Standardized patient methodology in mainland China: a nationwide survey.

BACKGROUND: To describe the current status of standardized patient (SP) practice in mainland China. METHODS: We conducted a nationwide survey in 2016. One hundred and eighty-three SP educators (SPEs) responded to the questionnaire, representing 80 medical centers from 25 provinces in mainland China. All of these centers were affiliated with China Standardized Patients Practice Teaching Guidance. In the survey, we assessed the methods of SPs' recruitment, hourly wage, how SPs were used and challenges of SP role. We also compared these data among the 4 different regions in China. RESULTS: In mainland China, the most frequent range of SPs' age was between 30 and 40 years (24.8%). The SPs were usually recruited by recommendations from the SPEs or a current SP (43.8%), as well as advertising in the hospitals (43.8%). The mean hourly wage was US$12.60 for teaching activities and US$18.82 for medical examinations. The median frequency for training SPs was 12.9 times per year. The SPs were used in areas such as internal medicine (89.6%), surgery (79.2%) and pediatrics (56.3%). The most challenging parts for the SPs were to remember all of the key points of the cases (51.9%) and portraying the emotions of the case (51.9%). Almost half of the SPs reported that, when interacting with medical students, they had difficulty in providing feedback in consistent with students' learning objectives. SPs' gender, age, rewards and scenarios playing were different significantly among the 4 geographic regions in China (P < 0.05). CONCLUSIONS: This survey provided the reliable data on the current situation of SP application in China. SP activities have had an encouraging progress but regional development imbalance.

Demonstrating Medical Student Competency in Palliative Care: Development and Evaluation of a New Objective Structured Clinical Examination Station.

BACKGROUND: The observed structured clinical examination (OSCE) is an important tool to assess clinical competencies; however, there are no reported palliative care OSCEs for medical student assessment. OBJECTIVE: We aimed to develop, implement, and evaluate the characteristics of a palliative care OSCE for fourth-year medical students. METHODS: We created a representative case and a checklist of 14 history items from three core palliative care competency domains. Subjects were fourth-year medical students who had completed our school's longitudinal palliative care curriculum. Measurements were students' scores compiled from the standardized patient's (SP) tally of the checklist results. We determined inter-rater reliability between the SP and a remote observer. Measurements included the difficulty and discrimination index, internal consistency reliability, factor analysis, and relationships between palliative care scores and composite seven station OSCE scores. RESULTS: In the implementation year, 95 students scored an average of 74% (standard deviation [SD] = 13%) on the 14 history items. There was 95% agreement in ratings on items between the SP and the remote observer. The Cronbach's alpha was 0.53, demonstrating moderate internal consistency. The palliative care scores correlated with overall OSCE communication scores (R = 0.29, p = 0.01) and history scores (R = 0.61, p = 0.01). CONCLUSIONS: A new OSCE to assess palliative care competencies was feasible to implement with high inter-rater reliability, evidence supporting validity, and moderate internal consistency. We believe this OSCE would prove useful to assess students' primary palliative care competency and to evaluate curricula in palliative care.

Pretraining and posttraining assessment of residents' performance in the fourth accreditation council for graduate medical education competency: patient communication skills.

HYPOTHESIS: Structured communication curricula will improve surgical residents' ability to communicate effectively with patients. DESIGN AND SETTING: A prospective study approved by the institutional review board involved 44 University of Connecticut general surgery residents. Residents initially completed a written baseline survey to assess general communication skills awareness. In step 1 of the study, residents were randomized to 1 of 2 simulations using standardized patient instructors to mimic patients receiving a diagnosis of either breast or rectal cancer. The standardized patient instructors scored residents' communication skills using a case-specific content checklist and Master Interview Rating Scale. In step 2 of the study, residents attended a 3-part interactive program that comprised (1) principles of patient communication; (2) experiences of a surgeon (role as physician, patient, and patient's spouse); and (3) role-playing (3-resident groups played patient, physician, and observer roles and rated their own performance). In step 3, residents were retested as in step 1, using a crossover case design. Scores were analyzed using Wilcoxon signed rank test with a Bonferroni correction. RESULTS: Case-specific performance improved significantly, from a pretest content checklist median score of 8.5 (65%) to a posttest median of 11.0 (84%) (P = .005 by Wilcoxon signed rank test for paired ordinal data)(n = 44). Median Master Interview Rating Scale scores changed from 58.0 before testing (P = .10) to 61.5 after testing (P = .94). Difference between overall rectal cancer scores and breast cancer scores also were not significant. CONCLUSIONS: Patient communication skills need to be taught as part of residency training. With limited training, case-specific skills (herein, involving patients with cancer) are likely to improve more than general communication skills.

Evaluation of online instruction to improve medical and dental students' communication and counseling skills.

