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• 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]

The article substantiates that the competence approach and the resulting paradigm in higher medical education can be ensured through the implementation of effective pedagogical technologies that will direct the efforts of future specialists to self-development and self-improvement in professional activity, based on the acquired theoretical knowledge and practical skills. The content of simulation technologies and the experience of their application in the world and domestic educational space are considered. An analysis of the use of the "standardized patient" method was carried out on the example of training conducted with students of the 6th year at the Department of Surgical Diseases of V. N. Karazin Kharkiv National University. The ethics, effectiveness, and value of involving the simulation practice "standardized patient" both during practicing the practical skills of future doctors and during the certification assessment were analyzed. The expediency of introducing simulation technologies into educational programs in the medical direction is substantiated, in particular when training specialists in order to increase the level of professionalism of future specialists in the field of health care. Conclusions were made about the perspective and expediency of further research in the direction of the introduction of simulation technologies as one of the aspects of active learning and control. The basis for this is the appropriate level of theoretical knowledge, which allows expanding the range of practical interaction of future specialists and raising the level of professionalism in the branch of health care. Conclusions were made about the perspective and expediency of further research in the direction of the introduction of simulation technologies as one of the aspects of active learning and control. The basis for this is the appropriate level of theoretical knowledge, which allows expanding the range of practical interaction of future specialists and raising the level of professionalism in the branch of health care.

Abstract Background Patient satisfaction is an important outcome measure of health service and is one of the main reasons for the gradual deterioration of doctor–patient relationships in China. This study used the standardized patient (SP) method to explore patient satisfaction and its health provider-related determinants among primary health facilities in rural China. Methods The dataset comprised 1138 clinic cases in 728 rural primary health facilities in 31 counties, spread across four provinces. Information regarding the consultation interaction between the unannounced SPs and primary physicians was recorded. Patient satisfaction was gathered from the feedback of SPs after the visit. Results The overall average score of SP satisfaction with rural primary health facilities was only 13.65 (SD = 3.22) out of 20. The SP scores were found to be consistent with those of real patients. After controlling variances in patient population via the SP method, the regression analysis demonstrated that health provider-related factors, such as physician-level characteristics, consultation process, affordability, and convenience, have a significant correlation with patient satisfaction among primary physicians. Among factors relating to physician-level characteristics, affordability, convenience and the consultation process of the visit, the quality of the consultation process (e.g., consultation time, proactively providing necessary instructions and other crucial information) were found to be the prominent determinants. Conclusions This study revealed the need to improve patient satisfaction in primary health facilities in rural China. To solve this issue, we recommend that policies to increase medical service quality be implemented in rural primary healthcare systems.

Abstract There are many examples of hybrid simulation models in healthcare education which are designed to simulate specific scenarios. However, there appears to be a need for a cost effective and configurable hybrid simulation platform which can be used by educators of various healthcare disciplines to simulate different scenarios. The purpose of this paper is to develop a proof-of-concept platform that can be easily implemented at little cost and provide flexibility to healthcare instructors to develop a variety of simulation scenarios, and to determine the effectiveness of this platform. Using a standardized patient, a person acting as a patient in a scripted manner, along with wearable and web-based technologies, a congestive heart failure simulation was used as an evaluative exercise for a group of personal support worker students at a Canadian Community College. Personal support workers typically provide care to any person who may require personal assistance with activities of daily living such as feeding, lifting, bathing, skin care and oral hygiene to name a few. Standardized patients are typically used in healthcare education to educate and evaluate soft skills, such as caregiver to patient communication, professionalism, as well as hard skills, such as history taking, examination and diagnostic skills (Rosen in J Crit Care 23:157–166, 2008). Instructor feedback indicated that the platform was easy to use and capable of simulating a large variety of scenarios. Pre and post test results are evidence of initial findings of promise indicating that the platform seemed to be effective in enabling students to meet learning outcomes. Focus group results seem to indicate an increase in student confidence as it relates to their ability to handle a similar scenario in the workplace.

• Clinical simulation is an increasingly vital part of clinical health care education. • Simulation allows for standardization of training experiences with patients. • SPS practice reduces the limitations of clinical practice for undergraduate nursing students. • SPS practice increases nursing students' self-efficacy, communication skills, problem-solving and learning satisfaction. • SPS practice is more effective for nursing education than standard training alone. This systematic review and meta-analysis was designed to investigate the effects of standardized patient simulation on undergraduate nursing students following PRISMA guidelines. We searched seven databases; three reviewers independently performed study selection and data extraction and employed the risk for bias assessment for nonrandomized studies (ROBINS) tool to evaluate the quality of evidence. To estimate effect size, a meta-analysis of the studies was performed using STATA 16.0. We identified 1,276 related published studies; 68 met our inclusion criteria, 14 of which were eligible for final analysis. Our findings indicate that standardized patient simulation can effectively improve undergraduate nursing students' communication skills, communication self-efficacy, self-efficacy, learning self-efficacy, problem-solving ability, and learning satisfaction; no evidence of publication bias was detected. Further studies are required to define detailed and standardized guidelines for supplementary research designs for experimental studies and effective methods of utilizing standardized patients. Expanding the application of evidence-based standardized patient simulation can improve reproduced clinical experiences and overcome limitations in clinical training for undergraduate nursing students. [ABSTRACT FROM AUTHOR]

