in receiving disease history from the patient and "clinical breast examination" on breast model, as well as informing the patient about the examination findings. Before the application, all students were given theoretical information about the subject and practiced with a learning guide on clinical breast examination. The pretest-posttest results of surveys received from the participating students and the standardized patient practice feedback form were analyzed. Results: Examining the surveys conducted before and after the implementation with 406 students, it was found that the students learned what the risk factors related with breast cancer are and they could question them while receiving the patient history (p<0.05). Their ability to perform breast examination was improved and they could detect the lump in breast (p<0.05). They gained experience about informing the patients and referring them to the departments related with preliminary diagnosis of breast cancer, as well as giving bad news (p<0.05). Conclusions: With a suitable scenario and planned educations, "Standardized Patient Practice" can be successfully used in preclinical educations. [ABSTRACT FROM AUTHOR]

Purpose: The COVID‐19 pandemic required a rapid transition to online education, including simulations. The current study identified students' perceptions of communicating with standardized patients in a virtual setting. Methods: This qualitative study thematically analyzed 485 reflections submitted by 248 students between Spring 2020 and Spring 2022. Statements describing both the virtual medium and dyadic interactions between students and patients were coded for emergent themes and also coded as positive (facilitative) or negative (critical). Results: Four themes emerged from the data related to the virtual medium: impact on nonverbal communication, patient engagement/rapport, presentation aids, and listening. Within these broad themes, 13 subthemes were identified, nine of which were negative/critical. Technology problems were specifically identified as compromising both engagement and listening. Even when technology worked well, students noted that it reduced the number of message cues received from the patient and complicated the process of sending cues (e.g., by requiring students to look away from a patient's face to make "eye contact" through a camera). Conclusions: Overall, students were critical of Zoom's impact on dyadic factors with standardized patients. However, they did acknowledge some positive aspects regarding the technology. These findings provide a foundation to consider when teaching students how to communicate effectively via teledentistry. [ABSTRACT FROM AUTHOR]

Background: The use of standardized patient simulation in psychiatric nursing education addresses the unique challenges presented by mental healthcare settings. Students' attitudes toward clinical simulation remain predominantly favorable, with many expressing enthusiasm for the opportunities it provides in terms of embracing challenges, enhancing realism, and promoting critical thinking through problem solving, decision-making, and adaptability. Methods: This quantitative study used a cross-sectional, descriptive, correlation design to investigate the effectiveness of standardized patient simulation as a teaching method in the Psychiatric and Mental Health nursing course in a university setting. A total of 84 nursing students were recruited for the convenience sample. Data were collected using a three-part questionnaire survey which included the following: a demographic data sheet, the Student Satisfaction and Self-confidence in Learning Scale, and a narrative open-ended question asking the participants to write the advantages and disadvantages of their simulation experience. Data were analyzed using the statistical software JMP pro17. Results: The total satisfaction with learning subscale score ranged between 5 and 25 with a mean score of 19.36 ± 6.32. The total self-confidence subscale score ranged between 8 and 40 with a mean score of 30.87 ± 9.1. Pearson's correlation coefficient r revealed a statistically significant positive relationship between the participants' satisfaction with the learning experience and their self-confidence (t = 0.923, p < 0.0001). Approximately 91.7% of the students recommended using simulation. The results confirmed the students' recommendations of simulation use in teaching psychiatric and mental health courses; furthermore, the results showed a statistically significant positive correlation with the total SSLS (p = 0.01) and satisfaction with learning subscale (0.003). Participants reported that authentic, practical, comfortable, and safe learning environments contributed to an enriched learning experience. Additionally, factors such as timesaving, access to information, cost-effectiveness, standardized teaching, varied exposure, skill development, and immediate feedback also enhanced the learning experience through patient simulation in psychiatric and mental health nursing. Conclusion: Simulations can contribute efficiently and positively to psychiatric and mental health nursing education in a manner that optimizes the learning experience while ensuring the consistency of student learning in a safe learning environment. [ABSTRACT FROM AUTHOR]

Background: Nurses around the world are expected to demonstrate competence in performing mental status evaluation. However, there is a gap between what is taught in class and what is practiced for patients with mental illness among nursing students during MSE performance. It is believed that proper pedagogics may enhance this competence. A longitudinal controlled quasi-experimental study design was used to evaluate the effect of using standardized patient simulation-based pedagogics embedded with a lecture in enhancing mental status evaluation cognition among nursing students in Tanzania. Methods: A longitudinal controlled quasi-experimental study design with pre-and post-test design studied 311 nursing students in the Tanga and Dodoma regions. The Standardized Patient Simulation-Based Pedagogy (SPSP) package was administered to the intervention group. Both groups underwent baseline and post-test assessments using a Interviewer-adminstered structured questionnaire as the primary data collection tool, which was benchmarked from previous studies. The effectiveness of the intervention was assessed using both descriptive and inferential statistics, specifically the Difference in Difference linear mixed model, and the t-test was carried out using IBM Statistical Package for Social Science (SPSS) software, version 25. Results: The participant's mean age was 21 years ± 2.69 with 68.81% of the students being female. Following the training Students in the intervention group demonstrated a significant increase in MSE cognition post-test, with an overall mean score of (M ± SD = 22.15 ± 4.42;p = < 0.0001), against (M ± SD = 16.52 ± 6.30) for the control group. Conclusion: A significant difference exists in the levels of cognition, among nursing students exposed to Mental Status Evaluation (MSE) materials through Standardized Patient Simulation-Based Pedagogy (SPSP) embeded with lectures. When MSE materials are delivered through SPSP along with lectures, the results are significantly superior to using lectures pedagogy alone. [ABSTRACT FROM AUTHOR]