Online, interactive video modules were created to demonstrate good skills in history taking, counseling, and communication. The authors evaluated the effect of the modules on students' data gathering, counseling, and communication skills with standardized patients (SPs). A student cohort without the online modules (n = 76 medical students and n = 43 dental students) was compared to a cohort of different students who were assigned the modules (n = 88 medical students and n = 39 dental students). Students were evaluated by SPs using case-specific content checklists and the Master Interview Rating Scale (MIRS). Compared to their counterparts who did not use the modules, medical and dental students who used the modules showed significantly higher performance on several outcomes. The areas that showed benefit were those that were novel to students. Student accuracy in grading others was generally unrelated to their own performance. In conclusion, the online, interactive video modules were associated with improvements in a majority of clinical skills.

Assessment of a motivational interviewing curriculum for year 3 medical students using a standardized patient case.

OBJECTIVE: We sought to evaluate a year 3 motivational interviewing (MI) curriculum using a standardized patient case. METHODS: The 2-h small group MI curriculum included a didactic presentation followed by interactive role plays. During a clinical skills assessment at the end of year 3 the MI skills of 80 students who had participated in the curriculum were compared with those of 19 students who had not participated. RESULTS: The standardized patient reliably rated the students on their performance of 8 items. Students who had participated in the MI curriculum were significantly more proficient than nonparticipating students in the performance of 2 strategic MI skills, importance and confidence rulers (ps<.006). The groups did not differ in their use of patient-centered counseling skills or collaborative change planning commonly used in MI. CONCLUSIONS: Third year medical students can learn to use MI skills that specifically aim to enhance patients' motivations for change. PRACTICE IMPLICATIONS: Medical schools should consider providing students with MI training and MI skill assessments using standardized patient cases to help students prepare to counsel patients for behavior change.

Impact of the site specialty of a continuity practice on students' clinical skills: performance with standardized patients.

BACKGROUND: The assessment of clinical competence and the impact of training in ambulatory settings are two issues of importance in the evaluation of medical student performance. PURPOSE: This study compares the clinical skills performance of students placed in three types of community preceptors' offices (pediatrics, medicine, family medicine) on yearly clinical skills assessments with standardized patients. Our goal was to see if the site specialty impacted on clinical performance. METHODS: The students in the study were completing a 3-year continuity preceptorship at a site representing one of the disciplines. Their performance on the four clinical skills assessments was compared. RESULTS: There was no significant difference in history taking, physical exam, communication, or clinical reasoning in any year (ANOVA p< or = .05) There was a small but significant difference in performance on a measure of interpersonal and interviewing skills during Years 1 and 2. CONCLUSION: The site specialty of an early clinical experience does not have a significant impact on performance of most of the skills measured by the assessments.

Dental students' attitudes toward treating diverse patients: effects of a cross-cultural patient-instructor program.

This article describes the effects of a cross-cultural patient-instructor (PI) program on dental students' attitudes toward diversity. PIs were individuals from the community trained to portray specific simulated patients who presented cross-cultural challenges to students. Dental students interviewed PIs during two rotations, one in their junior and one in their senior year. Using a retrospective pretest-posttest design, after completing each rotation, students reported their likelihood of engaging in certain desirable diversity thoughts and actions before versus after each PI rotation. Seventy-three students completed the first cross-cultural rotation, and eighty-two students completed the second. Each rotation improved students' diversity-related attitudes. The first rotation, in their junior year, had slightly greater effect on these outcomes than the second rotation, in their senior year. Students also reported very positive evaluations of the course. These findings suggest that students' attitudes toward diversity can be modified. PIs are a creative way to promote cross-cultural patient care with health professions students, making them more open to thinking about, discussing, and engaging in patient-oriented, diversity-related activities.

Using web-based video to enhance physical examination skills in medical students.

BACKGROUND AND OBJECTIVES: Physical examination (PE) skills among U.S. medical students have been shown to be deficient. This study examines the effect of a Web-based physical examination curriculum on first-year medical student PE skills. METHODS: Web-based video clips, consisting of instruction in 77 elements of the physical examination, were created using Microsoft Windows Moviemaker software. Medical students' PE skills were evaluated by standardized patients before and after implementation of the Internet-based video. RESULTS: Following implementation of this curriculum, there was a higher level of competency (from 87% in 2002-2003 to 91% in 2004-2005), and poor performances on standardized patient PE exams substantially diminished (from a 14%-22%failure rate in 2002-2003, to 4% in 2004-2005. CONCLUSIONS: A significant improvement in first-year medical student performance on the adult PE occurred after implementing Web-based instructional video.

A patient-instructor program to promote dental students' communication skills with diverse patients.