Background: Patient satisfaction is an important outcome measure of health service and is one of the main reasons for the gradual deterioration of doctor-patient relationships in China. This study used the standardized patient (SP) method to explore patient satisfaction and its health provider-related determinants among primary health facilities in rural China.Methods: The dataset comprised 1138 clinic cases in 728 rural primary health facilities in 31 counties, spread across four provinces. Information regarding the consultation interaction between the unannounced SPs and primary physicians was recorded. Patient satisfaction was gathered from the feedback of SPs after the visit.Results: The overall average score of SP satisfaction with rural primary health facilities was only 13.65 (SD = 3.22) out of 20. The SP scores were found to be consistent with those of real patients. After controlling variances in patient population via the SP method, the regression analysis demonstrated that health provider-related factors, such as physician-level characteristics, consultation process, affordability, and convenience, have a significant correlation with patient satisfaction among primary physicians. Among factors relating to physician-level characteristics, affordability, convenience and the consultation process of the visit, the quality of the consultation process (e.g., consultation time, proactively providing necessary instructions and other crucial information) were found to be the prominent determinants.Conclusions: This study revealed the need to improve patient satisfaction in primary health facilities in rural China. To solve this issue, we recommend that policies to increase medical service quality be implemented in rural primary healthcare systems. [ABSTRACT FROM AUTHOR]

The purpose of our study was to evaluate a learning activity that included an objective structured learning examination (OSLE) focused on identifying and communicating at-risk opioid behaviors in a community pharmacy setting through student perceptions and OSLE performance. The activity included a didactic lecture and an OSLE with two opioid use patient cases. Third-year pharmacy students' communication skills were evaluated using faculty-created rubrics. A voluntary, anonymous pre-/post-survey evaluated students' skills confidence and OSLE satisfaction. Responses were analyzed using independent t -tests. An inductive conventional content analysis identified the impact on students' perceptions and future behaviors from post-simulation reflections. One hundred forty-three and 111 students completed the pre- and post-surveys, respectively. Students self-reported confidence in their ability to identify red flags and assess at-risk opioid behaviors, counsel on opioid risk behaviors, refuse opioid prescription fills, and respond to patients' nonverbal responses, all significantly improved pre-to-post. Students reported the OSLE was beneficial to their learning. The mean overall OSLE score was 34.2 out of 45 points (SD ± 6.21). Identified student reflection themes included: importance of patient-centered care, pharmacists' role in patients with at-risk opioid behaviors, recognition of judgement against patients taking opioids, and importance of communication and empathy as strategies to mitigate conflict. Implementing a new learning activity focused on communication regarding at-risk opioid behaviors allowed students to engage in difficult conversations with standardized patients in a safe simulation environment. Students demonstrated competent skills, increased their self-reported confidence, and were highly satisfied with the learning activity. [ABSTRACT FROM AUTHOR]

Due to the COVID-19 pandemic, many pedagogical activities shifted from in-person to virtual modalities, including standardized patient (SP) encounters. While many academic institutions may not have previously been conducting SP encounters virtually, this change provided student pharmacists with new opportunities to learn and practice telehealth techniques, which are important with the continuously evolving healthcare landscape. This retrospective study analyzed pharmacy student performance on and perceptions of SP cases in fall 2019 (in-person) and fall 2020 (telehealth) semesters. The primary objective was to compare average total scores on SP cases from fall 2019 (in-person) and fall 2020 (telehealth) for first-, second-, and third-year pharmacy students (P1, P2, and P3, respectively). Secondary objectives were to compare average scores from case-specific and relationship and communication (R&C) checklists, as well as to describe student perceptions of the pedagogy. Total scores on SP cases decreased from in-person to telehealth for the average of all P1 SP cases, but not for P2 or P3 cases. Case-specific scores did not change, but R&C scores decreased significantly across all three years. Student survey data revealed difficulty with communicating effectively and building rapport via telehealth. Overall, student performance on in-person vs. telehealth SP encounters was similar, though P1 students performed more poorly on SP cases conducted via telehealth compared to P2 or P3 students. Thus, faculty could consider focusing on in-person encounters for early learners before introducing virtual encounters. This study also highlights the difficulty in establishing rapport when communicating with patients via telehealth. • Eighteen standardized patient (SP) cases in-person versus telehealth were compared. • Overall student performance on in-person versus telehealth SP cases was similar. • P1 students performed more poorly on telehealth cases versus P2 or P3 students. • In-person cases should be used for early learners before adding virtual encounters. [ABSTRACT FROM AUTHOR]

Background. Education with the use of medical simulation may involve the use of two modalities: manikins or standardized patients (SPs) to meet specific learning objectives. We have collected students' opinions about the two modalities which can be helpful in planning and evaluating the curriculum process. Although reviews or comparisons of student opinions appear in the literature, it is difficult to find a scale that would be based on a comparison of specific effects that can be obtained in the educational process. In order to fill this gap, an attempt was made to construct a questionnaire. Methods. An experimental version of a questionnaire measuring the final-year students' (273) opinions about the effectiveness of both simulation techniques has been designed on the basis of semi-structured interviews. They were conducted with 14 final-year students excluded from the subsequently analyzed cohort. The scale has been completed, tested and validated. Results. The authors developed a 33-statement questionnaire which contain two scales: teaching medicine with the manikins and with the SPs. Two factors were identified for each scale: Doctor-patient relationship and practical aspects. The scales can be used complementary or separately, as the article reports independent statistics for each scale. The Cronbach's alpha coefficient for the manikin scale is 0.721 and for the SP scale is 0.758. Conclusions. The questionnaire may be applied to medical students to identify their opinions about using manikins and SPs in teaching. It may have an important impact for planning curriculum and implementing particular modalities in accordance with the intended learning objectives. [ABSTRACT FROM AUTHOR]

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). There were no statistically significant differences between groups in the dimensions of excusing and overconfidence (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. [ABSTRACT FROM AUTHOR]

