Clinical Applications of Standardized Patients SPs

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Clinical Applications of Standardized Patients
(SPs)

• Kaohsiung Medical University
• May 8, 2007

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Lynn Seng, MSEd

• University of Pennsylvania
• School of Medicine (Penn Med)
• Philadelphia, PA USA
• Director, Special Educational Projects,
  1984-2006
• Director, Standardized Patient Program,
• 1996-2006

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What Who Are SPs?
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What are Standardized Patients (SPs)?

• People who are trained to
• pretend to be patients
• for the purposes of
• educating and evaluating students.

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Standardized because ...

• 1. SPs are trained to act and react in a
  specific, predictable way, according to the goals
  of the program and
• 2. Cases are often portrayed by more than one SP
  for the same program.

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Who are SPs?

• Regular people like your neighbors, shop
  clerks, dog walkers, etc.
• Some are actors many are not.
• Are all ages, sizes, colors, genders, etc.

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SPs are paid professionals

• 12 - 22 USD per hour
• 25 - 38 USD for specialized programs (e.g.,
  gynecology physical exams)

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SP Characteristics

• Are able to act
• Can memorize roles and lists
• Have excellent retention skills
• Are reliable
• Want to help educate students

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SPs in Clinical Education
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What schools use SPs?

• Allied Health
• Clinical Psychology
• Dental
• Medical
• Nursing
• Pharmacy
• Physical Therapy
• Veterinary

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How SPs are being used in medical education

• Help teach clinical, communication, and
  interpersonal skills
• Provide practice in a safe environment
• Introduce professionalism
• Evaluate skills

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7 Reasons for SPs in Medical Education

• 1. Fewer real patients to use for teaching
• Hospitalized patients are sicker
• Hospitalizations are shorter
• Patients are more empowered

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• 2. Faculty are too costly
• Faculty required to devote more time to research
  and clinics
• Schools unable to compensate departments for
  faculty time

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• 3. Reliable and consistent educational
  experiences
• Faculty design SP programs to match curriculum
• Every student sees same clinical patients

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• 4. Provide a safe environment
• Physical exam skills
• Emotional interviews (e.g., Giving Bad News)
• Diagnosis, treatment, management
• Cannot harm SPs

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• 5. Schools need better evaluation tools
• SPs provide reliable measures of students skills
• Schools use SPs to evaluate and improve own
  curriculum

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• 6. Help students prepare for exams
• USMLE Step II CS
• Students develop test-taking skills and
  confidence

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• 7. SPs provide feedback
• Immediate
• Interpersonal skills

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Purpose of SP Feedback

• To increase students awareness of their verbal
  and non-verbal behaviors ...

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Purpose of SP Feedback

• ... and how their verbal and non-verbal
  behaviors affect their patient.

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Benefits

• Patient perspective
• Immediate
• Verbal, with discussion clarification
• Appropriate

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Skills Taught with SPs
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Clinical Skills

• Interviewing History Taking
• Physical Exam
• Differential Diagnosis
• Treatment Management

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Communication Skills

• Difficult Subject, e.g.,
• Colon cancer screening (3rd most common cancer in
  Taiwan)
• Teen suicide
• HIV/AIDS
• Worker fatigue stress
• Sexual assault

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Communication Skills

• Difficult Patient, e.g.,
• Teenager contraception pregnancy
• Non-compliant patient asthma inhalers
• Foreigner illegal tourist cyber-bride
• Behavior modification smoking cessation
• Flirt suggestive, inappropriate
• Physician

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Professionalism

• Substance Abuse
• Teaching, Evaluating
• Ethics, e.g.,
• Gifts
• Relationships

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Interpersonal Skills

• Professional Appearance Behavior
• Eliciting Giving Information
• Listening
• Empathy
• Respectfulness

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University of Pennsylvania School of Medicine

• SP Programs

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Penn Med SP Programs

• Medical Students
• Residents Fellows
• Faculty Community Physicians
• and ...

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Penn Med SP Programs

• Medical School Administration
• Hospital Ethics Committee
• Other U of P schools
• Other Philadelphia schools

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Medical Students

• History physical exam
• Diagnosis, treatment, and management
• Communication
• Interpersonal
• Feedback
• Cultural Competence
• Introduction to professionalism

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SP Contact Hours in 2006

• MS1 12
• MS2 33.5
• MS3 10.5
• MS4 8
• Total 64 hours

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Residents Fellows

• Improving clinical skills
• Giving and getting feedback
• Ethical dilemmas
• Teaching evaluating students
• Teamwork

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Faculty Community Physicians

• Updating clinical skills
• Improving interpersonal skills
• Addressing ethical dilemmas
• Practicing giving bad news
• Improving feedback to students and residents

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Association of Standardized Patient Educators
(ASPE)

• www.aspeducators.org
• Annual Meetings
• June 17-20, 2007 Toronto, Canada
• June 29-July 2, 2008 San Antonio, Texas

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Questions Answers
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Shieh shieh!

• lynnseng.global_at_gmail.com