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Standardized Patients (standardized + patient)
Selected AbstractsSkin Cancer Prevention in the Primary Care Setting: Assessment Using a Standardized PatientPEDIATRIC DERMATOLOGY, Issue 2 2007M.P.H., Robin L. Hornung M.D. A secondary goal was to test the feasibility of this technique as a measure of actual physician behaviors in the outpatient setting. We used a convenience sample of 15 primary care physicians. The standardized patient was an 18-year-old woman with skin phototype I. She presented to physicians as needing a general physical examination for a summer lifeguard job at a beach. She stated a family history of skin cancer. Physician performances were rated using a standard checklist completed by the standardized patient following each visit. We found that none of the physicians asked questions specifically related to skin phototype or sun exposure habits such as childhood sunburns. Only 13% asked about mole changes. For counseling, 67% of physicians recommended sunscreen use; only 7% discussed sunscreen types or procedures for effective use. Only 13% counseled other skin protective behaviors. No significant differences by physician gender were found in these areas; however, female physicians counseled more global health behaviors than male physicians (p , 0.01). Our pilot data suggest that little skin cancer primary prevention counseling is performed for high-risk patients. The standardized patient technique worked well in obtaining outcome data for physicians' preventive practices. [source] Can Unannounced Standardized Patients Assess Professionalism and Communication Skills in the Emergency Department?ACADEMIC EMERGENCY MEDICINE, Issue 9 2009Sondra Zabar MD Abstract Objectives:, The authors piloted unannounced standardized patients (USPs) in an emergency medicine (EM) residency to test feasibility, acceptability, and performance assessment of professionalism and communication skills. Methods:, Fifteen postgraduate year (PGY)-2 EM residents were scheduled to be visited by two USPs while working in the emergency department (ED). Multidisciplinary support was utilized to ensure successful USP introduction. Scores (% well done) were calculated for communication and professionalism skills using a 26-item, behaviorally anchored checklist. Residents' attitudes toward USPs and USP detection were also surveyed. Results:, Of 27 USP encounters attempted, 17 (62%) were successfully completed. The detection rate was 44%. Eighty-three percent of residents who encountered a USP felt that the encounter did not hinder daily practice and did not make them uncomfortable (86%) or suspicious of patients (71%). Overall, residents received a mean score of 60% for communication items rated "well done" (SD ± 28%, range = 23%,100%) and 53% of professionalism items "well done" (SD ± 20%, range = 23%-85%). Residents' communication skills were weakest for patient education and counseling (mean = 43%, SD ± 31%), compared with information gathering (68%, SD ± 36% and relationship development (62%, SD ± 32%). Scores of residents who detected USPs did not differ from those who had not. Conclusions:, Implementing USPs in the ED is feasible and acceptable to staff. The unpredictability of the ED, specifically resident schedules, accounted for most incomplete encounters. USPs may represent a new way to assess real-time resident physician performance without the need for faculty resources or the bias introduced by direct observation. [source] When smokers are resistant to change: experimental analysis of the effect of patient resistance on practitioner behaviourADDICTION, Issue 8 2005Nick Francis ABSTRACT Aims In the field of motivational interviewing, practitioner confrontational behaviour has been associated with lower levels of patient behaviour change. We set out to explore whether resistance to change among smokers affects practitioner confrontational and other behaviours. Design Experimental manipulation of levels of patient resistance in a role play. Setting The study was conducted at the start of a 2-day health behaviour change workshop. Participants Thirty-two practitioners who had registered for the workshop. Intervention The practitioners were assigned randomly to interview a standardized patient (actor) who portrayed a smoker who had been briefed to display either high or low levels of resistance to change. Measurements Interviews were audiotaped and transcribed. Practitioners and standardized patients completed interview ratings at the end of each interview. After listening to each taped interview practitioners were assigned a global score for confrontation, empathy and expert instructional style. Interviews were then submitted to a qualitative analysis. Findings Higher levels of practitioner confrontational behaviour were observed in the high resistance group. This was evident both from the global scores (median 2 versus 0, P = 0.001) and the qualitative analysis. Global scores for empathy and expert instruction were not significantly different. Qualitative analysis also suggests a pervasive negative impact on other practitioner