• Combined Simulation/MUTA sessions increased NP student's confidence and learning. • SP/MUTA's ranked NP students as well-prepared in history and physical exam skills. • Combined Simulation/MUTA sessions uniquely prepare NP students for clinical practice. Nurse practitioner (NP) programs use skills-based activities such as structured simulations and instructional sessions to prepare students for clinical practice. NP students often have limited opportunities to perform sensitive exams during their clinical experiences. This study combined simulation and Male Urogenital Teaching Associate (MUTA) instruction to evaluate student's preparedness, knowledge, perceived learning, and confidence in diagnosing/managing urogenital complaints. Twenty-six NP students entering their first clinical course completed a simulation/MUTA clinical encounter. The encounter included a pre-brief, simulation, urogenital examination instructional session, learning activities, and debrief. Descriptive and inferential statistics were analyzed on pre-test/post-test and post-evaluation questionnaires. Data revealed a statistically significant difference in student's confidence postintervention. Students reported an increase in knowledge and preparedness. There is a paucity of evidence on the use of simulation with MUTA instruction in NP curriculum. Findings suggests that a combined simulation/MUTA instruction can meet student needs and increase preparedness, knowledge, and confidence. [ABSTRACT FROM AUTHOR]

This study aims to compare the impact of standardized patient and low-fidelity simulation methods on the success, satisfaction, and self-confidence levels of nursing students in prevention and management of pressure injury education. The study was designed as a randomized, controlled experimental study with pretest and posttest control groups. Eighty-one nursing students that met the inclusion criteria were randomly assigned to intervention (standardized patient; n = 40) and control (low-fidelity mannequin simulator; n = 41) groups. A descriptive characteristics form, the Student Satisfaction and Self-Confidence in Learning Scale, and the Simulation Design Scale were used for data collection. Implementation skills and knowledge levels of the students were evaluated by using a skills control list and pretest and posttest measurements, respectively. The posttest knowledge score of the students in the standardized patient group, which was measured after the simulation education, was higher (p < 0.05). We did not find any statistically significant difference between the two groups in terms of the scores obtained from the Students Satisfaction and Self-Confidence in Learning Scale and its subscales (p > 0.05). Compared to the low-fidelity mannequin group, the standardized patient group obtained higher scores from the Simulation Design Scale and its Objectives/Information subscale (p < 0.05). Regarding the skills needed in the implementation phases of pressure injury, the standardized patient group was more successful in terms of communication skills (p < 0.05). If the simulation design is well-planned, the use of a standardized patient and a low-fidelity mannequin have similar impacts on student satisfaction and self-confidence. However, the success scores and communication skills of the students in the standardized patient group were higher. • Simulation training increases the success of nursing students. • Different simulation methods have similar influence on student satisfaction and self-confidence. • Standardized patient simulation increases communication skills of the students. [ABSTRACT FROM AUTHOR]

Clinical teaching round is an important way to train students' clinical capacity. Standardized patient (SP) can simulate real clinical situations accurately and reproducibly. Compared with the traditional teaching round, the teaching round with introduction of standardized patients has its unique advantages and can improve the standardization, homogeneity and generalization of clinical teaching rounds more effectively. This article introduces the current status of the application of standardized patients, its application in clinical teaching rounds and challenges, emphasizing its potential in clinical training.

There is a need for innovative teaching practices in nursing education due to many factors, such as global changes, the rapid development of technology, the increasing number of students, and the recent pandemic. This research was conducted using standardized patients to evaluate the attitudes and skills of senior nursing students toward patient education practices following the implementation of a patient education training program. Mixed-methods design. The study was conducted at a nursing faculty. The sample of the study consisted of 47 senior nursing students. The students participating in the study were given a four-hour patient education training that included the preparation of patient education, preparation of materials, and effective presentation. A descriptive information form prepared by the researchers, the Patient Education Implementation Scale (PEIS), the Turkish version of the Patient Education Materials Assessment Tool for Printable Materials (PEMAT TR -P), and the presentation skill evaluation form (PSEF) were used to collect quantitative data. Semi-structured interview forms were utilized to collect qualitative data. SPSS for Windows v. 25.0 and MAXQDA20 were used for the data analyses. Results with a p value of <0.05 were considered statistically significant. The post-test mean PEIS scores of the students increased in the total scale and in all subdimensions. A significant difference was found in the understandability and actionability of patient education materials evaluated with PEMAT TR -P (p < 0.05). The mean PSEF score of the students was 85.14 ± 9.25 points. Within the scope of the research, two main themes, namely emotions and efficacy, were determined. This study confirms that structured patient education training, including the use of standardized patients, is important for supporting and developing nursing senior students' attitudes and skills toward patient education. • There is a need for innovative teaching practices in nursing education. • Patient education training can develop students' patient education skills. • The students reported positive experiences with standardized patient practice. [ABSTRACT FROM AUTHOR]

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

It has been a challenge to assess communication and professional values Milestones in emergency medicine (EM) residents using standardized methods, as mandated by the Accreditation Council for Graduate Medical Education (ACGME). This paper outlines an innovative method of assessing these Milestones using an established instructional method. EM faculty mapped the communication and professional values Milestones to an existing communication and interpersonal skills scale. We identified six communication-focused scenarios: death notification; informed consent; medical non-compliance; medical error; treatment refusal; and advanced directives. In a pilot, 18 EM residents completed these six standardized patient (SP) encounters. Our experience suggests SP encounters can support standardized direct observation of residents’ achievement of ACGME Milestones. Further effort can be made to create a tailored, behaviorally-anchored tool that uses the Milestones as the conceptual framework.

