standardized patients in training and evaluation judith g. gearhart, md
Post on 29-Mar-2015
218 Views
Preview:
TRANSCRIPT
Standardized Patients in Training and Evaluation
Judith G. Gearhart, MD
Our Objectives Define simulations Discuss applications Observe examples Examine opportunities for
standardized cases to enhance employee performance
Create a case framework Collaborate
Topics of Discussion Background and terms Standardized patients in teaching Standardized patients in evaluation Developing scenarios and
checklists Resources
Background
“Nothing new under the sun” (1916-1963)
Standardized patients and OSCE used since the 1970s in teaching and evaluation
Incorporated into the USMLE in 2005 Step 2CS Exam
Definitions
Standardized Patients (SPs):
“actors” trained to simulate a patient in a clinical presentation
and to give trainees feedback on performance
Definitions (cont’d)
Virtual patients:
online cases
paper cases Simulators:
models
manikins
Definitions (cont’d)
OSCE (Objective Structured Clinical Exam):
An examination assessing trainee performance in a simulated clinical setting using standardized patients and cases
Uses objective checklists to determine whether trainee performs desired competencies
Also known as:
CPX (Clinical Performance Exam, Clinical Practice Exam)
PBA (Performance-Based Assessment)
CSA (Clinical Skills Assessment)
Definitions (cont’d)
OSTE
Objective Structured Teaching Exam
Advantages of SPs Validity Availability Reliability Controllability Adaptability Minimal risk Feedback Extension of faculty
Uses of SPsEducation : Teach specific skills (interview,
history & physical, diagnosis, management, procedures, professional behaviors)
Provide exposure to clinical problems
Teach how to deal with important issues (cross-cultural issues, ethics, delivering bad news)
Uses of SPs (cont’d) Provide opportunities to meet
educational objectives regarding variety and type of clinical problems
Provide cases trainees should, but might not see without planning
Give trainees feedback Evaluate teaching methods
Uses of SPs (cont’d)
Evaluation of trainees Informal assessment and feedback
(ungraded, “low-stakes”, pass/fail) Formative or final assessment for
grade (with or without feedback) Assessment to determine
progression to next level or licensure (“high-stakes”)
Other uses
Admissions of med trainees or residents
OSTE (Objective Structured Teacher Examination)
Human Resources Practicing Physicians
Human ResourcesIssues Hospitality
receiving, registration,
information giving,
telephone etiquette Confidentiality Team interaction Professionalism
Things SPs Can Do
Act out scenarios (history, physical, need for counseling or information)
Simulate physical findings Use checklists developed by
faculty to evaluate trainees objectively
Give trainees feedback
Physical Findings that Can Be Simulated
Abdominal tenderness Asterixis Carotid bruits Confusion Dilated pupil Gait abnormalities Hyper/hypotension Jaundice Sensory losses Sputum production Wheezing, asymmetrical BS
Prior Development of UMC SP Program
Recruiting, screening, training patients to act out scenarios
Training patients to give feedback Maintaining the standardized
patient pool Working out remuneration Use of facilities
Development of UMC Standardized Patient Program (cont’d)
Creating scenarios and checklists Accessing those already available Scripting from patient/employee
encounters you’ve had Scripting case for objectives
Developing Cases and Checklists
First, determine objective for case teaching, evaluation, or
combination teaching/evaluating what skill?
Developing Cases and Checklists (cont’d)What skill(s)? Adapt for level of trainee Adapt for time frame Put in context of curriculum map
or institutional goals
Next, create the case (scenario) Access those already available Script from patient/employee
encounters you’ve had
Developing Cases and Checklists (cont’d)
Developing Cases and Checklists (cont’d) Identify minimal competencies/
behaviors/questions List in appropriate sequence Be specific Use language that an SP will
understand
Examples Patient asks for directions/clinical
information from employee who doesn’t know the answer
Employee encounters angry patient Procedures (venipuncture checklist) Model/mannequin cases (Sim center)
Examples
Admitting medical error Obtaining informed consent Delivering bad news Telephone triage Patient safety
SummaryUsing Standardized Patients can increase learning opportunities
through structured cases Using standardized cases can
provide another perspective
of trainee performance provide an objective rather than
subjective, measure of skills
Resources
Bibliography Web sites Organizations Clinical Procedures and Simulation
Center Clinical Skills Center
ResourcesASPE(Association of Standardized Patient Educators)
www.aspeducators.orgIndividual or institutional membership feeCasebank
Society for Simulation in Health Care
www.ssih.orgMultiple membership, individual, active, retired, student, resident feeFree without journal
top related