Comparison of peer, self, and faculty objective structured clinical examination evaluations in a PharmD nonprescription therapeutics course.

PURPOSE: Objective structured clinical examinations (OSCE) are a valuable assessment within healthcare education, as they provide the opportunity for students to demonstrate clinical competency, but can be resource intensive to provide faculty graders. The purpose of this study was to determine how overall OSCE scores compared between faculty, peer, and self-evaluations within a Doctor of Pharmacy (PharmD) curriculum. METHODS: This study was conducted during the required nonprescription therapeutics course. Seventy-seven first-year PharmD students were included in the study, with 6 faculty members grading 10-15 students each. Students were evaluated by 3 graders: self, peer, and faculty. All evaluators utilized the same rubric. The primary endpoint of the study was to compare the overall scores between groups. Secondary endpoints included interrater reliability and quantification of feedback type based on the evaluator group. RESULTS: The maximum possible score for the OSCE was 50 points; the mean scores for self, peer, and faculty evaluations were 43.3, 43.5, and 41.7 points, respectively. No statistically significant difference was found between the self and peer raters. However, statistical significance was found in the comparison of self versus faculty (p = 0.005) and in peer versus faculty (p < 0.001). When these scores were correlated to a letter grade (A, B, C or less), higher grades had greater similarity among raters compared to lower scores. Despite differences in scoring, the interrater reliability, or W score, on overall letter grade was 0.79, which is considered strong agreement. CONCLUSIONS: This study successfully demonstrated how peer and self-evaluation of an OSCE provides a comparable alternative to traditional faculty grading, especially in higher performing students. However, due to differences in overall grades, this strategy should be reserved for low-stakes assessments and basic skill evaluations.

Difference in medical student performance in a standardized patient encounter between telemedicine and in-person environments.

INTRODUCTION: Telemedicine is an increasingly common form of healthcare delivery in the United States. It is unclear how there are differences in clinical performance in early learners between in-person and telemedicine encounters. MATERIALS & METHODS: The authors conducted a single-site retrospective cohort study of 241 second-year medical students to compare performance between in-person and telemedicine standardized patient (SP) encounters. One hundred and twenty medical students in the 2020 academic year participated in a telemedicine encounter, and 121 medical students in the 2022 academic year participated in an in-person encounter. SPs completed a multi-domain performance checklist following the encounter, and the authors performed statistical analyses to compare student performance between groups. RESULTS: Students who completed in-person encounters had higher mean scores in overall performance (75.2 vs. 69.7, p < 0.001). They had higher scores in physical exam (83.3 vs. 50, p < 0.001) and interpersonal communication domains (95 vs. 85, p < 0.001) and lower scores in obtaining a history (73.3 vs. 80, p = 0.0025). There was no significant difference in assessment and plan scores (50 vs. 50, p = 0.96) or likelihood of appropriately promoting antibiotic stewardship (41.3% vs. 45.8%, p = 0.48). CONCLUSION: The authors identified significant differences in clinical performance between in-person and telemedicine SP encounters, indicating that educational needs may differ between clinical environments.

Utilizing a Virtual Reality Matrix in Medical Education.

Virtual reality (VR) is an emerging technology that has demonstrated incredible value within medical education. However, medical institutions adopting VR as a learning tool need to ensure that the immersive technology product they pick possesses standard usability criteria. The current literature is limited in defining what specific criteria institutions should look for, or how to select between various VR products. Since there have been little to no algorithms available to the medical education community to aid in this process, a reproducible matrix has been developed to evaluate multiple VR platforms at once which can help identify the best option for medical education programs. The matrix is a 10-point scoring system that includes what the research team considered to be the 10 most important factors when selecting a VR product for medical education. The scores of any two or more VR products can be quantitatively compared. Therefore, the matrix is to be used as a methodological framework to help objectively select the highest-rated immersive technology platform. The research team involved in the development of the matrix consisted of an associate dean for simulation and technology, a director of simulation and technology, and eight medical students.