behaviours. Conclusions Higher patient resistance probably leads to an increase in confrontational and other negative behaviours in health professionals attempting to promote behaviour change. This challenges important assumptions about the influence of practitioner behaviour on patient behaviour and subsequent health-related outcomes. [source] Skin Cancer Prevention in the Primary Care Setting: Assessment Using a Standardized PatientPEDIATRIC DERMATOLOGY, Issue 2 2007M.P.H., Robin L. Hornung M.D. A secondary goal was to test the feasibility of this technique as a measure of actual physician behaviors in the outpatient setting. We used a convenience sample of 15 primary care physicians. The standardized patient was an 18-year-old woman with skin phototype I. She presented to physicians as needing a general physical examination for a summer lifeguard job at a beach. She stated a family history of skin cancer. Physician performances were rated using a standard checklist completed by the standardized patient following each visit. We found that none of the physicians asked questions specifically related to skin phototype or sun exposure habits such as childhood sunburns. Only 13% asked about mole changes. For counseling, 67% of physicians recommended sunscreen use; only 7% discussed sunscreen types or procedures for effective use. Only 13% counseled other skin protective behaviors. No significant differences by physician gender were found in these areas; however, female physicians counseled more global health behaviors than male physicians (p , 0.01). Our pilot data suggest that little skin cancer primary prevention counseling is performed for high-risk patients. The standardized patient technique worked well in obtaining outcome data for physicians' preventive practices. [source] Use of Simulation Technology in Forensic Medical EducationACADEMIC EMERGENCY MEDICINE, Issue 2009Heather Rozzi Although the emergency department often provides the first and only opportunity to collect forensic evidence, very few emergency medicine residencies have a forensic medicine curriculum in place. Most of the existing curricula are composed only of traditional didactics. However, as with any lecture-based education, there may be a significant delay between the didactic session and clinical application. In addition, traditional curricula lack the opportunity for residents to practice skills including evidence collection, documentation, and use of a colposcope. At York Hospital, we have developed a forensic curriculum which consists of both traditional lectures and practical experience in our Medical Simulation Center. As part of their educational conference series, residents receive presentations on domestic violence, child abuse, elder abuse, evidence collection, sexual assault, ballistics, pattern injuries, documentation, forensic photography, and court testimony. Following these presentations, residents have the opportunity to apply their knowledge of forensic medicine in the Simulation Center. First, they interview a standardized patient. They then utilize the mannequins in the Simulation Center to practice evidence collection, photo documentation, and use of our specialized forensic medicine charts. After evidence collection and documentation, the residents provide safety planning for the standardized patients. Each portion is videotaped, and each resident is debriefed by victim advocates, experienced sexual assault nurse examiners, and emergency department faculty. The use of simulation technology in resident education provides the opportunity to practice the skills of forensic medicine, ultimately benefiting patients, residents, and law enforcement, and permitting teaching and evaluation in all six core competency areas. [source] Caught in the Act?HEALTH SERVICES RESEARCH, Issue 6 2006Consequences of Physician Detection of Unannounced Standardized Patients, Predictors, Prevalence Objective. To examine the prevalence, predictors, and consequences of physician detection of unannounced standardized patients (SPs) in a study of the impact of direct-to-consumer advertising on treatment for depression. Data Sources. Eighteen trained SPs were randomly assigned to conduct 298 unannounced audio-recorded visits with 152 primary care physicians in three U.S. cities between May 2003 and May 2004. Study Design. Randomized controlled trial using SPs. SPs portrayed six roles, created by crossing two clinical conditions (major depression or adjustment disorder) with three medication request scripts (brand-specific request, general request for an antidepressant, or no request). Data Collection. Within 2 weeks following the visit, physicians completed a form asking whether they "suspected" conducting an office visit with an SP during the past 2 weeks; 296 (99 percent) detection forms were returned. Physicians provided contextual data, a Clinician Background Questionnaire. SPs filled in a Standardized Patient Reporting Form for each visit and returned all written prescriptions and medication samples to the laboratory. Principal Findings. Depending on the definition, detection rates ranged from 5 percent (unambiguous