Aim: The objective of the study was to examine the effectiveness of simulation practices in improving the emergency case management skills of nursing students. Method: The study was designed as quasi-experimental research and carried out with nursing students (n=42) in three phases. In the first phase, theoretical training on emergency situations was delivered. The students were involved in the emergency case scenarios interacting with high-fidelity simulators and standardized patients, and their performances were recorded in the second phase. In the third phase, debriefing sessions were conducted. Pre- and post-tests and written feedback forms were used to gather the data. Results: The levels of knowledge (mean score of pre-test: 2.83; post-test: 5.95) were statistically significant (p

Background Education with the use of medical simulation may involve the use of two modalities: manikins or standardized patients (SPs) to meet specific learning objectives. We have collected students’ opinions about the two modalities which can be helpful in planning and evaluating the curriculum process. Although reviews or comparisons of student opinions appear in the literature, it is difficult to find a scale that would be based on a comparison of specific effects that can be obtained in the educational process. In order to fill this gap, an attempt was made to construct a questionnaire. Methods An experimental version of a questionnaire measuring the final-year students’ (273) opinions about the effectiveness of both simulation techniques has been designed on the basis of semi-structured interviews. They were conducted with 14 final-year students excluded from the subsequently analyzed cohort. The scale has been completed, tested and validated. Results The authors developed a 33-statement questionnaire which contain two scales: teaching medicine with the manikins and with the SPs. Two factors were identified for each scale: Doctor-patient relationship and practical aspects. The scales can be used complementary or separately, as the article reports independent statistics for each scale. The Cronbach’s alpha coefficient for the manikin scale is 0.721 and for the SP scale is 0.758. Conclusions The questionnaire may be applied to medical students to identify their opinions about using manikins and SPs in teaching. It may have an important impact for planning curriculum and implementing particular modalities in accordance with the intended learning objectives.

Objective: There is a lack of brief rating scales for the reliable assessment of psychotherapeutic skills, which do not require intensive rater training and/or a high level of expertise. Thus, the objective is to validate a 14-item version of the Clinical Communication Skills Scale (CCSS-S). Methods: Using a sample of N = 690 video-based ratings of role-plays with simulated patients, we calculated a confirmatory factor analysis and an exploratory structural equation modeling (ESEM), assessed convergent validities, determined inter-rater reliabilities and compared these with those who were either psychology students, advanced psychotherapy trainees, or experts. Results: Correlations with other competence rating scales were high (rs > 0.86-0.89). The intraclass correlations ranged between moderate and good [ICC(2, 2) = 0.65-0.80], with student raters yielding the lowest scores. The one-factor model only marginally replicated the data, but the internal consistencies were excellent (a = 0.91-95). The ESEM yielded a two-factor solution (Collaboration and Structuring and Exploration Skills). Conclusion: The CCSS-S is a brief and valid rating scale that reliably assesses basic communication skills, which is particularly useful for psychotherapy training using standardized role-plays. To ensure good inter-rater reliabilities, it is still advisable to employ raters with at least some clinical experience. Future studies should further investigate the one-or two-factor structure of the instrument. [ABSTRACT FROM AUTHOR]

• LGBT-specific training can promote self-awareness of biases in public health clinicians. • Video-recorded SP simulations are a novel way to improve affirming beliefs and behaviors. • There was no difference in affirming beliefs and behaviors, regardless of clinician role. • Merely training staff does not ensure the retention of LGBT-specific knowledge. • Clinicians who identified as LGBT were more affirming than their heterosexual counterparts. Identified gaps in the education of healthcare clinicians contribute to non-affirming beliefs and marginalizing behaviors towards LGBT individuals, resulting in poorer health outcomes. This study evaluated the effectiveness of an educational intervention that included video-recorded simulation in improving public health clinicians' affirming beliefs and behaviors. A one-group pretest-posttest design was used, and 69 public health clinicians participated. The intervention was a PowerPoint didactic training with video recordings of transgender standardized patient simulation encounters. The Gay Affirmative Practice (GAP) scale was administered at three timepoints (pretest, immediate posttest, and 2-month posttest). There was a statistically significant improvement in clinicians' affirmative beliefs (p <.001); however, beliefs scores returned to baseline 2 months later. An improvement in affirming behaviors from pretest to 2- month posttest was statistically significant (p =.003). Providing LGBT-specific education using video-recorded simulations may help improve clinicians' affirmative beliefs and behaviors; thus, improving the client-clinician relationship. Addressing obstacles to experiential learning in public health settings by using video-recorded simulation is recommended. [ABSTRACT FROM AUTHOR]

Research suggests that athletic training students lack knowledge and experience providing care to transgender patients. Additionally, research has identified a lack of comfort with sexual health screening in peer health professions. To assess how a curriculum, including a standardized patient (SP) encounter, influenced attitudes and skills in working with sexual health and gender minorities. Prospective observational study. Simulation lab. Twenty cisgender postbaccalaureate professional athletic training students (females = 16, males = 4; age = 23 ± 2 years). The intervention included a focused curriculum on transgender health care and sexual health. In a culminating SP encounter, one group (n = 10) interacted with a cisgender woman and the second group (n = 10) with a transgender woman. The students completed a postintervention survey. Instruments included the Attitudes Towards Transgender Patients tool, which is divided into 3 subscales: clinician education, transgender sport participation, and clinician comfort; and the the Sexual Health Knowledge and Attitudes and Sexual History–Taking instruments, which evaluated the effectiveness of the sexual health curriculum on knowledge, attitudes, and comfort. The investigator and SP actor evaluated the SP encounters. Data were analyzed using descriptive statistics, nonparametric Mann-Whitney U, and 1-way analyses of variance. We identified a significant difference between those completing a transgender SP encounter (mean = 5.30 ± 2.11) and those completing the cisgender SP encounter (mean = 3.50 ± 0.97) on the clinician education subscale (P =.035). There were no differences between groups on the transgender sport participation (P =.70) and clinician comfort (P =.32) subscales. On the SP actor evaluation, we found no significant differences (P =.08). The curriculum and SP encounter influenced knowledge, attitudes, and comfort when working with gender minorities and screening for sexual health. [ABSTRACT FROM AUTHOR]