A Verbal De-escalation Standardized Patient Workshop for Third- and Fourth-Year Medical Students.

Introduction: Verbal de-escalation is an essential skill for physicians across specialties and is the first-line intervention for patients who present with agitation. Training in verbal de-escalation for medical students is less robust compared to other health care disciplines. We describe the creation and evaluation of a novel verbal de-escalation curriculum for third- and fourth-year medical students on their psychiatry clerkship rotation. Method: We developed a simulation using standardized patient (SP) methodology and a dedicated reflection session, implementing it in the third-year psychiatry clerkship. Participants in the scenario received targeted feedback from their peers and SPs. The sessions were video recorded, and a random sample was selected and reviewed to identify key observations and themes from student performance. Results: A total of 139 students participated in the encounter. One hundred twenty-two of 125 students (82%) stated the activity met the learning objectives, with 108 (86%) assigning the letter grade A to the activity. Written feedback indicated that the majority of students believed the activity to be realistic, instructive, and helpful but felt the SPs de-escalated too quickly. Video review of the encounters found that while the students effectively used the skills, many jumped to a quick fix, and some offered inappropriate choices to end the encounter. Discussion: This SP activity was effective in allowing students to practice skills in a safe setting and was valued by students. In the future, adding another workshop in the fourth year could facilitate higher retention and practice of skills.

Do Interns Learn On-The-Job How to Obtain Proper Informed Consent for Surgical Procedures?

OBJECTIVE: Obtaining surgical informed consent (SIC) is a critical skill most residents are expected to learn "on-the-job." This study sought to quantify the effect of 1 year of clinical experience on performance obtaining SIC in the absence of formal informed consent education. DESIGN: In this case-control cohort study, PGY1 and PGY2 surgical residents in an academic program were surveyed regarding their experiences and confidence in obtaining SIC; then assessed obtaining informed consent for a right hemicolectomy from a standardized patient. SETTING: Single academic general surgery residency program in Buffalo, NY. PARTICIPANTS: Ten PGY1 and eight PGY2 general surgery residents were included in the study, after excluding residents with additional years of training. RESULTS: PGY2 residents had significantly more experience obtaining SIC compared to PGY1 residents (median response: ">50" vs "between 6 and 15," p = 0.001), however there was no difference in self-reported confidence in ability obtaining SIC (mean 3.2/5 in PGY1 vs 3.4/5 in PGY2, p = 0.61), self-reported knowledge of SIC (mean 3.1/5 in PGY1 vs 3.6/5 in PGY2, p = 0.15), performance on a test regarding SIC (mean score 9.0/20, SD 3.9 for PGY1 vs mean score 9.6/20, SD 3.5, t = 0.387, p = 0.739) or performance during a standardized patient interview (mean 11.2/20, SD 2.78 for PGY1 vs mean 11.4/20, SD 1.51 for PGY2, p = 0.87). In the interviews all residents addressed general risks (bleeding/infection), however both groups performed worse in addressing procedure-specific risks including anastomotic leak as risk for hemicolectomy. CONCLUSIONS: A year of clinical training between PGY1 to PGY2 did not improve performance in obtaining surgical informed consent when lacking formal education, despite self-confidence in their ability. A curriculum covering the content, delivery and assessment of informed consent should be initiated for residents upon arrival to surgical training.

The Interprofessional Standardized Patient Experience: An Effective Interprofessional Education Activity for Prelicensure Health Professional Students.

