Construction and validation of an interprofessional simulated scenario for the identification and management of sepsis.

OBJECTIVE: Build and validate a realistic interprofessional simulation scenario for the identification and management of sepsis by doctors and nurses. METHOD: Methodological study developed in 2021, in two stages: construction of the guide and content validation by expert judges; and development of the simulation and validation of the scenario by doctors and nurses. 15 specialists participated in the research in the first stage and eight care professionals in the second stage. 0.8 was adopted as a parameter for the Content Validation Index (CVI). RESULTS: The scenario guide addressed nosocomial sepsis with an abdominal focus in an adult patient and its validation obtained a total CVI of 0.97. All areas evaluated in the simulation scenario obtained agreement indices greater than 0.8. CONCLUSION: The construction and validation of the guide allowed the elaboration of guiding material for the development of an interprofessional simulated scenario, whose execution and validation process demonstrated its suitability in approaching the identification and management of sepsis by doctors and nurses. It is recommended to carry out future research evaluating its applicability to other situational contexts.

Analysis of virtual standardized patients for assessing clinical fundamental skills of medical students: a prospective study.

BACKGROUND: History-taking is an essential clinical competency for qualified doctors. The limitations of the standardized patient (SP) in taking history can be addressed by the virtual standardized patient (VSP). This paper investigates the accuracy of virtual standardized patient simulators and evaluates the applicability of the improved system's accuracy for diagnostic teaching support and performance assessment. METHODS: Data from the application of VSP to medical residents and students were gathered for this prospective study. In a human-machine collaboration mode, students completed exams involving taking SP histories while VSP provided real-time scoring. Every participant had VSP and SP scores. Lastly, using the voice and text records as a guide, the technicians will adjust the system's intention recognition accuracy and speech recognition accuracy. RESULTS: The research revealed significant differences in scoring across several iterations of VSP and SP (p < 0.001). Across various clinical cases, there were differences in application accuracy for different versions of VSP (p < 0.001). Among training groups, the diarrhea case showed significant differences in speech recognition accuracy (Z = -2.719, p = 0.007) and intent recognition accuracy (Z = -2.406, p = 0.016). Scoring and intent recognition accuracy improved significantly after system upgrades. CONCLUSION: VSP has a comprehensive and detailed scoring system and demonstrates good scoring accuracy, which can be a valuable tool for history-taking training.

Mitigating Misinformation Toolkit: Addressing COVID-19 Misinformation Through Interprofessional Learning and Collaboration Using a Standardized Patient-Based Educational Module.

Introduction: Medical mis- and disinformation are on the rise and impact patient health outcomes. The complexity of modern medicine and health care delivery necessitates that care be delivered by an interprofessional team of providers well versed in addressing this increased prevalence of medical misinformation. Health professions educational curricula often lack opportunities for students to learn how to address medical misinformation, employ advanced communication techniques, and work collaboratively. Methods: Based on literature and our previous qualitative research, we created a module offering prework learning on COVID-19 and addressing misinformation through advanced communication techniques and interprofessional collaboration. After completing prework, students participated in a standardized patient encounter addressing COVID misinformation. Health professions student dyads completed a preencounter planning huddle and together interviewed a standardized patient. Students received global and checklist-based feedback from standardized patients and completed pre- and postsession self-assessments. Results: Twenty students participated (10 third-year medical, nine third-year pharmacy, one fourth-year pharmacy). Key findings included the following: Nine of 15 survey questions demonstrated statistically significant improvement, including all three questions assessing readiness to have difficult conversations and six of 10 questions assessing interprofessional collaboration and team function. Discussion: Students participating in this novel curriculum advanced their readiness to address medical misinformation, including COVID-19 vaccine disinformation, with patients and coworkers to improve health decision-making and patient care. These curricular methods can be customized for use with a range of health professions learners.

Life-Threatening Clinical Simulations for Nursing Students: Promoting Critical Thinking and Satisfaction.