Objectives: In middle-income countries, poor physician-patient communication remains a recognized barrier to enhancing healthcare quality and patient satisfaction. This study investigates the influence of provider-patient communication skills on healthcare quality and patient satisfaction in the rural primary healthcare setting in China. Methods: Data were collected from 504 interactions across 348 rural primary healthcare facilities spanning 21 counties in three provinces. Using the Standardized Patient method, this study measured physician-patient communication behaviors, healthcare quality, and patient satisfaction. Communication skills were assessed using the SEGUE questionnaire framework. Multivariate linear regression models and multivariate logistic regression models, accounting for fixed effects, were employed to evaluate the impact of physicians' communication skills on healthcare quality and patient satisfaction. Results: The findings indicated generally low provider-patient communication skills, with an average total score of 12.2 ± 2.8 (out of 24). Multivariate regression models, which accounted for physicians' knowledge and other factors, demonstrated positive associations between physicians' communication skills and healthcare quality, as well as patient satisfaction (P < 0.05). Heterogeneity analysis revealed stronger correlations among primary physicians with lower levels of clinical knowledge or more frequent training. Conclusion: This study emphasizes the importance of prioritizing provider-patient communication skills to enhance healthcare quality and patient satisfaction in rural Chinese primary care settings. It recommends that the Chinese government prioritize the enhancement of provider-patient communication skills to improve healthcare quality and patient satisfaction. [ABSTRACT FROM AUTHOR]

Gaps still exist in medical education about the sexual health needs of sexual diverse populations, and little is known about how translatable current learning modules are to patient encounters. Efforts at an academic medical institution have been made to address this need, including a two-hour adolescent sexuality workshop during the Core Clerkship in Pediatrics. This workshop's efficacy was evaluated in an objective structured clinical examination (OSCE) given to rising fourth-year medical students, where the standardized patient case focused on an adolescent cisgender male with dysuria and in a new, same-sex relationship. Performance of students who completed the workshop prior to the OSCE (n = 48) were compared to those of students who did not participate in the workshop prior to the OSCE (n = 17). The encounters were recorded and transcribed, and the deidentified transcripts were scored on a rubric focusing on five domains: sexual identity disclosure, behavioral assessment, psychosocial history, counseling and anticipatory guidance, and relationship building. Student's t-test comparison of the scores found significantly higher scores for the psychosocial history domain (p =.04), particularly concerning disclosure of a new boyfriend and recent sexual activity (p =.008), for students who had the workshop before the OSCE. Students who took the adolescent sexuality workshop performed better in gathering psychosocial information in an OSCE encounter a sexual minority adolescent. These results affirm prior work that active learning on sexual diverse health in medical school curricula may prepare students for effective engagement with adolescents exploring their sexuality. [ABSTRACT FROM AUTHOR]

Simulation is a safe, supported, and accessible learning method for students to gain skills and experience, especially in difficult to access range of practice areas such as voice. The study aimed to explore change in students' perceptions of knowledge, confidence, anxiety, and clinical readiness for assessment and management of an adult with a voice disorder after participation in simulation-based learning activities. Participants (N = 113) were students enrolled in a mandatory course dedicated to the voice and voice disorders. Students completed 32 hours of academic coursework which included lectures and tutorials and two 30-minute simulation-based learning activities with a standardized patient playing the role of an adult with a voice disorder. The impact of the simulation-based learning activities on student perceptions of their knowledge, confidence, anxiety, and clinical readiness for work within the area of voice were surveyed at three time points: (1) pre lectures, (2) post lectures but pre simulation, and (3) post simulation. Change across time was analyzed using repeated measures analysis of variance with post hoc Bonferroni adjustment. All students perceived significant (P ≤ 0.001) positive changes in knowledge and confidence across time points for all activities, except for writing an assessment report. Anxiety related to the management of a client with a voice disorder fluctuated significantly (P ≤ 0.001) throughout the program. Overall, the majority (>90%) of students agreed or strongly agreed that the simulation-based learning activities were useful and helped them to develop clinical skills, apply content taught in lectures, and gain confidence and interest in voice. This study supports incorporation of simulation-based learning as part of students' clinical preparation for the assessment and management of voice disorders. [ABSTRACT FROM AUTHOR]