Introduction: For future success in the modern health care environment, health professions students require effective interprofessional education experiences to develop their perceptions of other professionals on the health care team. The Interprofessional Standardized Patient Experience (ISPE) is an interprofessional education activity for prelicensure health professional students in nursing, pharmacy, physical therapy, medicine, social work, and occupational therapy. Methods: The ISPE involved collaboration among students to conduct a subjective interview. Students from six health care professions individually interviewed a simulated patient while being observed by students from other professions. A structured faculty-guided debriefing session followed the comprehensive interview process. Students completed a voluntary pre- and post-ISPE survey with interprofessional questions and feedback on the activity. Descriptive statistics were used to analyze individual responses. Differences in student opinions by student profession and by the number of professions present were examined using chi-square tests. Results: Over 4 consecutive academic years, 1,265 students completed the ISPE, and 1,028 completed the pre- and post-ISPE surveys. Analysis of the survey responses indicated that the ISPE enhanced student awareness of the functions of an interprofessional team and increased student knowledge of the roles of different health care professions. Students rated the ISPE as a valuable experience. Differences were noted in some of the measures by profession and group size. Discussion: A single ISPE had a significant impact on prelicensure students' perceptions. The ISPE is a novel and effective approach to interprofessional education that students appreciate.

Evaluation of the Effectiveness of Standardized Patient Simulation as a Teaching Method in Psychiatric and Mental Health Nursing.

Background: The use of standardized patient simulation in psychiatric nursing education addresses the unique challenges presented by mental healthcare settings. Students' attitudes toward clinical simulation remain predominantly favorable, with many expressing enthusiasm for the opportunities it provides in terms of embracing challenges, enhancing realism, and promoting critical thinking through problem solving, decision-making, and adaptability. Methods: This quantitative study used a cross-sectional, descriptive, correlation design to investigate the effectiveness of standardized patient simulation as a teaching method in the Psychiatric and Mental Health nursing course in a university setting. A total of 84 nursing students were recruited for the convenience sample. Data were collected using a three-part questionnaire survey which included the following: a demographic data sheet, the Student Satisfaction and Self-confidence in Learning Scale, and a narrative open-ended question asking the participants to write the advantages and disadvantages of their simulation experience. Data were analyzed using the statistical software JMP pro17. Results: The total satisfaction with learning subscale score ranged between 5 and 25 with a mean score of 19.36 ± 6.32. The total self-confidence subscale score ranged between 8 and 40 with a mean score of 30.87 ± 9.1. Pearson's correlation coefficient r revealed a statistically significant positive relationship between the participants' satisfaction with the learning experience and their self-confidence (t = 0.923, p < 0.0001). Approximately 91.7% of the students recommended using simulation. The results confirmed the students' recommendations of simulation use in teaching psychiatric and mental health courses; furthermore, the results showed a statistically significant positive correlation with the total SSLS (p = 0.01) and satisfaction with learning subscale (0.003). Participants reported that authentic, practical, comfortable, and safe learning environments contributed to an enriched learning experience. Additionally, factors such as timesaving, access to information, cost-effectiveness, standardized teaching, varied exposure, skill development, and immediate feedback also enhanced the learning experience through patient simulation in psychiatric and mental health nursing. Conclusion: Simulations can contribute efficiently and positively to psychiatric and mental health nursing education in a manner that optimizes the learning experience while ensuring the consistency of student learning in a safe learning environment.

Healthcare professional students' skills in sexual health communication and history taking: inter-rater reliability of standardized patients and faculty ratings in dar es Salaam, tanzania- a cross-sectional study.