detection) to 23.6 percent (any degree of suspicion) of SP visits. In 12.8 percent of encounters, physicians accurately detected the SP before or during the visit but they only rarely believed their suspicions affected their clinical behavior. In random effects logistic regression analyses controlling for role, actor, physician, and practice factors, suspected visits occurred less frequently in HMO settings than in solo practice settings (p<.05). Physicians more frequently referred SPs to mental health professionals when visits aroused high suspicion (p<.05). Conclusions. Trained actors portrayed patient roles conveying mood disorders at low levels of detection. There was some evidence for differential treatment of detected standardized patients by physicians with regard to referrals but not antidepressant prescribing or follow-up recommendations. Systematic assessment of detection is recommended when SPs are used in studies of clinical process and quality of care. [source] Measuring physiotherapists' guideline adherence by means of clinical vignettes: a validation studyJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 5 2006Geert M.J. Rutten MPH Abstract Rationale, aims and objectives, To assess the criterion validity of paper-and-pencil vignettes to assess guideline adherence by physiotherapists in the Netherlands. The evidence-based physiotherapy practice guideline for low back pain was used as an example. Methods, Four vignettes were constructed and pre-tested. Three vignettes were found to represent an adequate case-mix. They described one patient with specific low back pain, one with non-specific low back pain and a normal recovery process and one with non-specific low back pain and a delay in the recovery process. Invited to participate were 113 primary care physiotherapists who had joined an randomized controlled trial study 8 months before, in which guideline adherence had been measured by means of semi-structured treatment recording forms. The criterion validity was determined with Spearman's rs, using Cohen's classification for the behavioural sciences to categorize its effect size. Results, Of the 72 physiotherapists who agreed to participate, 39 completed the questions on the vignettes. In the end, both adherence measures were available for 34 participants, providing 102 vignettes and 268 recording forms. Mean guideline adherence scores were 57% (SD = 17) when measured by vignettes and 74% (SD = 15) when measured by recording forms. Spearman's rs was 0.31 (P = 0.036), which, according to Cohen's classification, is a medium effect size. Conclusion, Vignettes are of acceptable validity, and are an inexpensive and manageable instrument to measure guideline adherence among large groups of physiotherapists. Further validation studies could benefit from the use of standardized patients as a gold standard, a more diverse case mix to better reflect real physiotherapy practice, and the inclusion of longitudinal vignettes that cover the patients' course of treatment. [source] Refuting patients' obligations to clinical training: a critical analysis of the arguments for an obligation of patients to participate in the clinical education of medical studentsMEDICAL EDUCATION, Issue 3 2001Jude T Waterbury Context The clinical teaching of medical students is essential to the continuation of medicine, but it has a major impact on the patient's health care and autonomy. Some people believe that there is a moral obligation for patients to participate in this training. Such an obligation, real or perceived, may endanger patients' autonomy. Objectives The author makes a critical analysis of the main arguments he encounters supporting such an obligation. These arguments are: (1) the furthering of medical education; (2) compensation when uninsured or unable to pay; (3) an equitable return for the care received in a teaching hospital, and (4) fulfilment of a student's need for (and some say right to) clinical training. Methods Related literature is reviewed in search of evidence and/or support for such arguments. Conclusions The review reveals that these arguments either cannot be verified or do not necessarily place any obligations on the patient. It is argued that, while a medical student may have a right to clinical education, the obligation to fulfil this right rests with the medical university and not on the patients of its teaching hospitals. Solutions Several proposals are made about how to satisfy this need without infringing on the patient's right to refuse participation, explaining the patient's rights and role in clinical teaching, and the use of standardized patients where necessary. [source] Can Unannounced Standardized Patients Assess Professionalism and Communication Skills in the Emergency Department?ACADEMIC EMERGENCY MEDICINE, Issue 9 2009Sondra Zabar MD Abstract Objectives:, The authors piloted unannounced standardized patients (USPs) in an emergency medicine (EM) residency to test feasibility, acceptability, and performance assessment of professionalism and communication skills. Methods:, Fifteen postgraduate year (PGY)-2 EM residents were scheduled to be visited by two