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Background: Standardised patients (SPs) are often asked to portray complex physical roles in which authenticity is paramount; however, SPs come from a variety of backgrounds, and may lack knowledge of basic anatomy and physiology that can hamper their portrayal. This lack of knowledge can lead to gaps in accuracy and credibility., Context: In our efforts to bridge the gap and create training that would lead to authentic and confident portrayals, we developed the 'gut bucket'. This three-dimensional learning tool is tactile, portable, simple and affordable., Innovation: The 'gut bucket' has life-size abdominal organs made from fabric resting in a standard plastic washbasin. The organs can be easily removed and manipulated to simulate different disease states (for example: appendicitis, kidney stones or cholecystitis). The tool is visually engaging and durable, encouraging SPs to handle the organs and become familiar with their size and placement within the basin and on themselves., Implications: The SPs in our programme found that the 'gut bucket' provided a deeper level of knowledge, made them more confident in their portrayal and enhanced their experience, and they generally preferred the 'gut bucket' over traditional methods of training. This was demonstrated using 'gut bucket' training evaluation forms. The 'gut bucket' can easily be incorporated into training sessions to provide a kinaesthetic approach as well as increased engagement for the SPs. We hope others may benefit by sharing our experience with the 'gut bucket'., (© 2014 John Wiley & Sons Ltd.)

Background: The literature on simulated or standardized patient (SP) methodology is expanding. However, at the level of the program, there are several gaps in the literature. We seek to fill this gap through documenting experiences from four programs in Australia, Canada, Switzerland and the United Kingdom. We focused on challenges in SP methodology, faculty, organisational structure and quality assurance., Methods: We used a multiple case study method with cross-case synthesis. Over eighteen months during a series of informal and formal interactions (focused meetings and conference presentations) we documented key characteristics of programs and drew on secondary document sources., Results: Although programs shared challenges in SP methodology they also experienced differences. Key challenges common to programs included systematic quality assurance and the opportunity for research. There were differences in the terminology used to describe SPs, in their recruitment and training. Other differences reflected local conditions and demands in organisational structure, funding relationships with the host institution and national trends, especially in assessments., Conclusion: This international case study reveals similarities and differences in SP methodology. Programs were highly contextualised and have emerged in response to local, institutional, profession/discipline and national conditions. Broader trends in healthcare education have also influenced development. Each of the programs experienced challenges in the same themes but the nature of the challenges often varied widely.

Background: Simulated patients (SPs) play a critical role in medical education. The development of SP methodology has resulted in wide ranging responsibilities. For SPs to work effectively, we believed it was important to clearly articulate their responsibilities, and that this would be best achieved by consultation with all stakeholders-SPs, students, tutors, and administrators., Methods: As part of a quality assurance initiative, we designed a questionnaire and focus group study to explore stakeholders' perceptions of the responsibilities of SPs in teaching. Convenience and purposive sampling was used to recruit participants to questionnaires and focus groups, respectively. Data were analyzed thematically., Results: Eighty-six questionnaires were collected, and six focus groups were conducted. Five sets of guidelines on responsibilities were produced. In addition, guidelines were established for feedback that SPs and tutors could use to maximize impact., Discussion: The results highlight the complexity of SP-based teaching. Clarification of all stakeholders' responsibilities demonstrates the importance of a team approach to SP-based teaching. Focusing attention on just one set of stakeholder's responsibilities is unlikely to improve perception of quality. The process for developing the guidelines may be valuable for those who work with SPs. Stakeholder engagement is likely to ensure greater commitment than those developed by faculty.

Purpose: The Integrated Procedural Performance Instrument (IPPI) consists of clinical scenarios in which bench-top models are positioned to simulated patients. Trainees are required to perform technical skills while engaging with the patient. The purpose of this study was to determine whether an IPPI format examination could discriminate between different levels of trainees., Methods: Sixteen fourth-year medical students and 16 first-year surgery residents participated in 4 IPPI scenarios. Videotaped performances were scored by 2 blinded independent clinician raters on previously validated instruments: checklist of technical skills, Global Rating Scale of technical skills, and communication scale. We conducted separate mixed design analyses of variance (level x cases) on the 3 scales., Results: Residents performed better than medical students on the checklist (74% vs 60%, P < .05), the Global Rating Scale of technical skills (75% vs 56%, P < .01), and the coherence communication subscale (79% vs 69%, P < .05)., Conclusions: An IPPI examination discriminated between students' and residents' technical skills and coherence in communication skills. It also highlighted a potential gap in the training of residents' communication skills.

Objectives: To describe the use of patient-actors as educators in a senior-level pharmacy practice course, and to contrast the value and application of "standardized patient" and "simulated patient" educational methodologies., Design: The objective structured clinical examination (OSCE) of the licensing examination were utilized during and at the end of the course along with external assessment to determine the impact of this educational methodology. Interviews with a randomly selected cohort of 14 students were undertaken 3 years after graduation and licensure to evaluate long-term impact of this course., Assessment: Overall, students responded positively to the shift from "standardized" patients to "simulated" patients, recognizing their value in teaching clinical and pharmaceutical care skills. Concerns were expressed regarding objectivity in assessment and individual grading. Over 98% of students successfully passed the OSCE component of the licensing examination. Long-term follow-up suggests students valued this approach to education and that it provided them with a foundation for better understanding of the psychosocial needs of patients in practice., Conclusions: Simulated-patient educators can play an important role in the pharmacy curriculum, and can complement practitioner-educators in providing students with a real-world context for understanding complex patient care needs.

Purpose: Teaching medical students to spontaneously identify biopsychosocial issues (e.g. family violence) remains a challenge. We examined the extent to which using unannounced standardised patients (SPs) presenting in a clerk's clinical setting could assist with this teaching challenge., Methods: All clerks attended a family violence seminar in their family medicine rotation. Intervention students additionally saw an unannounced SP portraying 1 of 2 scenarios in their preceptor's office during the rotation, and received immediate feedback about their performance. An end of rotation objective structured clinical examination (OSCE) included an SP presentation similar to that seen by the intervention students., Results: Clerks who received the intervention demonstrated increased questioning about family violence, from 0% (0 of 29 students) to 19% (5 of 26 students) in 1 OSCE scenario (P = 0.019), and from 40% (12 of 30 students) to 76% (19 of 25 students) in the other (P = 0.007)., Conclusions: Seeing unannounced SPs had a dramatic effect on later student performance. This potentially powerful intervention could be applied to a range of clinical issues.