BACKGROUND: Low- and middle-income countries face a disproportionate impact of sexual health problems compared to high-income countries. To address this situation proper interpersonal communication skills are essential for clinician to gather necessary information during medical history-taking related to sexual health. This study aimed to evaluate the interrater reliability of ratings on sexual health-related interpersonal communication and medical history-taking between SPs and trained HCP faculty for health care professional students. METHODS: We conducted a cross-sectional comparative study to evaluate the interrater reliability of ratings for sexual health-related interpersonal communication and medical history-taking. The data were collected from medical and nursing students at Muhimbili University of Health and Allied Sciences, who interviewed 12 Standardized Patients (SPs) presenting with sexual health issues. The video-recorded interviews rated by SPs, were compared to the one rated by 5 trained Health Care Professional (HCP) faculty members. Inter-rater reliability was evaluated using percent agreement (PA) and kappa statistics (κ). RESULTS: A total of 412 students (mean age 24) were enrolled in the study to conduct interviews with two SPs presenting with sexual health concerns. For interpersonal communication (IC), the overall median agreement between raters was slight (κ2 0.0095; PA 48.9%) while the overall median agreement for medical sexual history-taking was deemed fair (κ2 0.139; PA 75.02%). CONCLUSION: The use of SPs for training and evaluating medical and nursing students in Tanzania is feasible only if they undergo proper training and have sufficient time for practice sessions, along with providing feedback to the students.

Enhancing General Surgery Clerkships: The Application and Value of Standardized Patient-Based Situational Simulation Teaching.

OBJECTIVE: We explored the value of a standardized patient-based situational simulation teaching method in general surgery internships. METHODS: A prospective, single-blind, randomized controlled trial was conducted with clinical medicine undergraduates from the 2020 cohort of our university as subjects. These students were randomly divided into a traditional teaching (TT) group and a combined teaching (CT) group based on their internship schedules. The TT group followed the conventional teaching model, while the CT group engaged in the standardized patient-based situational simulation teaching method. The study compared differences in pre-internship theoretical scores, post-internship theoretical scores, medical record writing quality, and student satisfaction between the two groups. RESULTS: The CT group (n=108) significantly outperformed the TT group (n=104) in post-internship theoretical scores and medical record writing quality (all P<0.05) and showed marked improvement in stimulating students' interest in learning (P=0.015), enhancing clinical diagnostic and treatment abilities (P<0.001), improving doctor‒patient communication skills (P<0.001), strengthening medical mission sense (P<0.001), reinforcing physicians' sense of responsibility (P<0.001), and facilitating the application of learned knowledge (P<0.001). These differences were statistically significant. CONCLUSION: The standardized patient-based situational simulation teaching method (CT) in general surgery internships has been highly recognized by students and can enhance their clinical competency, offering considerable value for broader.

The impact of provider-patient communication skills on primary healthcare quality and patient satisfaction in rural China: insights from a standardized patient study.

OBJECTIVES: In middle-income countries, poor physician-patient communication remains a recognized barrier to enhancing healthcare quality and patient satisfaction. This study investigates the influence of provider-patient communication skills on healthcare quality and patient satisfaction in the rural primary healthcare setting in China. METHODS: Data were collected from 504 interactions across 348 rural primary healthcare facilities spanning 21 counties in three provinces. Using the Standardized Patient method, this study measured physician-patient communication behaviors, healthcare quality, and patient satisfaction. Communication skills were assessed using the SEGUE questionnaire framework. Multivariate linear regression models and multivariate logistic regression models, accounting for fixed effects, were employed to evaluate the impact of physicians' communication skills on healthcare quality and patient satisfaction. RESULTS: The findings indicated generally low provider-patient communication skills, with an average total score of 12.2 ± 2.8 (out of 24). Multivariate regression models, which accounted for physicians' knowledge and other factors, demonstrated positive associations between physicians' communication skills and healthcare quality, as well as patient satisfaction (P < 0.05). Heterogeneity analysis revealed stronger correlations among primary physicians with lower levels of clinical knowledge or more frequent training. CONCLUSION: This study emphasizes the importance of prioritizing provider-patient communication skills to enhance healthcare quality and patient satisfaction in rural Chinese primary care settings. It recommends that the Chinese government prioritize the enhancement of provider-patient communication skills to improve healthcare quality and patient satisfaction.

Effect of standardized patient simulation-based pedagogics embedded with lecture in enhancing mental status evaluation cognition among nursing students in Tanzania: A longitudinal quasi-experimental study.

