Key challenges in simulated patient programs: an international comparative case study.

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

African Americans and genetic research, risk versus benefit: implications for the profession of social work.

The Human Genome Project was a 13-year study with great potential for improving the health of the current generation and extending the life of future generations. Genetic research, though showing potential for good, may also result in societal problems. This article considers the implications of future genetic research for African Americans and other vulnerable groups with a retrospective view of medical research and the African Americans' experience. In light of the growing health disparity between Whites and Blacks, this article argues for minority participation in clinical trials and other studies. It addresses the role of social workers as genetic counselors and encourages, especially social workers of color, involvement in the field of genetics as advocates, teachers, and as members of research teams.

Evaluation of a framework for case development and simulated patient training for complex procedures.

BACKGROUND: Simulation for training and assessing clinicians is increasing but often overlooks the patient's perspective. In this paper, actors are trained to portray patients undergoing operations under local anesthetic within a high-fidelity simulated operating theater (SOT). There are few published accounts of approaches to case development and simulated patient (SP) training. We assess the feasibility of SPs playing complex surgical roles and evaluate a three-phased framework for case development and SP training. METHODS: We developed two patient roles for carotid endarterectomy (CEA) under local anesthesia. In all cases, the conscious patient interacted with the surgical team throughout the procedure. SPs were trained to simulate routine and crisis situations, using our framework. After consulting with each SP, surgeons "performed" a CEA upon a model attached to the SP. Evaluation of the framework used interviews, observations, and written evaluations with SPs, surgeons, and the project team. Descriptive statistics summarize surgeons' ratings of realism and qualitative data are analyzed thematically. RESULTS: In all, 46 simulations were conducted with 23 surgeons and three SPs. Real patient interview transcripts provided SPs with authentic information. The SP framework was easy to use, SP training was successful and surgeons' rated SP realism very highly. SPs valued guidance from the SOT control room using an audiolink. CONCLUSIONS: Actors can be trained to portray patients undergoing complex procedures. Our framework for case development and SP training was effective in creating realistic roles. Future studies could evaluate this framework for additional procedures.

Soldier peer mentoring care and support: bringing psychological awareness to the front.

Since the Persian Gulf War of 1990-1991, the operational tempo for soldiers has steadily increased, whereas the numbers of soldiers available to fulfill these missions has decreased. As a result, soldiers and their families are experiencing increased levels of stress that continue to manifest in ways that can often be destructive for the soldiers, their families, and the Army community. Current mitigation and identification support systems such as the Chain of Command, noncommissioned officer leadership, chaplains, and family support systems have all provided critical services, but may not be expected to optimally perform necessary early risk management assessment. Behavioral health care as a self-referral system is often still perceived as career ending, shameful, or even culturally unacceptable. Our allies have also experienced similar family, operational, and combat concerns. In 1996, at the direction of their Commandant General, the British Royal Marines developed and instituted a peer-driven risk management and support system that has experienced a high degree of success and acceptance among its forces-enough so that the Royal Navy is now in the process of implementing a similar program. The Soldier Peer Mentoring and Support program, as part of the proposed deployment Cycle Support Program, is a model for peer group assessment based on the British Royal Marines psychological risk management and support system. This article presents and describes this project, which has been considered for use within the U.S. Army, as a potential augmenter of existing behavioral health support assets as a culturally acceptable, company-level support program in deployment and home stations.

A study of the influence of protective factors as a resource to African American males in traditional batterers' interventions.

The purpose of this study was to examine the relationship between protective factors and the responses of African American males in traditional batterers' interventions. African American male batterers have been viewed as responding poorly to batterers' interventions and were reported in the literature as at risk for dropout and treatment failure. This research proposed that there were culturally related protective factors that enhanced traditional interventions for African American males, increasing their potential for changing abusive behaviors. This within-group study used secondary data to examine the influence of protective factors on the responses of 268 active duty Navy African American males. They were a sub-sample of 861 males randomly assigned to one of four different interventions for batterers. The interventions included a cognitive behavioral men's group, couple's group, safety and stabilization group, and a control group. Each of their cases had been officially substantiated by the Navy for assault of their spouses. The measures for the protective factors of religion, self-esteem, and family support were drawn from the original study's self-report measurement tool. The results of the statistical analyses were found to be significant. The protective factors performed as social controls for reducing certain types of abusive behaviors. Little research has been conducted on the influence of cultural factors on batterers intervention outcome for African Americans. This study established a strong support for further research.