Background:The evidence-do gap between the availability of clinical guidelines and provider practice is well documented, resulting in low health care quality. With the rapid development of telemedicine worldwide, this study aimed to investigate the evidence-do gap and explore the factors for the evidence versus practice deficits as well as low quality in direct-to-consumer telemedicine. Methods:We adopted the standardized patient approach to evaluate the health worker performance and calculate the evidence-do gap in quality of the consultation process, diagnosis, and treatment in telemedicine based on China's national clinical guidelines. Moreover, we further explored the factors associated with the gap through multiple linear regression and logistic regressions. Results:Validated physician–patient interactions (N = 321) were included. On the one hand, the consultation process and treatment quality are less commendable with the huge evidence-do gap. More than three-quarters of the physicians provided low-quality care, as against standard clinical guidelines. On the other hand, the level I, specialized hospitals, doctor, associate chief physicians, and attending physicians, sponsored by Internet enterprises, more times of provider's responses and words were associated with high-quality processes; More total times of provider's responses, urticaria, and nonoffice hours of the visit were associated with high-quality diagnosis; Sponsored by Internet enterprises, more total words of provider's all responses, and urticaria were associated with high-quality treatment. Conclusions:Our findings have important implications in an era in which to better comprehend the evidence-do gap. Efforts to bridge the evidence-do gap should be focused on the important role of institutions and physicians. [ABSTRACT FROM AUTHOR]

The burden of sexually transmitted infections (STIs) continues to increase in developing countries like China, but the access to STI care is often limited. The emergence of direct-to-consumer (DTC) telemedicine offers unique opportunities for patients to directly access health services when needed. However, the quality of STI care provided by telemedicine platforms remains unknown. After systemically identifying the universe of DTC telemedicine platforms providing on-demand consultations in China in 2019, we evaluated their quality using the method of unannounced standardized patients (SPs). SPs presented routine cases of syphilis and herpes. Of the 110 SP visits conducted, physicians made a correct diagnosis in 44.5% (95% CI: 35.1% to 54.0%) of SP visits, and correctly managed 10.9% (95% CI: 5.0% to 16.8%). Low rates of correct management were primarily attributable to the failure of physicians to refer patients for STI testing. Controlling for other factors, videoconference (vs SMS-based) consultation mode and the availability of public physician ratings were associated with higher-quality care. Our findings suggest a need for further research on the causal determinants of care quality on DTC telemedicine platforms and effective policy approaches to promote their potential to expand access to STI care in developing countries while limiting potential unintended consequences for patients. [ABSTRACT FROM AUTHOR]

Summary: Background: Primary health care is the foundation of high-performing health systems. Achieving an improved primary care system requires a thorough understanding of the current quality of care among various providers within the system. As the world's largest developing country, China has made significant investments in primary care over the past decade. This study evaluates the quality of primary care across different provider types in China, offering in-sights for enhancing China's primary care system. Methods: We merged data from four standardized patient (SP) research projects to compare the quality of five major primary care providers in China: rural clinics, county hospitals, migrant clinics, urban community health cen-ters (CHCs), and online platforms. We evaluated quality of care across process quality (e.g., checklist completion), diagnosis quality (e.g., diagnostic accuracy), and case management (e.g., correct medication), employing multiple regression analyses to explore quality differences by provider type, and their associations with physician characteristics. Findings: We document a poor quality of primary care in China, with no-table disparities across different providers. CHCs emerge as relatively reliable primary care providers in terms of process quality, diagnostic accuracy, and cor-rect medication prescriptions. Online platforms outpace rural clinics, county hospitals, and migrant clinics in many areas, showcasing their potential to en-hance access to quality healthcare resources in under-resourced rural regions. We observe a positive association between the qualifications of physicians and the quality of primary care, underscoring the necessity for a greater presence of more highly qualified practitioners. Interpretation: Primary care quality in China varies greatly among providers, reflecting inequalities in healthcare access. While online platforms indicate po-tential for improving care in under-resourced areas, their high referral rates suggest they cannot completely substitute traditional care. The findings em-phasize the need for more qualified practitioners and stringent regulation to enhance care quality and reduce unnecessary treatments. Funding: No founders had a role in the study design, data collection, data analysis, data interpretation, or writing of the report. We have acknowledged this in the revised manuscript.

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.