BACKGROUND: Nurses around the world are expected to demonstrate competence in performing mental status evaluation. However, there is a gap between what is taught in class and what is practiced for patients with mental illness among nursing students during MSE performance. It is believed that proper pedagogics may enhance this competence. A longitudinal controlled quasi-experimental study design was used to evaluate the effect of using standardized patient simulation-based pedagogics embedded with a lecture in enhancing mental status evaluation cognition among nursing students in Tanzania. METHODS: A longitudinal controlled quasi-experimental study design with pre-and post-test design studied 311 nursing students in the Tanga and Dodoma regions. The Standardized Patient Simulation-Based Pedagogy (SPSP) package was administered to the intervention group. Both groups underwent baseline and post-test assessments using a Interviewer-adminstered structured questionnaire as the primary data collection tool, which was benchmarked from previous studies. The effectiveness of the intervention was assessed using both descriptive and inferential statistics, specifically the Difference in Difference linear mixed model, and the t-test was carried out using IBM Statistical Package for Social Science (SPSS) software, version 25. RESULTS: The participant's mean age was 21 years ± 2.69 with 68.81% of the students being female. Following the training Students in the intervention group demonstrated a significant increase in MSE cognition post-test, with an overall mean score of (M ± SD = 22.15 ± 4.42;p = < 0.0001), against (M ± SD = 16.52 ± 6.30) for the control group. CONCLUSION: A significant difference exists in the levels of cognition, among nursing students exposed to Mental Status Evaluation (MSE) materials through Standardized Patient Simulation-Based Pedagogy (SPSP) embeded with lectures. When MSE materials are delivered through SPSP along with lectures, the results are significantly superior to using lectures pedagogy alone.

Use of standardized patients in patient education practices of senior nursing students: A mixed-methods study.

BACKGROUND: There is a need for innovative teaching practices in nursing education due to many factors, such as global changes, the rapid development of technology, the increasing number of students, and the recent pandemic. OBJECTIVES: This research was conducted using standardized patients to evaluate the attitudes and skills of senior nursing students toward patient education practices following the implementation of a patient education training program. DESIGN: Mixed-methods design. SETTINGS: The study was conducted at a nursing faculty. PARTICIPANTS: The sample of the study consisted of 47 senior nursing students. INTERVENTION: The students participating in the study were given a four-hour patient education training that included the preparation of patient education, preparation of materials, and effective presentation. METHODS: A descriptive information form prepared by the researchers, the Patient Education Implementation Scale (PEIS), the Turkish version of the Patient Education Materials Assessment Tool for Printable Materials (PEMATTR-P), and the presentation skill evaluation form (PSEF) were used to collect quantitative data. Semi-structured interview forms were utilized to collect qualitative data. SPSS for Windows v. 25.0 and MAXQDA20 were used for the data analyses. Results with a p value of <0.05 were considered statistically significant. RESULTS: The post-test mean PEIS scores of the students increased in the total scale and in all subdimensions. A significant difference was found in the understandability and actionability of patient education materials evaluated with PEMATTR-P (p < 0.05). The mean PSEF score of the students was 85.14 ± 9.25 points. Within the scope of the research, two main themes, namely emotions and efficacy, were determined. CONCLUSIONS: This study confirms that structured patient education training, including the use of standardized patients, is important for supporting and developing nursing senior students' attitudes and skills toward patient education.

Effects of Standardized Patient Simulation and Mobile Applications on Nursing Students' Clinical Competence, Self-Efficacy, and Cultural Competence: A Quasi-Experimental Study.