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Introduction: Female genital cutting/mutilation (FGC/M) is a ritual to remove any or all of the external female genitalia. Educational strategies regarding the teaching of FGC/M for nursing students are scarce. The focus of this article is to describe the development, implementation, and evaluation of a virtual, FGC/M-related dramatization simulation with a standardized patient (SP). Methods: This educational intervention used an East African immigrant woman as the SP with 35 undergraduate nursing students in two nursing schools in the Midwest United States. Results: Participants appraised the simulation as an effective way to teach and learn about FGC/M. Debriefing was a key part of the simulation. Discussion: Students felt the simulation was novel and engaging for a highly sensitive topic. The SP thought the virtual setting made it more comfortable for her to reveal sensitive facts. The researchers confirmed that the simulation required extensive time commitment to develop, critique, and implement. [ABSTRACT FROM AUTHOR]

Introduction: Medical mis- and disinformation are on the rise and impact patient health outcomes. The complexity of modern medicine and health care delivery necessitates that care be delivered by an interprofessional team of providers well versed in addressing this increased prevalence of medical misinformation. Health professions educational curricula often lack opportunities for students to learn how to address medical misinformation, employ advanced communication techniques, and work collaboratively., Methods: Based on literature and our previous qualitative research, we created a module offering prework learning on COVID-19 and addressing misinformation through advanced communication techniques and interprofessional collaboration. After completing prework, students participated in a standardized patient encounter addressing COVID misinformation. Health professions student dyads completed a preencounter planning huddle and together interviewed a standardized patient. Students received global and checklist-based feedback from standardized patients and completed pre- and postsession self-assessments., Results: Twenty students participated (10 third-year medical, nine third-year pharmacy, one fourth-year pharmacy). Key findings included the following: Nine of 15 survey questions demonstrated statistically significant improvement, including all three questions assessing readiness to have difficult conversations and six of 10 questions assessing interprofessional collaboration and team function., Discussion: Students participating in this novel curriculum advanced their readiness to address medical misinformation, including COVID-19 vaccine disinformation, with patients and coworkers to improve health decision-making and patient care. These curricular methods can be customized for use with a range of health professions learners., (© 2024 Hayman et al.)

Objective: Obtaining surgical informed consent (SIC) is a critical skill most residents are expected to learn "on-the-job." This study sought to quantify the effect of 1 year of clinical experience on performance obtaining SIC in the absence of formal informed consent education., Design: In this case-control cohort study, PGY1 and PGY2 surgical residents in an academic program were surveyed regarding their experiences and confidence in obtaining SIC; then assessed obtaining informed consent for a right hemicolectomy from a standardized patient., Setting: Single academic general surgery residency program in Buffalo, NY., Participants: Ten PGY1 and eight PGY2 general surgery residents were included in the study, after excluding residents with additional years of training., Results: PGY2 residents had significantly more experience obtaining SIC compared to PGY1 residents (median response: ">50" vs "between 6 and 15," p = 0.001), however there was no difference in self-reported confidence in ability obtaining SIC (mean 3.2/5 in PGY1 vs 3.4/5 in PGY2, p = 0.61), self-reported knowledge of SIC (mean 3.1/5 in PGY1 vs 3.6/5 in PGY2, p = 0.15), performance on a test regarding SIC (mean score 9.0/20, SD 3.9 for PGY1 vs mean score 9.6/20, SD 3.5, t = 0.387, p = 0.739) or performance during a standardized patient interview (mean 11.2/20, SD 2.78 for PGY1 vs mean 11.4/20, SD 1.51 for PGY2, p = 0.87). In the interviews all residents addressed general risks (bleeding/infection), however both groups performed worse in addressing procedure-specific risks including anastomotic leak as risk for hemicolectomy., Conclusions: A year of clinical training between PGY1 to PGY2 did not improve performance in obtaining surgical informed consent when lacking formal education, despite self-confidence in their ability. A curriculum covering the content, delivery and assessment of informed consent should be initiated for residents upon arrival to surgical training., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

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., (© 2024 Fusco et al.)

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., Competing Interests: The authors declare no competing interests., (© 2024 Published by Elsevier Ltd.)

Abstract Background The conventional methods for teaching neurological examination with real patients to medical students have some limitations if the patient with the symptom or disease is not available. Therefore, we developed a Virtual Reality-based Neurological Examination Teaching Tool (VRNET) and evaluated its usefulness in in teaching neurological examinations for the medical students. Methods In this prospective, randomized, single-blind study, we recruited 98 medical students and divided them into two groups: 1) A standardized patient(SP) group that received the clinical performance examination utilizing standard patients complaining of dizziness was provided neurological findings using conventional method such as verbal description, photographs, and video clips; 2) A SP with VRNET group that was provided the neurological findings using the newly developed tool. Among the 98 students, 3 did not agree to participate, and 95 were enrolled in this study. The SP group comprised 39 students and the SP with VRNET group had 56 students. Results There were no statistical differences in VRNET’s realness and student satisfaction between the SP and SP with VRNET groups. However, a statistically significant difference was found in the Neurologic Physical Exam (NPE) score (p = 0.043); the SP with VRNET group had higher NPE scores (3.81 ± 0.92) than the SP group (3.40 ± 1.01). Conclusions VRNET is useful in teaching senior (graduating) medical students with SP with a neurologic problem.