Abstract Background Eye examinations and eyeglasses acquisition are typically integrated into a cohesive procedure in China. We conducted a randomized controlled trial using incognito standardized patient (SP) approach to evaluate the impact of separating eyeglasses sales on the accuracy of final prescription. Methods 52 SPs were trained to provide standardized responses during eye examinations, and undergoing refraction by a senior ophthalmologist at a national-level clinical center. SPs subsequently received eye examinations at 226 private optical shops and public hospitals in Shaanxi, northwestern China. The visits were randomly assigned to either control group, where SPs would typically purchase eyeglasses after refraction, or treatment group, where SPs made an advance declaration not to purchase eyeglasses prior to refraction. The dioptric difference between the final prescriptions provided by local refractionists and expert in the better-seeing eye was determined using the Vector Diopteric Distance method, and the completeness of exams was assessed against national standards. Multiple regressions were conducted to estimate the impact of no eyeglasses sales on the accuracy of the final prescription of local refractionists, as well as the completeness of examinations. Results Among 226 eye exams (73 in public hospitals, 153 in private optical shops), 133 (58.8%) were randomized to control group and 93 (41.2%) to no eyeglasses sales group. The inaccuracy rate of final prescriptions provided by local refractionists (≥ 1.0 D, experts’ final prescription as the reference) was 25.6% in control group, while 36.6% in no-sale group (P = 0.077). The likelihood of providing inaccurate final prescriptions was significantly higher in no-sale group compared to control group (OR = 1.607; 95% CI: 1.030 to 2.508; P = 0.037). This was particularly evident in private optical shops (OR = 2.433; 95% CI: 1.386 to 4.309; P = 0.002). In terms of process quality, the no-sale group performed significantly less subjective refraction (OR = 0.488; 95% CI: 0.253 to 0.940; P = 0.032) and less testing SP’s own eyeglasses (OR = 0.424; 95% CI: 0.201 to 0.897; P = 0.025). The duration of eye exams was 3.917 min shorter (95% CI: -6.798 to -1.036; P = 0.008) in no-sale group. Conclusions Separating eyeglasses sales from optical care could lead to worse quality of eye care. Policy makers should carefully consider the role of economic incentives in healthcare reform.

Introduction: Leadership Education in Neurodevelopmental and Related Disabilities (LEND) programs have an emphasis on developing skills in providing family-centered and interdisciplinary care. Due to Coronavirus pandemic-related restrictions, opportunities for interdisciplinary education were limited for the 2020-2021 LEND Trainee cohort at The Ohio State University Nisonger Center. Standardized Patient (SP) encounters can be a mechanism for instruction and assessment of interprofessional competence. Methods: An SP encounter was developed for the The Ohio State University 2020-2021 LEND Cohort. Prior to the activity, participants (N = 11) were given clinic notes to review from their respective disciplines. During the activity, participants met virtually to develop collaborative recommendations which were then delivered to the SP who portrayed the mother of a young child receiving a new diagnosis of autism spectrum disorder. Following the encounter, 4 LEND faculty observers completed the Modified McMaster-Ottawa Team Rating Scale and participants completed the Interprofessional Collaboration Competency Attainment Scale-Revised (ICCAS-R). Results: Eleven LEND trainees completed the ICCAS-R with an overall increase in the mean score from 3.86 to 4.12. Four LEND faculty members completed the Modified McMaster-Ottawa Team Rating Scale, with the Communication domain demonstrating the highest level of competence. Discussion: This activity was well-received by both faculty and LEND trainees. Although delivered in virtual format, it could easily be transitioned to an in-person encounter for future LEND trainees. The success of this activity further supports that standardized patient encounters can be a feasible mechanism for instruction and assessment of interprofessional competencies and serve as a training mechanism for LEND programs. Significance: Given the complex needs of young children with autism spectrum disorder, it is necessary for trainees who will be caring for this population to foster interprofessional skill development. This pilot standardized patient activity represents a unique approach to interdisciplinary education and includes a clinical scenario relevant to the goals of LEND training programs. The activity also highlights a successful mechanism for the instruction and assessment of interprofessional competence in virtual format, thus increasing the potential widespread dissemination of this activity. [ABSTRACT FROM AUTHOR]

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.

AbstractIntroduction The quality of the performances of standardized patients plays a significant role in the effectiveness of clinical skills education. Therefore, providing standardized patients with constant feedback is essential. It is especially important to get students’ perspectives immediately following their encounters with standardized patients. In the literature, there is no scale for use by students to evaluate the performance of standardized patients. Thus, the three main goals of this study were to: (1) develop a scale for use by students to evaluate the performance of standardized patients, (2) examine the psychometric properties of the scale, and (3) determine a cut-off score for the scale in a standard-settingMaterials and methods Seven hundred and two medical students participated in the scale- development process, the pilot test, and the validation process, and seven educators took part in the standard-setting process. After the evaluation of content validity, construct validity was assessed via exploratory and confirmatory factor analyses. For the standard-setting study, the extended Angoff method was used.Results The exploratory factor analysis revealed that the scale had a single-factor structure, which was confirmed by confirmatory factor analysis. The Cronbach’s alpha internal consistency coefficient was 0.91. The scale consists of nine items. The cut-off score was determined to be 24.11/45, which represents the minimum acceptable standard for standardized patient performance.Conclusions Our study outlined the critical steps in developing a measurement tool and produced a valid and reliable scale that allows medical students to assess the performance of standardized patients immediately following their interaction with the standardized patient. This scale constitutes an important contribution to the literature as it provides a tool for standardized patient trainers to assess standardized patients’ weaknesses and help them improve their performance.KEY MESSAGESEvaluation of SP performance is essential to ensure the educational quality of clinical skills training programs.Students are the most relevant stakeholders to give feedback about SP performance immediately after encounters.The ‘Standardized Patient Performance Rating Scale – Student Version’ is a valid, reliable scale that can be used by students for the evaluation of standardized patients’ strengths and weaknesses at individual-performance levels quickly.