BACKGROUND: Simulation-based education has emerged as an effective approach in nursing education worldwide. We aimed to evaluate the effectiveness of a surgical nursing education program based on a simulation using standardized patients and mobile applications among nursing students. METHODS: A mixed-methods design with a quasi-experimental longitudinal approach and focus group interviews was employed. The data were collected from 130 third-year nursing students at three different time points who were equally divided into experimental and control groups. This study measured the level of clinical surgical nursing competence, self-efficacy in clinical performance, cultural competence, and satisfaction with simulation experience. Four focus group interviews were conducted using open-ended questions to explore the participants' perspectives on the course's efficacy and satisfaction. RESULTS: There were statistically significant differences in clinical surgical nursing competence (F = 8.68, p < 0.001), self-efficacy in clinical performance (F = 13.56, p < 0.001), and cultural competence (F = 10.35, p < 0.001) across time between the intervention and control groups. Student satisfaction with the simulation-based training was high, particularly regarding debriefing and reflection, with an overall mean satisfaction level of 4.25 (0.40). Students' perspectives regarding integrated hybrid training are categorized into three themes: educational achievement, dynamic learning experiences, and satisfaction and suggestion. CONCLUSION: Simulation-based learning provides a dynamic and immersive educational experience that enables undergraduate nursing students to develop and refine essential clinical skills while also fostering confidence and cultural competence.

High-Fidelity, Indigenously Prepared, Low-Cost Moulage as a Valid Simulation Tool to Improve Trauma Education.

Background Simulation-based trauma education facilitates repeated practice in a controlled and safer environment for the learner without any risk to the patient's well-being. Moulage contributes to the perception of reality during training using standardized patients. However, the high cost of commercial moulage items is often prohibitive for regular use. This study aimed to assess the effectiveness of indigenously prepared, low-cost moulage as a valid simulation tool to improve trauma education, explore possible replacements of commercial moulage products, and determine their merits and demerits. Methodology Readily available economic items were used to make low-cost moulage on the simulated patients to replicate trauma victims. A cross-sectional design used a pre-validated Modified Moulage Authenticity Rating Scale to collect data from 61 participants of Advanced Trauma Life Support and Advanced Trauma Care for Nurses courses to analyze the effectiveness and fidelity of moulage. Results In total, 54 (89%) participants scored the low-cost moulage to provide high fidelity effectively. The majority of respondents graded the authenticity of moulage as good. Overall, 46 (75%) participants felt moulage injuries were quite realistic. All agreed that the moulage-based simulation offered a good teaching-learning alternative to assess and manage trauma victims. Further, 45 (73%) participants felt they were in an actual clinical situation, and 58 (95%) stated it could help them in their clinical practice. Conclusions Indigenously prepared, low-cost moulage is a feasible and cost-effective means to enhance fidelity in simulation-based trauma education. It can also be a possible replacement for commercial moulage. Further research is needed to rigorously evaluate the effectiveness of indigenously prepared, cost-effective moulage in trauma education to enhance patient care outcomes. This technique can also be easily translated into other simulation-based medical education domains.

How to HEEAL: A Patient and Peer-Centric Simulation Curriculum for Medical Error Disclosure.

Introduction: Medical errors are an unfortunate certainty with emotional and psychological consequences for patients and health care providers. No standardized medical curriculum on how to disclose medical errors to patients or peers exists. The novel HEEAL (honesty/empathy/education/apology-awareness/lessen chance for future errors) curriculum addresses this gap in medical education through a multimodality workshop. Methods: This 6-hour, two-part curriculum incorporated didactic and standardized patient (SP) simulation education with rapid cycle deliberate practice (RCDP). The morning focused on provider-patient error disclosure; the afternoon applied the same principles to provider-provider (peer) discussion. Summative simulations with SPs evaluated learners' skill baseline and improvement. Formative simulations run by expert simulation educators used RCDP to provide real-time feedback and opportunities for adjustment. Medical knowledge was measured through pre- and postintervention multiple-choice questions. Learners' confidence and attitude towards medical errors disclosure were surveyed pre- and postintervention with assistance of the Barriers to Error Disclosure Assessment tool, revised with the addition of several questions related to provider-provider disclosure. Results: Fourteen medical students participated in this pilot curriculum. Statistical significance was demonstrated in medical knowledge (p = .01), peer-disclosure skills (p = .001), and confidence in medical error disclosure (p < .001). Although there was improvement in patient-disclosure skills, this did not reach statistical significance (p = .05). Discussion: This curriculum addresses the need for designated training in medical error disclosure. Learners gained knowledge, skills, and confidence in medical error disclosure. We recommend this curriculum for medical students preparing for transition to residency.