ObjectiveThere is a lack of brief rating scales for the reliable assessment of psychotherapeutic skills, which do not require intensive rater training and/or a high level of expertise. Thus, the objective is to validate a 14-item version of the Clinical Communication Skills Scale (CCSS-S).MethodsUsing a sample of N = 690 video-based ratings of role-plays with simulated patients, we calculated a confirmatory factor analysis and an exploratory structural equation modeling (ESEM), assessed convergent validities, determined inter-rater reliabilities and compared these with those who were either psychology students, advanced psychotherapy trainees, or experts.ResultsCorrelations with other competence rating scales were high (rs > 0.86–0.89). The intraclass correlations ranged between moderate and good [ICC(2,2) = 0.65–0.80], with student raters yielding the lowest scores. The one-factor model only marginally replicated the data, but the internal consistencies were excellent (α = 0.91–95). The ESEM yielded a two-factor solution (Collaboration and Structuring and Exploration Skills).ConclusionThe CCSS-S is a brief and valid rating scale that reliably assesses basic communication skills, which is particularly useful for psychotherapy training using standardized role-plays. To ensure good inter-rater reliabilities, it is still advisable to employ raters with at least some clinical experience. Future studies should further investigate the one- or two-factor structure of the instrument.

Background: Vaccine hesitancy is challenging for clinicians and of increasing concern since COVID-19 vaccination rollout began. Standardized patients (SPs) provide an ideal method for assessing resident physicians' current skills, providing opportunity to practice and gain immediate feedback, while also informing evaluation of curriculum and training. As such, we designed and implemented an OSCE station where residents were tasked with engaging and educating a vaccine-hesitant patient. Aim: Describe residents' vaccine counseling practices, core communication and interpersonal skills, and effectiveness in meeting the objectives of the case. Explore how effectiveness in overcoming vaccine hesitancy may be associated with communication and interpersonal skills in order to inform educational efforts. Setting: Annual OSCE at a simulation center. Participants: 106 internal medicine residents (51% PGY1, 49% PGY2). Program Description: Residents participated in an annual residency-wide, multi-station OSCE, one of which included a Black, middle-aged, vaccine-hesitant male presenting for a routine video visit. Residents had 10 min to complete the encounter, during which they sought to educate, explore concerns, and make a recommendation. After each encounter, faculty gave residents feedback on their counseling skills and reviewed best practices for effective communication on the topic. SPs completed a behaviorally anchored checklist (30 items across 7 clinical skill domains and 2 measures of trust in the vaccine's safety and resident) which will inform future curriculum. Program Evaluation: Fifty-five percent (SD: 43%) of the residents performed well on the vaccine-specific education domain. PGY2 residents scored significantly higher on two of the seven domains compared to PGY1s (patient education/counseling—PGY1: 35% (SD: 36%) vs. PGY2: 52% (SD: 41%), p = 0.044 and activation—PGY1: 37% (SD: 45%) vs. PGY2: 59% (SD: 46%), p = 0.016). In regression analyses, education/counseling and vaccine-specific communication skills were strongly, positively associated with trust in the resident and in the vaccine's safety. A review of qualitative data from the SPs' perspective suggested that low performers did not use patient-centered communication skills. Discussion: This needs assessment suggests that many residents needed in-the-moment feedback, additional education, and vaccine-specific communication practice. Our program plans to reinforce evidence-based practices physicians can implement for vaccine hesitancy through ongoing curriculum, practice, and feedback. This type of needs assessment is replicable at other institutions and can be used, as we have, to ultimately shed light on next steps for programmatic improvement. [ABSTRACT FROM AUTHOR]

The objective structured clinical examination (OSCE) is among validated approaches used to assess clinical competence through structured and practical evaluation. Most studies of OSCE have used standardized patients (SPs). However, to our knowledge, there is limited information regarding the specific communication skills enhanced by providing communication training (CT) with SPs. Recently, an artificial intelligence (AI) technology was developed. The aim of this study was to evaluate the experience and outcomes of CT with SPs and impact of using AI for this training. This study targeted fourth-year students participating in a pre-learning course for pharmacy practice experience offered at a Japanese university in 2020. The ENcode, Decode, Control, and REgulate model, which evaluates 24 communication skills, was utilized as a questionnaire-based survey. The survey was conducted prior to CT, following CT, and after a second CT session six weeks later with AI. Seven skills, namely "desire suppression," "expectation acceptance," "facial expression," "emotional communication," "dominance," "maintaining relationships," and "dealing with disagreements," were enhanced by the CT with SPs. These skills were included in the broad categories of "management" and "expression" skills. They were not significantly enhanced by following AI training. However, differences observed between the students who underwent AI training and those who did not demonstrated a positive effect in almost all skills, suggesting that AI training can enhance certain skills. CT with SPs enhances students' "management" and "expression" skills. Additionally, AI shows potential for improving the effect of CT. [ABSTRACT FROM AUTHOR]