BACKGROUND: Integrating life-threatening clinical simulations improves learning outcomes. This study assessed nursing students' critical thinking factors before and after simulation, evaluated nursing clinical reasoning ability and learning satisfaction at two time points, and explored relationships and predictions among critical thinking, clinical reasoning, and satisfaction before and after simulation. METHOD: Surveys and focus groups were used for this mixed-methods study. RESULTS: Quantitative findings revealed increased critical thinking scores for curiosity, skepticism, and systematicity; clinical reasoning; and satisfaction after simulation. Qualitative results supported these improvements and indicated enhanced curiosity for clinical knowledge and iterative phases of clinical reasoning. Students expressed satisfaction with the simulations. Objectivity significantly influenced clinical reasoning and satisfaction in nursing students following life-threatening simulations. CONCLUSION: Fostering a culture of critical thinking in life-threatening simulations is crucial. Educators must teach the importance of objectivity in clinical practice, encourage critical evaluation, and foster self-reflection in simulations. [J Nurs Educ. 2024;63(9):595-603.].

Difficult Conversations: A Collaborative Interprofessional Simulation for Social Work, Athletic Training and Physician Assistant Programs.

Students graduating from professional healthcare programs are expected to demonstrate competence in their area of study to enter the workforce and immediately start working with people. High expectations and a fast-paced environment are typical aspects of these professional positions and often result in higher rates of burnout, compassion fatigue, and lack of empathy, leading to an overall decrease in patient satisfaction. As a result, patients who face difficult situations may often feel as though their needs are not being addressed. The purpose of this study was to examine the effectiveness of a shared educational module and simulated patient encounters on improving student confidence and competence engaging in difficult conversations with patients regarding intimate partner violence, substance abuse, and suicidal ideation. Students in the social work (n=14), athletic training (n=7), and physician assistant degree programs (n=20) participated in a collective learning module focusing on patient-centered care (PCC) skills required for having difficult conversations with patients. After students completed the shared learning module and prior to the simulated experience, students were given the Inter-professional Teams in Difficult Conversations Self-Assessment survey, a self-assessment tool measuring level of competence in engaging in difficult conversations. Students were then assigned to one of three rooms at random and varied in topic from intimate partner violence, substance abuse, or suicidal ideation. After the simulation, students completed the Inter-professional Teams in Difficult Conversations Self-Assessment survey again. Standardized patients (SP) also completed the Patient-Professional Interaction Questionnaire (PPIQ) immediately after the simulated experience. As hypothesized, students self-reported very high confidence in their ability to engage in difficult conversations using PCC, but SPs reported feeling little empathy or understanding of their situation from the students. Findings from this research demonstrate the disconnect in transfer of knowledge from understanding what PCC skills are to implementing them during difficult conversations.

Stillbirth Simulation for Nursing and Midwifery.

Collaboration is necessary to design and execute a nursing simulation that meets undergraduate and graduate competency expectations for communication, effective relationships, and stillbirth care. This simulation plan aligns with the ten international healthcare simulation standards published by the International Nursing Association for Clinical Simulation and Learning (INACSL). Course faculty work with simulation faculty, staff, and volunteer actors to plan and implement a consistent experience for pre-licensure and or graduate nursing students to develop critical clinical skills and attitudes across spheres of care while caring for parents experiencing pregnancy loss.

Oncologists' communication about tobacco and alcohol use during treatment for esophagogastric cancer: a qualitative observational study of simulated consultations.

PURPOSE: Tobacco and alcohol use influence cancer risk as well as treatment outcomes, specifically for esophageal and gastric cancer patients. Therefore, it is an important topic to discuss during consultations. This study aims to uncover medical, radiation, and surgical oncologists' communication about substance use, i.e., tobacco and alcohol use, in simulated consultations about curative and palliative esophagogastric cancer treatment. METHODS: Secondary analyses were performed on n = 40 standardized patient assessments (SPAs) collected in three Dutch clinical studies. Simulated patients with esophagogastric cancer were instructed to ask about smoking or alcohol use during treatment. The responses of the 40 medical, radiation, and surgical oncologists were transcribed verbatim, and thematic analysis was performed in MAXQDA. RESULTS: Oncologists consistently advocated smoking cessation during curative treatment. There was more variation in their recommendations and arguments in the palliative compared to the curative setting and when addressing alcohol use instead of smoking. Overall, oncologists were less stringent regarding behavior change in the palliative than in the curative setting. Few oncologists actively inquired about the patient's perspective on the substance use behavior, the recommended substance use change, or the support offered. CONCLUSION: Clear guidelines for oncologists on when and how to provide unequivocal recommendations about substance use behavior change and support to patients are needed. Oncologists might benefit from education on how to engage in a conversation about smoking or alcohol.