The Effect of a Repeated Standardized Patient-Based End-of-Life Care Training Program on Nursing Students' Knowledge, Attitudes, and Emotions Toward End-of-Life Patients.

BACKGROUND: Sufficient knowledge of end-of-life care, positive attitudes, and emotions regarding death and dying are essential criteria for showcasing favorable palliative care educational results to undergraduate nursing students. However, nursing students have negative attitudes toward end-of-life care and know little about it. AIM: This study aimed to examine the effect of a repeated standardized patient-based training program (intervention) on nursing students' knowledge, attitudes, and emotions about end-of-life patients. METHOD: This study adopted a pretest-posttest quasi-experimental research design. The sample consisted of 50 fourth-year nursing students divided into intervention (n = 25) and control (n = 25) groups. All participants attended the intervention. The intervention group attended the intervention twice, while the control group attended it only once. Data were collected using a personal information form, the Frommelt Attitudes Toward Care of the Dying Scale, the Positive and Negative Affect Schedule, and the End-of-Life Care Nursing Questionnaire. The data were analyzed using descriptive statistics, Pearson's Chi-square test, dependent groups t test, Pearson-Spearman, Mann-Whitney test, Wilcoxon test, and Friedman test. RESULTS: The intervention helped participants learn more about end-of-life care (χ2 = 27.167, P = .000; F = 42.725, P = .000) and develop more positive attitudes toward end-of-life patients (F = 13.279, P = .000; F = 6.934, P = .000). The intervention also helped participants develop communication skills. CONCLUSION: Universities should integrate repeated standardized patient-based into nursing curricula.

Dental students' perceptions of standardized patient experiences using Zoom: Dyadic factors.

PURPOSE: The COVID-19 pandemic required a rapid transition to online education, including simulations. The current study identified students' perceptions of communicating with standardized patients in a virtual setting. METHODS: This qualitative study thematically analyzed 485 reflections submitted by 248 students between Spring 2020 and Spring 2022. Statements describing both the virtual medium and dyadic interactions between students and patients were coded for emergent themes and also coded as positive (facilitative) or negative (critical). RESULTS: Four themes emerged from the data related to the virtual medium: impact on nonverbal communication, patient engagement/rapport, presentation aids, and listening. Within these broad themes, 13 subthemes were identified, nine of which were negative/critical. Technology problems were specifically identified as compromising both engagement and listening. Even when technology worked well, students noted that it reduced the number of message cues received from the patient and complicated the process of sending cues (e.g., by requiring students to look away from a patient's face to make "eye contact" through a camera). CONCLUSIONS: Overall, students were critical of Zoom's impact on dyadic factors with standardized patients. However, they did acknowledge some positive aspects regarding the technology. These findings provide a foundation to consider when teaching students how to communicate effectively via teledentistry.

Medical Error Disclosure: An Entrustable Professional Activity During an Objective Standardized Clinical Examination for Clerkship Students.