OBJECTIVE Standardized patients (SP) are a tool utilized regularly in athletic training to promote student confidence and independent thinking. SP are widely used in nursing, physical therapy, and in over 80% of medical education programs. The use of SP to supplement student learning and career preparation, in the undergraduate setting has been a validated in increasing student confidence. SP’s are a tool that utilize an actor trained to portray a patient who has a specific medical condition or illness and the actor is trained to respond to the students in a consistent manner. SP’s allow students the opportunity to engage in patient-centered experiences that may include history-taking, physical examination, interpersonal skill development or a combination of all of these elements. Additionally, students value the use of SP’s to improve clinical confidence and enhanced learning experiences. The use of standardized patients in academic programming enhances a student’s clinical experience. From medical education, standardized patients have shown enhancements in students critical thinking, self-efficacy, and communication skills. As the requirements to become a credentialed athletic trainer have shifted from a bachelor’s degree to a master’s degree the time developing confidence in autonomous clinical practice and critical thinking skills have lessened. A sample of masters and bachelor’s students did not show a significance in critical thinking ability of master’s vs. bachelor’s students. From this research it was suggested that athletic training pedogeological programming investigate high-impact practices to promote critical thinking. The use of standardized patients to assess critical thinking is a high-impact practice that requires further investigation. With that, the purpose of our study was two- fold. First, we wanted to identify if students critical thinking improved with the implementation of standardized patients. Second, we wanted to determine if students felt prepared to implement critical thinking in a patient or stakeholder encounter. STUDY DESIGN AND SETTING Prospective Cohort Study, 2-year, Collegiate Master Athle(c Training Program INTERVENTION Over the course of two academic years the same cohort was exposed to 5 separate SP encounters. One week prior to and immediately following each encounter students completed the Watson-Glaser Abbreviated Critical Thinking Inventory (CTI) and the Learner Critical Thinking (CT) Self- Assessment Inventory. The Watson-Glaser Abbreviated CTI is a widely accepted and utilized appraisal tool for measuring critical thinking.9 The tool is constructed around five critical thinking subscales: 1) inference, 2) recognition of assumption, 3) deduction, 4) interpretation, and 5) evaluation of arguments. The abbreviated Watson Glaser CTI has two questions within each of the five subscales, for a total of 10 questions. The Learner CT Self-Assessment is an 11- question survey tool designed to ask the student how well prepared they feel, as well as how appropriately course instructors prepared them for the critical thinking activity. This inventory asked participants to rate how the instructor of the course helped students integrate critical thinking into SP preparation, as well as how often the course instructor supported the critical thinking process. MAIN.OUTCOME.MEASURE The Watson-Glaser Abbreviated CTI and Learner CT Self-Assessment inventory were both administered one week prior to and immediately following all 5 standardized pa(ent encounters. The main outcome measures were the pre-post scores collected from the two inventories. All outcomes were assessed independently as well as comprehensively across all 5 Standardized Pa(ents. RESULTS Student scores on the Watson-Glaser CTI showed statistically significant differences overall from case one to case five for ability to infer, assume, and deduce (p=0.02, 0.03, & 0.01). Table 2 shows results of overall and sub- scale outcomes for the Watson-Glaser Abbreviated CTI. Additionally, students felt more prepared to implement critical thinking on case five compared to case one (p= 0.01) on the Learner CT Self-Assessment. Students generally showed improved critical thinking abilities across all 5 standardized patient encounters with the largest improvement being observed in case three. Outcomes on Learner Critical Thinking Self-Assessment demonstrated improved preparedness within each case, except for case five which implemented a new patient delivery strategy. Lastly, students identified overall increased preparedness across all five cases. CONCLUSIONS The results of this study indicate that the use of standardized patients to integrate and challenge critical thinking is likely a sufficient tool. With the use of standardized patients to supplement the clinical experience students critical thinking, critical self-reIlection, interpersonal skills, and confidence are likely to improve. Academic programs should continue to integrate critical thinking inventories and challenges into programmatic assessments and outcomes. Specifically, programs should seek to incorporate critical thinking related to inferring, interpreting, and argument. [ABSTRACT FROM AUTHOR]