This article describes the design and evaluation of a patient-instructor (PI) program that was developed to teach and assess dental student communication skills with patients, with an emphasis on cross-cultural patient encounters. The PIs were individuals from the community trained to portray specific simulated patients. One hundred eighteen dental students (three graduating classes) completed two half-day rotations that occurred in the junior year; seventy-nine of those students (two graduating classes) also completed a third rotation that occurred in the senior year. On each rotation, students worked with several simulated patients in mock clinic appointments. PIs used a standardized rating scale and case-specific content checklists to assess students' ability to elicit and provide essential information. Across counterbalanced cases, students improved as they progressed through encounters. Rate of improvement varied by rotation, but students improved most during their first rotation. Overall performance was best on the final rotation. Qualitative review of content checklist items indicated areas of strengths and weaknesses in communication regarding medical, dental, psychosocial, and cultural content. Results can direct curriculum changes to improve communication skills. Future research should address the effects of the PI program on students' diversity-related attitudes and behaviors.

Long-term retention of smoking cessation counseling skills learned in the first year of medical school.

BACKGROUND: Tobacco use is a significant cause of preventable morbidity and mortality in the United States, yet clinicians underutilize smoking cessation counseling. Medical schools are increasingly including training for smoking cessation skills in preclinical curricula. Information about long-term retention of these skills is needed. OBJECTIVE: To assess retention of smoking cessation counseling skills learned in the first year of medical school. DESIGN: Retrospective review of data collected for routine student and curriculum assessment. PARTICIPANTS: Two cohorts of medical students at the University of Connecticut School of Medicine (total N = 112) in 1999-2001 and 2002-2004. MEASUREMENTS AND MAIN RESULTS: Scores by standardized patients were compared from first and fourth-year assessments, based on checklist items corresponding to the 5 strategies recommended by the U.S. Public Health Service (Ask, Advise, Assess, Assist, Arrange). In study cases, 97% of first-year students "asked" about smoking and retained this skill in fourth year (p = .08). Ninety-four percent of first-year students "assessed" readiness to quit and retained this skill (p = .21). Ninety-six percent of first-year students "advised" smokers to quit and retained this skill (p = .18). Eighty-six percent of first year students "assisted" smokers in quitting and retained this skill (p = 0.10). Eighty-one percent of first year students "arranged" follow-up contact and performance of this strategy improved in the fourth year to 91% (p = .03). CONCLUSIONS: Smoking cessation counseling skills demonstrated by first year medical students were, with brief formal reinforcement in the third year, well retained into the fourth year of medical school. It is appropriate to begin this training early in medical education.

Impact of a new curriculum on medical students' interpersonal and interviewing skills.

OBJECTIVES: In 1998 we reported on the rise and fall of medical student communication skills during the 4 years of medical school. Since then, the University of Connecticut School of Medicine has completed a major curriculum renewal project with an emphasis on early clinical work, lifelong learning and more ambulatory training. The goals of this study were to compare students' interviewing and interpersonal skills in standardised patient (SP) assessments in the old and new curricula and to assess the success of the new curriculum in preventing a decline in student skills in this domain. METHODS: The clinical skills of 202 students were measured longitudinally during encounters with SPs in each of their 4 years of medical school. Students in this study and the earlier study were evaluated using the Arizona Clinical Interviewing Rating (ACIR) Scale. RESULTS: Compared with students from the previous curriculum, students on the new curriculum in this study showed an improvement in ACIR scores. Year 1 mean ACIR scores (1 = poor to 5 = excellent) were, respectively, 3.6 for the old curriculum cohort and 4.0 for the new curriculum group. In Year 4 the mean score for the old curriculum cohort was 3.7 and that for the new curriculum group was 3.8. Students on the new curriculum still showed a decline in ACIR scores from Years 1 to 4, but it was not as severe a decline as it had been previously. CONCLUSIONS: Pre-clinical medical students perform better on measures of interpersonal communication than their clinical counterparts. The students who participated in the new curriculum demonstrated an earlier acquisition of and a less steep decline in interviewing and interpersonal skills during the course of medical school.

Face-to-face clinical skills feedback: lessons from the analysis of standardized patient's work.

BACKGROUND: Current evidence suggests that trainees are evaluated less stringently when feedback is given face-to-face, limiting its value. PURPOSE: We expected that standardized patients (SPs) would also be more lenient in scoring when they gave immediate feedback to the students. METHODS: Data from 6 clinical skills assessments of students in Years 1 to 4 of medical school were used. Comparisons in scoring were made for the cases on which students received feedback and those where they did not. Analysis was done using a hierarchical linear regression model to test for significant differences. RESULTS: The results indicated no significant difference in scoring for the history and physical exam checklists. There was a small but significant difference on the measure of interpersonal and interviewing skills. CONCLUSIONS: The SPs were trained to avoid stringency, leniency, and restricted range in scoring students. These training methods may be useful for training faculty to give face-to-face feedback.

Downward comparison and coping with serious medical problems.

Correlates of selective comparisons by mothers of high-risk infants and individuals with rheumatoid arthritis showed that mothers were especially likely to make downward comparisons. Arthritis patients making downward comparisons were rated by their health care providers as more positively adjusted, independent of actual severity of illness. Implications for support providers are discussed.