Standardized Vaccine-Hesitant Patients in the Assessment of the Effectiveness of Vaccine Communication Training.

OBJECTIVES: To determine if training residents in a structured communication method elicits specific behaviors in a laboratory model of interaction with vaccine-hesitant parents. STUDY DESIGN: Standardized patients portraying vaccine-hesitant parents were used to assess the effectiveness of training in the Announce, Inquire, Mirror, Secure (AIMS) Method for Healthy Conversations. Blinded pediatric residents were pseudorandomized to receive AIMS or control training and underwent pre- and post-training encounters with blinded standardized patients. Encounters were assessed by blinded raters using a novel tool. Participant confidence and standardized patient evaluations of the participants' general communication skills were assessed. RESULTS: Ratings were available for 27 AIMS and 26 control participants. Statistically significant increases in post-training scores (maximum = 30) were detected in AIMS, but not in control, participants (median, 21.3 [IQR, 19.8-24.8] vs 18.8 [IQR, 16.9-20.9]; P < .001). Elements (maximum score = 6) with significant increases were Inquire (0.67 [IQR, 0-1.76] vs -0.33 [IQR, -0.67 to 0.33]; P < .001); Mirror (1.33 [IQR, 0 to 2] vs -0.33 [IQR, -0.92 to 0]; P < .001) and Secure (0.33 [IQR, 0 to 1.67] vs -0.17 [IQR, -0.67 to 0.33]; P = .017). Self-confidence increased equally in both groups. Standardized patients did not detect a difference in communication skills after training and between groups. Internal consistency and inter-rater reliability of the assessment tool were modest. CONCLUSIONS: Standardized patients proved useful in studying the effectiveness of structured communication training, but may have been limited in their ability to perceive a difference between groups owing to the predetermined encounter outcome of vaccine refusal. AIMS training should be studied in real-world scenarios to determine if it impacts vaccine acceptance.

Evaluation of the Psychometric Properties of Relational Insights 360 Among Baccalaureate Nursing Students With the Use of Standardized Patients.

BACKGROUND AND PURPOSE: The purpose of this study was to evaluate reliability and validity of the relational competency assessment instrument, Relational Insights 360 (RI-360) (Koloroutis & Trout, 2012), among 104 baccalaureate nursing students and 10 standardized patients (SPs) upon completion of a communication simulation. METHODS: The reliability of the RI-360 was determined by Cronbach's alpha coefficient. Interrater reliability of the RI-360 was measured between the SPs and the primary investigator with percentages. Factor analysis was run to evaluate the construct validity. RESULTS: The RI-360 was internally consistent with an alpha coefficient of 0.93. Interrater reliability for all items on the RI-360 was 42% between students' scores and SPs' scores and 38.9% between the Primary Investigator's scores and SPs' scores. Exploratory factor analysis showed that factor loadings ranged from 0.29 to 0.84. CONCLUSIONS: The RI-360 appears to be a valid and reliable scale for use in measuring relational competency among nursing students and SPs.

HIV and Depression: Examining Medical Students Clinical Skills.

Major depression is a prevalent psychiatric disorder among people living with HIV (PWH). Major depression symptoms, including suicidal ideation, can hinder clinical care engagement and anti-retroviral treatment adherence. Research suggests that inquiry about major depression symptomatology and suicidal ideation should be standard practice when offering primary care services to PWH. However, studies examining depression and suicidal ideation inquiry are scarce. This study's aim was to describe medical students' clinical skills for dealing with major depression symptomatology and suicidal ideation among PWH in Puerto Rico. A total of 100 4th year medical students participated in a Standardized Patient simulation with a trained actor posing as a PWH and with a previous major depression diagnosis. One-way frequency tables were used to characterize the sample and the percentage of each observed clinical skill. Two key findings stem from these results only 10% of the participants referred the patient to psychological/psychiatric treatment, and only 32% inquired about suicidal ideation. Our findings highlight the need for enhancing medical students' competencies regarding mental health issues, particularly when providing services to at risk populations such as PWH within primary care settings.

Measuring Primary Health Care Clinicians' Skills for Depression Management.

Introduction: Primary health care clinicians play an important role in the management of depression. Thus, it is very important to have a valid and reliable assessment of the competences needed to manage depression in primary health care, with the use of clinical simulation providing such an opportunity. Objective: The present study describes the assessment of primary health care clinicians' depression-related skills through a series of objective structured clinical examination stations. Material and Methods: Clinicians from multi-professional teams for the management of depression at two primary health care clinics in Santiago, Chile, went through seven objective structured clinical examination stations, lasting 10 to 20 min each, to assess their depression-related skills. The clinical and communicative skills measured were in accordance with clinical guidelines. Standardized patients portrayed cases usually encountered in clinical practice, while expert raters evaluated clinicians' performance with standardized checklists. Results: Psychosocial clinicians performed better than biomedical clinicians in the assessed skills. The most notable results were as follows: a high level of accomplishment in the relationship with patient, medical anamnesis, health checkup, and lab test requests; heterogeneous performance in patient management according to screening results, feedback to the patient, and registration in clinical records; and major deficiencies in the differential diagnosis of bipolar disorder. Discussion: The objective structured clinical examinations administered provided an opportunity to perform an in-depth examination of the depression-related skills of primary health care clinicians, where flaws in the screening and diagnosis procedures used by biomedical clinicians were detected. Given the significant involvement of these types of clinicians in depression management, undergraduate-level and continuing health education opportunities are needed.