Introduction: Most health care providers will be involved in a medical error during their careers. It is critical that future physicians receive formal training on error disclosure. Methods: We designed a formative skills-based objective standardized clinical exam (OSCE) for fourth-year medical students to assess competence in disclosing an error during a required entrustable professional activity. Faculty observed the encounter and completed a checklist evaluating students' performance in communication skills and content knowledge. Students received immediate formative feedback. They then participated in a facilitated case-based experience, discussed the critical elements of disclosure, utilized role-play to reinforce skills, and reflected on self-care practices. Finally, students completed a survey evaluating their perception of the OSCE's impact on their disclosure knowledge, skills, and attitudes. Results: Ninety-two students participated in the OSCE. Of those, 67 (73%) completed a retrospective pre/post survey assessing their disclosure knowledge, skills, and attitudes. Forty-one (62%) did not identify the error. Students who identified the error (26, 39%) were more likely to use the two-patient identifier than students who did not identify the error, χ2(1) = 13.3, p < .001. Self-reported comfort and confidence in disclosure improved, as did self-care practices (ps ≤ .005). Discussion: Students agreed that health care providers should disclose an error and know how to do so. Student self-reported comfort in disclosure and knowledge of how to disclose and how to report an error all improved following the OSCE and structured debrief. The OSCE and case-based experience can be adapted for implementation in curricula about error disclosure.

Standardized patients' experiences of portraying characters in difficult communication scenarios: Narrative inquiry.

BACKGROUND: There are limited studies that explored the preparation and challenges faced by standardized patients (SPs) in portraying characters in difficult communication scenarios, and the strategies used to overcome these challenges. The purpose of this study was to understand the experience of SPs in interpreting difficult communication situations and the learning needs of performing similar scenarios. And it allows the researchers to explore the meaning, beliefs, values, and aspiration associated with their role as SPs. The findings could shade light on the significance of their experiences and provide valuable insights for the development of future SP training programs. METHODS: The design of this study is framed by a narrative inquiry, using semi-structured guidelines to conduct in-depth interviews with 11 SPs who have participated in the performances of difficult communication situations. Research data were analyzed by Polkinghorne narrative analysis, and Riessman's four criteria were used to establish rigor. RESULTS: Analysis revealed the following five themes: scenarios to real life connections, process of preparing for a performance, methods to detach from character, obtaining unexpected rewards, and needs for performance training. There are two to three subthemes that are subsumed under each theme. CONCLUSIONS: To strengthen training in difficult communication for healthcare professionals, the use of SPs to interpret challenging difficult communication scenarios will continue to increase. Educators need to ensure that SPs are fully prepared physically and emotionally before, during and after their performance. Offering of continuing education and training in feedback techniques are crucial to extend the tenure of SPs, reduce their frustration, prevent attrition, and ultimately, reduce training costs. In the future, SP training should also include detachment and feedback techniques to alleviate SPs' stress.

Evaluating the Impact of an Adolescent Sexuality Education Workshop on Medical Student Communication in an Objective Structured Clinical Examination.

PURPOSE: Gaps still exist in medical education about the sexual health needs of sexual diverse populations, and little is known about how translatable current learning modules are to patient encounters. Efforts at an academic medical institution have been made to address this need, including a two-hour adolescent sexuality workshop during the Core Clerkship in Pediatrics. This workshop's efficacy was evaluated in an objective structured clinical examination (OSCE) given to rising fourth-year medical students, where the standardized patient case focused on an adolescent cisgender male with dysuria and in a new, same-sex relationship. METHODS: Performance of students who completed the workshop prior to the OSCE (n = 48) were compared to those of students who did not participate in the workshop prior to the OSCE (n = 17). The encounters were recorded and transcribed, and the deidentified transcripts were scored on a rubric focusing on five domains: sexual identity disclosure, behavioral assessment, psychosocial history, counseling and anticipatory guidance, and relationship building. RESULTS: Student's t-test comparison of the scores found significantly higher scores for the psychosocial history domain (p = .04), particularly concerning disclosure of a new boyfriend and recent sexual activity (p = .008), for students who had the workshop before the OSCE. DISCUSSION: Students who took the adolescent sexuality workshop performed better in gathering psychosocial information in an OSCE encounter a sexual minority adolescent. These results affirm prior work that active learning on sexual diverse health in medical school curricula may prepare students for effective engagement with adolescents exploring their sexuality.