Resumen: Introducción: la comunicación es una competencia transversal en los estudiantes de Enfermería. A pesar de su importancia, no se disponen de instrumentos válidos y confiables para medir esta competencia en los estudiantes de Enfermería chilenos en contextos simulados. El objetivo de esta investigación fue diseñar y evaluar las propiedades psicométricas de la Escala de habilidades comunicacionales aplicado por pacientes estandarizados. Métodos: se realizó un estudio transversal en 2 etapas, en la primera se construyó el instrumento y en la segunda se evaluaron sus propiedades psicométricas. En la primera etapa se realizó la revisión de la literatura y de las teorías comunicacionales en enfermería. En la segunda etapa se realizó la validez aparente con pacientes simulados, se evaluó el contenido con expertos y se aplicó el instrumento a 183 estudiantes de 3.er y 4.o año de Enfermería de una universidad privada. Se determinó la validez del constructo mediante el análisis factorial exploratorio, la homogeneidad por alpha de Cronbach y el análisis de la concordancia interevaluador. Resultados: como resultado de la primera etapa se creó un instrumento basado en el modelo de relaciones interpersonales. Al someterse a validez aparente y de contenido, se hicieron modificaciones en algunos ítems. El análisis factorial exploratorio arrojó la presencia de 3 factores que representaron el 56,3% de la variancia. El alpha de Cronbach tuvo un valor de 0,8 (IC 95%; 0,841-0,896), mientras que la concordancia interevaluador fue de 0,7; p = 0,015 (0,132-0,946). Conclusión: la Escala de habilidades comunicacionales aplicado por pacientes estandarizados es válida y confiable para medir habilidades comunicacionales en los estudiantes de Enfermería en el contexto de simulación clínica. Abstract: Introduction: Communication is an important competence for nursing students. Despite its relevance, there are no valid and reliable instruments available to measure this competence in Chilean nursing students in simulated contexts. The aim of this research was to design and evaluate the psychometric properties of the CSASP. Methods: A cross-sectional study was carried out in two stages: instrument construction and assessment of the psychometric properties of the scale. In the first stage, we conducted a literature review of English and Spanish-language articles on the CINHAL, PubMed, and ProQuest databases. In the second stage, we evaluated the face and content validity with simulated patients and experts. Then, the instrument was applied to 183 senior nursing students at a private university in Santiago de Chile. Construct validity was performed by exploratory factor analysis, homogeneity by Cronbach's Alpha, and Inter-rater reliability analysis with an intraclass correlation coefficient. Conclusion: The CSASP is valid and reliable for measuring communication skills in nursing students in the context of clinical simulation.

The quality of the performances of standardized patients plays a significant role in the effectiveness of clinical skills education. Therefore, providing standardized patients with constant feedback is essential. It is especially important to get students' perspectives immediately following their encounters with standardized patients. In the literature, there is no scale for use by students to evaluate the performance of standardized patients. Thus, the three main goals of this study were to: (1) develop a scale for use by students to evaluate the performance of standardized patients, (2) examine the psychometric properties of the scale, and (3) determine a cut-off score for the scale in a standard-setting Seven hundred and two medical students participated in the scale- development process, the pilot test, and the validation process, and seven educators took part in the standard-setting process. After the evaluation of content validity, construct validity was assessed via exploratory and confirmatory factor analyses. For the standard-setting study, the extended Angoff method was used. The exploratory factor analysis revealed that the scale had a single-factor structure, which was confirmed by confirmatory factor analysis. The Cronbach's alpha internal consistency coefficient was 0.91. The scale consists of nine items. The cut-off score was determined to be 24.11/45, which represents the minimum acceptable standard for standardized patient performance. Our study outlined the critical steps in developing a measurement tool and produced a valid and reliable scale that allows medical students to assess the performance of standardized patients immediately following their interaction with the standardized patient. This scale constitutes an important contribution to the literature as it provides a tool for standardized patient trainers to assess standardized patients' weaknesses and help them improve their performance. Evaluation of SP performance is essential to ensure the educational quality of clinical skills training programs. Students are the most relevant stakeholders to give feedback about SP performance immediately after encounters. The 'Standardized Patient Performance Rating Scale – Student Version' is a valid, reliable scale that can be used by students for the evaluation of standardized patients' strengths and weaknesses at individual-performance levels quickly. [ABSTRACT FROM AUTHOR]

BackgroundSince the 1960s, standardized patients (SPs) have been used to prepare medical students for clinical work for these patients provide a controlled domain for learners. Specifically, these type of formative experiences provide a low stakes environment for practice and feedback, thereby increasing learner comfort in communicating with patients. Communication is the cornerstone of patient care, and it is well-established as a core clinical competency for medical students by numerous medical boards, associations, and accreditation agencies. While methods for communication training are of paramount importance, no validated scales assess the impact of these trainings on patient-provider communication where measures are based on attitudinal constructs that predict behavior, such as self-efficacy and preparedness. Thus, the aim of this study is to validity of a Patient Communication Scale (PCS) using an online virtual role-play training simulation.MethodTo validate the scale, 117 medical students were administered the PCS survey before and after completing a professional development virtual role-play simulation where they practiced motivational interviewing skills, talking to a patient who insists on antibiotics for a viral infection.ResultsA confirmatory factor analysis supported the two-factor model based on the subscales of preparedness and self-efficacy. Factor loadings showed all items correlated highly with theoretical constructs (r ≥ 0.902, p < 0.001). The PCS had high internal consistency (α = 0.916). Because there is a lack of scales that have been used to assess medical student as well as medical practitioner patient communication capabilities, specifically their preparedness and self-efficacy, criterion-related validity was not assessed. Convergent, content and construct validity were established.ConclusionThe Patient Communication Scale appears to be a valid tool in measuring the impact of online patient-provider communication skills training and holds promise for assessing other delivery methods.