AVALIAÇÃO DE HABILIDADES CLÍNICAS POR EXAME OBJETIVO ESTRUTURADO POR ESTAÇÕES, COM EMPREGO DE PACIENTES PADRONIZADOS; Uma aplicação no Brasil (parte lI)

Resumo: Neste trabalho, descrevemos os resultados da aplicação, do exame clínico objetivo estruturado por estações, com emprego de pacientes padronizados, para avaliação final de 41 estudantes que concluíram a disciplina de Semiologia Geral da Faculdade de Medicina de Ribeirão Preto . Foram construídas 6 estações, com duração de 6 minutos cada, para avaliação de aspectos da tomada da história clínica em pacientes simulados e da realização do exame clínico em pacientes reais. Uma semana após o exame, os estudantes responderam a um questionário com itens sobre sua percepção da prova. A aplicação destes métodos permitiu a obtenção de informações muito detalhadas, tanto sobre o desempenho geral dos estudantes, como sobre virtudes e defeitos da disciplina que os mesmos haviam acabado de cursar. A percepção dos estudantes sobre aspectos gerais do exame, como seleção de tarefas, casos e conteúdos foi satisfatória. No entanto, relataram dificuldades importantes com o controle do tempo em cada estação e referiram que o exame foi muito estressante. Estes fatores, que podem estar ligados a aspectos de ordem cultural mais amplos, devem ser levados em consideração quando da introdução, em outros centros, destes métodos inovadores de avaliação de habilidades clínicas, já consagrados em outros países.

Summary We describe the application of an Objective Structured Clinical Examination (OSCE) Standardized Patients (SP) for the assessment of basic clinical skills of Junior medical students at Ribeirão Preto Medical School. This OSCE comprised 6 stations lastng 6 min each. Two stations were staffed by Sps for evaluation of history-taking skills. The other stations had real patients with true signs, for assessment of physical examination skills. Performance of the examinees was evaluated by faculty members using detailed checklists. One week later, students answered a questionnaire with items on their perception of the examination. Faculty members were impressed with the quality of the information provided by the exam, which allowed them to confidently discriminate students regarding their performance level. Also, the assessment revealed a number of flaws in the course, which prompted the relevant corrections backed by objective data. Students were fairly comfortable with clinical cases, tasks and contents, but reported serious difficulties with time management and regarded the examination to be remarkably stressful. These factors, which might be associated with broader cultural aspects, should be taken into consideration when running OSCEs for the first time.

AVALIAÇÃO DE HABILIDADES CLÍNICAS POR EXAME OBJETIVO ESTRUTURADO POR ESTAÇÕES, COM EMPREGO DE PACIENTES PADRONIZADOS: Descrição de dois métodos (Parte I)

Resumo Neste trabalho, descreve-se a sistemática adotada para a aplicação, de dois métodos inovadores de avaliação objetiva de habilidades clínicas. A técnica de exame clínico objetivo estruturado por estações, com o uso de pacientes padronizados, foi preparada para ser aplicada na avaliação final dos estudantes que concluirem uma disciplina que visa ensinar a realização da Observação Clínica (Anamnese e Exame Físico) na Faculdade de Medicina de Ribeirão Preto. Foram elaboradas 6 estações com duração de 6 minutos cada. Duas estações foram ocupadas por pacientes simulados, para avaliação de tomada de história clínica. As 4 estações restantes foram ocupadas com pacientes reais para a avaliação de aspectos do exame físico. Em todas as estações previu-se também, avaliar a interação do estudante com os pacientes. Nas 4 estações de exame físico, o estudante tem, ainda, que responder a questões breves sobre os achados encontrados. O desempenho dos estudantes em cada estação será avaliado por docentes com o emprego de protocolos de observação estruturados e padronizados, cujos conteúdos são descritos neste artigo.

Summary: We describe the procedures adapted for the application, of an Objective Structured Clinical Examination (OSCE) using Standardized Patients (SP) for the assessment of basic clinical skills of junior medical students at Ribeirão Preto Medical School. This OSCE comprised 6 stations lasting 6 min each. Two stations were staffed by Sps for evaluation of history-taking skills. The other stations had real patients with true signs, for assessment of physical examination skills. Performance of the examinees was evaluate by faculty members using detailed checklists, the contents of which are fully described in this paper.