• Nurse educators can easily transfer this hybrid simulation including telehealth, high-fidelity simulation, and educational gaming throughout a variety of different scenarios. • A detailed scenario matrix and script was essential for continuity and achievement of learning outcomes for all clinical groups. • Prebriefing sessions that provided students opportunities to practice communication and clinical skills were key to the success of this hybrid simulation. • Tacit knowledge or clinical judgment is developed over time through recurrent simulation experiences offered across the curricula As a result of pandemic restrictions, faculty determined that there was an immediate need for innovative telehealth simulation experiences to be integrated in the nursing curricula. To meet this need, an evolving hybrid simulation scenario that transitioned a standardized telehealth client to the emergency department was created. A gaming platform was also incorporated throughout the simulation. Adult Learning Theory and Socratic method were the frameworks for the creation, implementation, and evaluation of the simulation experience. The Telehealth Triage Documentation Form and a scenario matrix were implemented. Students were able to practice effective telepresence, teamwork, and clinical judgment competencies during the various stages of the simulation experience. Remote and face-to-face learners had the ability to fully participate in every aspect of the two-hour clinical experience. Students and standardized patients experiencing their first telehealth simulation are better able to meet learning outcomes when a customized documentation form and script are implemented. Tacit knowledge related to telehealth is developed over time through recurrent simulation experiences offered across the curricula. Educational gaming platforms can be successfully integrated into hybrid simulation experiences. [ABSTRACT FROM AUTHOR]

• This study examines simulated patients' beliefs towards mental illness. • Simulated patients had very low beliefs toward mental illness scores, reflecting overall low levels of stigma in this population. • Portraying mental illness scenarios can be a powerful educational tool in reducing stigma and improving behavior towards people with mental illness This study examines the simulated patients' beliefs towards mental illness from England, and Turkey. The beliefs towards mental illness scale was administered to 43 simulated patients. Simulated patients had very low beliefs toward mental illness scores, reflecting overall low levels of stigma in this population. It was observed that the belief scores of the SPs were very low, providing support for the use of interactive simulation activities to reduce mental health stigma. It is thought that experiencing the life of an individual with mental illness has a positive effect on patients' beliefs about mental illnesses. [ABSTRACT FROM AUTHOR]

There are many examples of hybrid simulation models in healthcare education which are designed to simulate specific scenarios. However, there appears to be a need for a cost effective and configurable hybrid simulation platform which can be used by educators of various healthcare disciplines to simulate different scenarios. The purpose of this paper is to develop a proof-of-concept platform that can be easily implemented at little cost and provide flexibility to healthcare instructors to develop a variety of simulation scenarios, and to determine the effectiveness of this platform. Using a standardized patient, a person acting as a patient in a scripted manner, along with wearable and web-based technologies, a congestive heart failure simulation was used as an evaluative exercise for a group of personal support worker students at a Canadian Community College. Personal support workers typically provide care to any person who may require personal assistance with activities of daily living such as feeding, lifting, bathing, skin care and oral hygiene to name a few. Standardized patients are typically used in healthcare education to educate and evaluate soft skills, such as caregiver to patient communication, professionalism, as well as hard skills, such as history taking, examination and diagnostic skills (Rosen in J Crit Care 23:157–166, 2008). Instructor feedback indicated that the platform was easy to use and capable of simulating a large variety of scenarios. Pre and post test results are evidence of initial findings of promise indicating that the platform seemed to be effective in enabling students to meet learning outcomes. Focus group results seem to indicate an increase in student confidence as it relates to their ability to handle a similar scenario in the workplace. [ABSTRACT FROM AUTHOR]

• Nurses are in a position to identify and intervene for victims and provide care in a therapeutic manner. Incorporating human trafficking education in nursing programs is a way to develop the skills necessary for future practice in a safe and formative environment. • Undergraduate nursing students who participated in a human trafficking simulation with a standardized patient described themes of building relationships with the client and improving critical thinking skills. They learned to use communication strategies, deliver patient-centered care, respect autonomy, manage priorities, adapt to change, and use reflection to improve practice. Nurses can identify and intervene for victims of human trafficking. Educational interventions are needed to prepare nurses to provide care in a therapeutic manner. A convenience sample of 123 undergraduate, associate degree nursing students participated in a human trafficking simulation with a standardized patient. A cross-sectional, descriptive qualitative study was conducted with content analysis of data to determine consistent themes in student's self-reflections. Nursing students described building a therapeutic relationship with the client using communication skills, patient-centered care, and respect for autonomy. Critical thinking skills were improved by having to manage priorities, adapt to change, and reflect on improving practice. The use of simulation to educate nursing students about human trafficking can provide the necessary skills to build a culture of safety and create individualized rescue plans for victims. [ABSTRACT FROM AUTHOR]

Resumen: Introducción: En el área de Ginecología y Obstetricia, muchas de las destrezas clínicas básicas son difíciles de adquirir, pues la historia clínica y examen físico está en estrecho contacto con la intimidad. La simulación se ha manifestado como una alternativa, siendo las pacientes estandarizadas quienes podrían facilitar el aprendizaje de competencias clínicas y comunicacionales. Este trabajo tiene por objetivo medir el grado de satisfacción y percepción de la adquisición de competencias por parte de alumnos expuestos a escenarios de simulación ambulatorios en sala espejo. Materiales y métodos: La instrucción fue realizada a internos de sexto año de medicina y residentes de primer año de la especialidad, con pacientes estandarizadas en escenarios que abarcaron las patologías más prevalentes del área ambulatoria. Se realizó un minitest teórico y una encuesta. Resultados: Se obtuvieron 606 minitest y 590 encuestas. De los encuestados, un 99% indicó que recibió retroalimentación útil y un 96,2% que mejora destrezas. El 100% está de acuerdo o completamente de acuerdo que las sesiones permiten cometer errores en forma segura y un 97,5% las considera excelentes o buenos. Conclusión: La implementación de simulación con pacientes estandarizadas es bien evaluada por los alumnos y mejora sus competencias, lo cual nos estimula a seguir desarrollándola. Abstract: Introduction: In the field of Gynaecology and Obstetrics, many necessary clinical skills are challenging to acquire because the medical history and physical examination are closely linked with intimacy. Simulation has emerged as an alternative in which standardized patients could facilitate the learning of clinical and communicational competencies. The purpose of this work is to measure the satisfaction and perception of the acquisition of skills by students exposed to ambulatory simulation scenarios in rooms with unidirectional mirror. Materials and methods: The training was conducted on sixth-year medical interns and first-year specialty residents, with standardized patients in scenarios that covered the most prevalent pathologies in the ambulatory area. A theoretical mini test and a survey were carried out. Results: 606 mini-tests and 590 questionnaires were obtained. 99% of the respondents reported that they received useful feedback and 96.2% that they improve skills. 100% agree or completely agree that the sessions allow them to make mistakes safely, and 97.5% consider them excellent or good. Conclusión: The implementation of simulation with standardized patients is well evaluated by the students and improves their competencies, encouraging us to develop it further.