IntroductionDuring the COVID-19 pandemic, tele-simulation emerged as an educational alternative, being useful for the development of Nutritional Care Process (NCP) skills. The importance of this study lies in knowing the impact of tele-simulation on perception and learning for the NCP. The aim of this research was to know the academic performance and the student’s perception of their ability to apply a dietary anamnesis.Materials and methodsA quantitative, longitudinal, three-temporal study was conducted with a purposive sample of 25 Nutrition and Dietetics students during 2021. All students performed three tele-simulations with a standardized patient, in relation to the NCP.ResultsThe mean response among the three tele-simulations developed on perception in tele-simulation with a standardized patient was 4.6 (Scale 1–5). The aspect with the best perception of the students was observed in relation to the feasibility and viability of the tele-simulation. The students improved in disciplinary aspects such as the investigation of the culinary technique, representativeness and quantification of the intake through the application of the NCP.ConclusionTele-simulation with standardized patient is viable as a teaching-learning methodology for the application of the PNC. It is possible to demonstrate a higher performance in the nutritional interview.

Introduction: Communication is an essential skill for pharmacists. Motivational interviewing is an advanced communication technique used for health behavior change. Studies have evaluated standardized patient (SP) simulation to develop communication skills; however, little is known about the use of SP simulations with asynchronous feedback in a telepharmacy scenario. Objective: The objective of this study was to determine if the use of asynchronous embedded faculty feedback will improve students' motivational interviewing skills. Methods: During didactic training, students were introduced to motivational interviewing, practiced evaluation using a standardized rubric (max score 25), and participated in role‐play. Following training, students completed 2 weeks of lab simulation, one formative and one summative, in which students completed a 5‐min motivational interview with a SP via Zoom© which was recorded to allow for student self‐evaluation and asynchronous faculty video‐embedded feedback. Each encounter was assessed by faculty using the standardized rubric. The primary outcome measure was the difference in faculty evaluation scores of student interviews between the formative and summative labs. Secondary outcome measures included the difference in student self‐evaluation scores between the formative to summative labs and a number of students achieving competency (≥ 80%) or mastery (≥ 90%). Statistical analysis was completed using Wilcoxon signed rank tests (SAS® version 9.4). Results: One hundred fourteen students completed the study. Scores improved by a mean of 3.8 points between the formative and summative labs. Student self‐evaluation improved an average of 1.5 points between the labs. Competency and mastery were achieved by 89.5% and 52.6% of students, respectively. Score differences were not influenced by SP assigned. Use of SP and embedded asynchronous feedback in a motivational interviewing telepharmacy simulation resulted in improved student performance. [ABSTRACT FROM AUTHOR]

Abstract Objective To evaluate the effect of a teaching mode combining SimBaby with standardized patients (SP) on medical students’ attitudes toward communication skills (CS). Methods Forty 8-year medical program students majoring in clinical medicine were randomly divided into the SimBaby group (n = 20) and the SP + SimBaby group (n = 20). The Communication Skills Attitude Scale (CSAS) was used to evaluate medical students’ attitudes toward CS learning. Results In the SimBaby and SP + SimBaby groups, there were no statistically significant differences in the Positive Attitude Subscale (PAS) and Negative Attitude Subscale (NAS) scores between males and females (p > 0.05). Compared to the SimBaby group, the SP + SimBaby group showed statistically significant differences in PAS, NAS, and the two dimensions of importance in medical context and learning (p 0.05). Conclusion Compared with SimBaby alone, the SP + SimBaby teaching mode can improve medical students’ attitude toward CS learning, suggesting that the organic integration of multiple simulation-based medical teaching methods plays an important role in the acquisition of CS.