USPs while working in the emergency department (ED). Multidisciplinary support was utilized to ensure successful USP introduction. Scores (% well done) were calculated for communication and professionalism skills using a 26-item, behaviorally anchored checklist. Residents' attitudes toward USPs and USP detection were also surveyed. Results:, Of 27 USP encounters attempted, 17 (62%) were successfully completed. The detection rate was 44%. Eighty-three percent of residents who encountered a USP felt that the encounter did not hinder daily practice and did not make them uncomfortable (86%) or suspicious of patients (71%). Overall, residents received a mean score of 60% for communication items rated "well done" (SD ± 28%, range = 23%,100%) and 53% of professionalism items "well done" (SD ± 20%, range = 23%-85%). Residents' communication skills were weakest for patient education and counseling (mean = 43%, SD ± 31%), compared with information gathering (68%, SD ± 36% and relationship development (62%, SD ± 32%). Scores of residents who detected USPs did not differ from those who had not. Conclusions:, Implementing USPs in the ED is feasible and acceptable to staff. The unpredictability of the ED, specifically resident schedules, accounted for most incomplete encounters. USPs may represent a new way to assess real-time resident physician performance without the need for faculty resources or the bias introduced by direct observation. [source] Use of Simulation Technology in Forensic Medical EducationACADEMIC EMERGENCY MEDICINE, Issue 2009Heather Rozzi Although the emergency department often provides the first and only opportunity to collect forensic evidence, very few emergency medicine residencies have a forensic medicine curriculum in place. Most of the existing curricula are composed only of traditional didactics. However, as with any lecture-based education, there may be a significant delay between the didactic session and clinical application. In addition, traditional curricula lack the opportunity for residents to practice skills including evidence collection, documentation, and use of a colposcope. At York Hospital, we have developed a forensic curriculum which consists of both traditional lectures and practical experience in our Medical Simulation Center. As part of their educational conference series, residents receive presentations on domestic violence, child abuse, elder abuse, evidence collection, sexual assault, ballistics, pattern injuries, documentation, forensic photography, and court testimony. Following these presentations, residents have the opportunity to apply their knowledge of forensic medicine in the Simulation Center. First, they interview a standardized patient. They then utilize the mannequins in the Simulation Center to practice evidence collection, photo documentation, and use of our specialized forensic medicine charts. After evidence collection and documentation, the residents provide safety planning for the standardized patients. Each portion is videotaped, and each resident is debriefed by victim advocates, experienced sexual assault nurse examiners, and emergency department faculty. The use of simulation technology in resident education provides the opportunity to practice the skills of forensic medicine, ultimately benefiting patients, residents, and law enforcement, and permitting teaching and evaluation in all six core competency areas. [source] Summative Assessment in Medicine: The Promise of Simulation for High-stakes EvaluationACADEMIC EMERGENCY MEDICINE, Issue 11 2008John R. Boulet PhD Abstract Throughout their careers, physicians are exposed to a wide array of assessments, including those aimed at evaluating knowledge, clinical skills, and clinical decision-making. While many of these assessments are used as part of formative evaluation activities, others are employed to establish competence and, as a byproduct, to promote patient safety. In the past 10 years, simulations have been successfully incorporated in a number of high-stakes physician certification and licensure exams. In developing these simulation-based assessments, testing organizations were able to promote novel test administration protocols, build enhanced assessment rubrics, advance sophisticated scoring and equating algorithms, and promote innovative standard-setting methods. Moreover, numerous studies have been conducted to identify potential threats to the validity of test score interpretations. As simulation technology expands and new simulators are invented, this groundbreaking work can serve as a basis for organizations to build or expand their summative assessment activities. Although there will continue to be logistical and psychometric problems, many of which will be specialty- or simulator-specific, past experience with performance-based assessments suggests that most challenges can be addressed through focused research. Simulation, whether it involves standardized patients (SPs), computerized case management scenarios, part-task trainers, electromechanical mannequins, or a combination of these methods, holds great promise for high-stakes assessment. [source] | ||||||||||