Abstract Background Moulages can greatly extend the possibilities of simulation in teaching and assessment. Since moulages that fit an educator’s exact needs are often unavailable commercially, this paper explains how 2-dimensional transfer tattoos can be independently developed, produced, and evaluated. Methods From representative photographs of the specific skin condition an analogue copy of the pathological finding is drawn. Once validated by the medical expert, it can be digitized by scanning and processed using graphics software. The final digital image file is printed onto transfer paper. Once applied and fixed onto the intended wearer, usually a simulated patient, its authenticity can be confirmed, and further transfer tattoos can be produced. Results Using this moulage technique we produced 10 different 2-dimensional transfer tattoos to date, including hematoma, Janeway lesions and splinter nails. These moulages are used in clinical skills training, formative and high-stakes summative assessment in undergraduate medical and nursing programs. Conclusions By sharing our development process for 2-dimensional transfer tattoos, health profession educators can produce their own that best fit their local educational needs. Due to their high authenticity and standardization, 2-dimensional transfer tattoos are ideal for use in high-stakes assessment.

Abstract Gynecological Teaching Associates (GTAs) and Male Urogenital Teaching Associates (MUTAs) instruct healthcare professional learners to perform accurate and respectful breast, speculum, bimanual vaginal, rectal, urogenital, and prostate examinations. During such sessions, the GTA/MUTA uses their own body to instruct while providing real-time feedback. While GTAs/MUTAs fall under the broader umbrella of Standardized Patient methodology, the specificity of their role indicates need for establishment of Standards of Best Practice (SOBP) for GTA/MUTA programs. On behalf of the Association of Standardized Patient Educators (ASPE), the Delphi process was utilized to reach international consensus identifying the Practices that comprise the ASPE GTA/MUTA SOBP. The original ASPE SOBP was used as the foundation for the iterative series of three surveys. Results were presented at the ASPE 2019 conference for additional feedback. Fifteen participants from four countries completed the Delphi process. Four of the original ASPE SOBP Domains were validated for GTA/MUTA programs: Safe Work Environment, Instructional Session Development, Training GTAs/MUTAs, and Program Management. Principles and Practices were shaped, and in some instances created, to best fit the distinct needs of GTA/MUTA programs. The ASPE GTA/MUTA SOBP apply to programs that engage GTAs/MUTAs in formative instructional sessions with learners. Programs that incorporate GTAs/MUTAs in simulation roles or in summative assessment are encouraged to reference the ASPE SOBP in conjunction with this document. The SOBP are aspirational and should be used to shape Practices within the program’s local context. The ASPE GTA/MUTA SOBP will continue to evolve as our knowledge-base and practice develop.

Abstract Background Gynecological Teaching Associates (GTAs) and Male Urogenital Teaching Associates (MUTAs) are individuals trained to instruct health professional learners with their own body to conduct accurate, patient-centered breast, pelvic, urogenital, rectal, and/or prostate examinations. Evidence indicates that this results in improvements in technical competence and communication skills, but there is wide variability to how such programs are implemented and engaged within the curriculum. In this scoping review, we mapped evidence regarding (1) how GTA/MUTA programs are utilized with health professional learners, (2) how GTA/MUTA programs are implemented using the Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP) as a framework, and (3) what broad outcomes are addressed in publications. Methods PubMed, ERIC, PsychINFO, CINAHL, and Sociological Abstracts were searched for all publications addressing instruction of physical examinations with a GTA/MUTA and/or administration of GTA/MUTA programs. Studies were charted in tandem until consensus was identified and then charted individually, using an iterative process. The scoping review protocol was registered prospectively. Results One hundred and one articles were identified, and nearly all highlighted positive results regarding GTA/MUTA programs. Most studies addressed medical students within the USA and Europe. During instructional sessions, three (SD=1.4) learners worked with each GTA/MUTA and an average of 32 min (SD=17) was allocated per learner. GTAs/MUTA instructed both independently (n=33) and in pairs (n=51). Thirty-eight articles provided detailed information consistent with one or more of the Domains of the ASPE SOBP, with six providing specific information regarding safe work environments. Conclusions While studies demonstrate consistently positive outcomes for learners, there is wide variability in implementation patterns. This variability may impact learning outcomes and impact both physical and psychological safety for GTAs/MUTAs and learners. Terminology used to refer to GTAs/MUTAs is inconsistent and may obscure relevant publications. Additional research is indicated to explore the pedagogical variables that result in positive learning outcomes and examine methods to ensure physical and psychological safety of GTAs/MUTAs and learners. Trial registration https://osf.io/x9w2u/ .

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