Weight bias reduction intervention among nurse practitioner students using simulation-based experiences.

ABSTRACT: Few nurse practitioner (NP) programs include obesity and weight bias education in their curriculum. However, NPs will likely provide care for people living with obesity, many of whom have been discriminated against based on their weight by previous providers, and many NP students may feel unprepared to navigate weight management competently. This pilot study included a weight bias reduction (WBR) intervention, which included a simulation-based experience (SBE) with a standardized participant (SP) and educational activities embedded within the NP curriculum. Nineteen NP students participated in this pilot study, but only seven students had matching data for preintervention to postintervention scores. There were no statistically significant differences in preintervention and postintervention Attitudes Toward Obese Persons (ATOP) or Beliefs About Obese Persons (BAOP) scores. Despite this small sample size and not achieving statistical significance, SBE-SP holds promise to depict realistic patient encounters to improve NPs' attitudes and beliefs toward persons with obesity and to reduce weight bias. Therefore, incorporating SBE-SP may be a feasible component of the NP curriculum.

Enhancement of the assessment of physician-patient communication skills in the United States Medical Licensing Examination.

The National Board of Medical Examiners (NBME) reviewed all components of the United States Medical Licensing Examination as part of a strategic planning activity. One recommendation generated from the review called for enhancements of the communication skills component of the Step 2 Clinical Skills (Step 2 CS) examination. To address this recommendation, the NBME created a multidisciplinary team that comprised experts in communication content, communication measurement, and implementation of standardized patient (SP)-based examinations. From 2007 through 2012, the team reviewed literature in physician-patient communication, examined performance characteristics of the Step 2 CS exam, observed case development and quality assurance processes, interviewed SPs and their trainers, and reviewed video recordings of examinee-SP interactions. The authors describe perspectives gained by their team from the review process and outline the resulting enhancements to the Step 2 CS exam, some of which were rolled out in June 2012.

The impact of statistical adjustment on conditional standard errors of measurement in the assessment of physician communication skills.

The use of standardized patients to assess communication skills is now an essential part of assessing a physician's readiness for practice. To improve the reliability of communication scores, it has become increasingly common in recent years to use statistical models to adjust ratings provided by standardized patients. This study employed ordinary least squares regression to adjust ratings, and then used generalizability theory to evaluate the impact of these adjustments on score reliability and the overall standard error of measurement. In addition, conditional standard errors of measurement were computed for both observed and adjusted scores to determine whether the improvements in measurement precision were uniform across the score distribution. Results indicated that measurement was generally less precise for communication ratings toward the lower end of the score distribution; and the improvement in measurement precision afforded by statistical modeling varied slightly across the score distribution such that the most improvement occurred in the upper-middle range of the score scale. Possible reasons for these patterns in measurement precision are discussed, as are the limitations of the statistical models used for adjusting performance ratings.

Quality assurance best practices for simulation-based examinations.

Whether used for formative or summative evaluation, health professions schools, residency programs, continuing medical education programs, and specialty boards using simulation-based assessment must consider quality assurance methods to ensure reliable results. This article addresses the content, training, and administrative protocols that are necessary for findings based on valid, reliable, and fair assessments.

The role of standardized patient and trainer training in quality assurance for a high-stakes clinical skills examination.

For over 30 years, medical educators have used standardized patients (SPs), laypersons trained to portray a patient case in a realistic manner, to teach and to assess clinical skills. All medical schools in the US have SP programs in place, and the US and Canada require national examinations using SPs to assess the competency of those wishing to obtain licensure to practice medicine in these countries. To ensure a valid and reliable examination, unwanted variance that can be introduced by SP performance must be addressed. The goal of SP training is to imbue the SP with the characteristics, mannerisms and history of a real patient so that the portrayal is consistent and accurate. The challenge is to ensure consistent portrayal of each case with sufficient realism to elicit the expected clinical performance and to ensure standardized SP performance across multiple examinees. This paper considers the quality assurance methods applied to training the SP trainers and the protocols used to train the SPs, to ensure that the SP performances are sufficiently accurate and standardized, and that the evaluators completing the checklists and scales used for scoring do so correctly and consistently.

Medical student identification of domestic violence as measured on an objective, standardized clinical examination.

OBJECTIVE: This study examined the incidence and predictors of domestic violence screening by third-year medical students at an end of clerkship Objective Standardized Clinical Examination. STUDY DESIGN: Two hundred and seventy-five third-year medical students completed an 8-station end of clerkship Objective Standardized Clinical Examination as part of this retrospective observational study, one with nonspecific abdominal pain and possible domestic violence. Checklists on history, physical, communication, and interpersonal skills were collected. Domestic violence screening was analyzed by logistic regression and analysis of variance. RESULTS: The incidence of domestic violence screening by history alone was 34% before the physical. Interpersonal scores on the overall exam and domestic violence station, but not gender or rotation sequence, predicted domestic violence questioning. CONCLUSION: In this standardized patient study there was a low rate of domestic violence screening by history.

Construct validity of an objective structured clinical examination (OSCE) in psychiatry: associations with the clinical skills examination and other indicators.

OBJECTIVE: The construct validity of checklist and global process scores for an objective structured clinical examination (OSCE) in psychiatry was assessed. Multiple regression analysis was used to predict psychiatry OSCE scores from the clinical skills examination, an obstetrics/gynecology (OB/GYN) OSCE, and the National Board of Medical Examiners (NBME) psychiatry subject examination. METHODS: Archival data from two successive classes of third-year medical students (1999-2000, N=142; 2000-2001, N=144) were aggregated and analyzed. RESULTS: The pattern and magnitude of convergence and discrimination were indicative of adequate construct validity for both the psychiatry checklist scores and the global process score. Clinical skills examination scores for history taking, interpersonal skills, and physical examination were related to psychiatry OSCE scores that reflected the same skill set. Construct validity was fairly higher for the global process rating. CONCLUSION: Evidence of construct validity of a psychiatry OSCE was obtained from multiple measures of performance, including the clinical skills examination. Findings lend support to the continued use of checklist and global process evaluations as part of OSCEs in psychiatry.