OBJECTIVES: Few medical schools incorporate formal education on human trafficking (HT) and sex trafficking (ST) into their curriculum. Our objective was to develop, implement, and evaluate education on HT and ST in the first-year medical student curriculum. METHODS: The curriculum included a standardized patient (SP) experience and lecture. As part of their mandatory sexual health course, students interviewed an SP who presented with red flags for ST and then participated in a discussion led by a physician-facilitator in an observed small group setting. A multiple-choice survey to assess knowledge about HT and ST was developed and administered to students before and after the SP interview. RESULTS: Of the 50 first-year medical students, 29 (58%) participated in the survey. Compared with the students' baseline scores (according to the percentage of correct responses), scores after the educational intervention showed a significant increase in percentage correct on questions related to trafficking definition and scope (elder care, P =.01; landscaping, P =.03); victim identification (P <.001); referral to services (P <.001); legal issues (P =.01); and security (P <.001). On the basis of the feedback, a 2-hour lecture, which was adapted from the American Medical Women's Association–Physicians Against the Trafficking of Humans "Learn to Identify and Fight Trafficking" training, was presented the next year to all first-year medical students as part of their longitudinal clinical skills course and before the SP case. Curriculum objectives included learning trafficking definitions, victim/survivor identification, intersections with health care, the local impact of HT, and available resources. CONCLUSION: This curriculum fulfills course objectives and could be replicated at other institutions. Further evaluation of this pilot curriculum is necessary to evaluate its effectiveness. [ABSTRACT FROM AUTHOR]

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Computer-based simulation (CBS) is an interactive pedagogical training method that has seen increased interest, especially in recent years. There is some evidence that CBS in pharmacy education is not as widely adopted compared to other healthcare disciplines. Pharmacy education literature to date has not specifically discussed the potential barriers which may cause this uptake challenge. In this systematic narrative review, we attempted to explore and discuss potential barriers that may impact the integration of CBS in pharmacy practice education and provide our suggestions to overcome them. We searched five major databases and used the AACODS checklist for grey literature assessment. We identified 42 studies and four grey literature reports, published between 1 January 2000 and 31 August 2022, which met the inclusion criteria. Then, the specific approach of Braun and Clarke for thematic analysis was followed. The majority of the included articles were from Europe, North America, and Australasia. Although none of the included articles had a specific focus on barriers to implementation, thematic analysis was used to extract and discuss several potential barriers, such as resistance to change, cost, time, usability of software, meeting accreditation standards, motivating and engaging students, faculty experience, and curriculum constraints. Ad- dressing academic, process, and cultural barriers can be considered the first step in providing guidance for future implementation research for CBS in pharmacy education. The analysis suggests that to effectively overcome any possible barriers to implementing CBS, different stakeholders must engage in careful planning, collaboration, and investment in resources and training. The review indicates that additional research is required to offer evidence-based approach and strategies to prevent overwhelming or disengaging users from either learning or teaching process. It also guides further research into exploring potential barriers in different institutional cultures and regions. [ABSTRACT FROM AUTHOR]

• Diversity curriculum allows students to apply cultural principles. • Nursing students identify culturally influenced behaviors as a challenge to care. • Students need clinical experiences to engage in culturally appropriate nursing care. • Simulation allows students to safely and routinely apply/evaluate care. As the U.S. population is becoming more diverse, nursing students need enhanced clinical experiences to become proficient in patient-centered, culturally appropriate nursing care. The addition of cultural care simulation curriculum utilizing a live standardized patient aims to enhance student understanding of cultural care by applying care in a safe, controlled setting. Incorporating the curricular principles of diversity, equity, and inclusion into simulation allows nursing students to apply their understanding of cultures and cultural behaviors in clinical environments. By using a standardized patient and simulation scenario of a patient with cultural needs, students are provided the opportunity to assess, plan, implement, and evaluate culturally appropriate care. [ABSTRACT FROM AUTHOR]

Introduction: Standardized patients (SPs) are actors who role‐play patients in objective structured clinical examinations (OSCEs). Potential benefits of using SPs may include standardized learning experiences and realistic emulations. Use of SPs on academic performance remains unreported. Objective: To compare students' identification of medication therapy problems (MTPs) in medication history OSCEs utilizing SPs versus those utilizing student peer actors. Methods: This single‐center historical cohort study included two cohorts of third‐year student pharmacists in a capstone course in spring 2019 and 2021. One cohort had peers acting as patients and another interacted with SPs. Students completed two OSCEs and were assessed by faculty using a performance‐based rubric. Outcomes included students' identification of MTPs defined per Pharmacy Quality Alliance Frameworks, OSCE performance, levels of MTP management, and questionnaire item responses. Results: One‐hundred forty‐three subjects were enrolled: 86 in the peer and 57 in the SP cohorts. Baseline characteristics between cohorts were similar across age, overall grade point average, and composite Pharmacy College Admission Test score. Fewer students in the SP cohort identified MTPs versus the peer actor cohort on both OSCEs (52.6% vs. 89.7%, p < 0.001, and 64.9% vs. 88.2%, p = 0.001), and OSCE grades were significantly lower in the SP cohort (76.0% vs. 81.5%, p = 0.01, and 76.5% vs. 89.0%, p < 0.001). Medication therapy problem management was significantly different between the cohorts across both OSCEs (p < 0.05). Students responded to questionnaire items by agreeing SPs were effective and improved the OSCEs. Conclusion: Use of SPs in medication history OSCEs was associated with significant decreases in students' identification of MTPs and lower OSCE grades. Continued research is warranted to assess factors associated with differences in performance and to provide recommendations optimizing SP and peer actor roles. [ABSTRACT FROM AUTHOR]

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.