Mitigating Misinformation Toolkit: Online Simulation and Standardized Patient Cases for Interprofessional Students to Address Vaccine Hesitancy and Misinformation.

Introduction: Medical misinformation, which contributes to vaccine hesitancy, poses challenges to health professionals. Health professions students, while capable of addressing and advocating for vaccination, may lack the confidence to engage with vaccine-hesitant individuals influenced by medical misinformation. Methods: An interprofessional in-person simulation activity (90 minutes) using standardized patients was developed and instituted for students in medicine, nursing, pharmacy, and public health programs. Student volunteers were recruited from classes approximately halfway through their respective degree programs (i.e., second or third year of a 4-year program). Online simulation was used as a method to prepare for in-person simulation. Impact on students was assessed primarily through a postprogram student self-assessment. Results: A total of 220 students participated in the program; 206 (94%) had paired data available to analyze. Following program participation, self-assessed abilities increased from pre to post, from 2.8 out of 5 (good) to 3.9 out of 5 (very good; p < .001). Ninety-eight percent of students felt that their ability to address medical misinformation was somewhat/much better after the activity, compared to before, and that their ability to address vaccine hesitancy was somewhat/much better. The overall program was rated highly, with mean scores for each program evaluation item >4 out of 5 (very good). Discussion: An interprofessional cohort of students demonstrated improvement in self-assessed skills to participate in a conversation with an individual with hesitancy to receive vaccines and/or beliefs informed by misinformation. Students felt that this program was relevant and important to their professional development.

Addressing Medication Administration Safety Through Simulation: A Quasi-Experimental Study Among Nursing Students.

Healthcare institutions are dedicated to minimizing medication errors and promoting their reporting. This study investigates the impact of simulation on nursing students' attitudes toward and intention to report medication errors. A quasi-experimental one-group pre-post-test study was conducted. Third-year nursing students (N = 63) participated in a scenario-based simulation for medication administration. Participants' errors were documented. Participants self-reported attitudes toward medication administration safety and intention to report errors. The most reported error was "contraindicated in disease" (61%). The simulation increased attitudes of preparedness by the training program received (p < 0.01) and belief in the patient's involvement in preventing errors (p < 0.01), and decreased the belief that professional incompetence reveals errors (p = 0.015). Intention to report errors was influenced by medication error training received (p = 0.045), confidence in error reporting (p < 0.001), and a sense of responsibility to disclose errors (p = 0.001). Simulation effectively shapes attitudes and intentions regarding medication error reporting. Improving nursing students' awareness, skills, and clinical judgment can foster a safety culture and potentially reduce patient harm. Future research should examine the long-term effects of simulation and its impact on reducing medication errors.

Quality and Accountability of ChatGPT in Health Care in Low- and Middle-Income Countries: Simulated Patient Study.

Using simulated patients to mimic 9 established noncommunicable and infectious diseases, we assessed ChatGPT's performance in treatment recommendations for common diseases in low- and middle-income countries. ChatGPT had a high level of accuracy in both correct diagnoses (20/27, 74%) and medication prescriptions (22/27, 82%) but a concerning level of unnecessary or harmful medications (23/27, 85%) even with correct diagnoses. ChatGPT performed better in managing noncommunicable diseases than infectious ones. These results highlight the need for cautious AI integration in health care systems to ensure quality and safety.

Simulation with a standardised patient to reduce stigma towards people with schizophrenia spectrum disorder among nursing students: A quasi-experimental study.

OBJECTIVES: This study examined the effectiveness of simulation with a standardised patient on the perception of stigma associated with schizophrenia among undergraduate nursing students. It also assessed the reliability of the AQ-27 questionnaire in this context. METHOD: A quasi-experimental study without a control group was conducted on a non-probabilistic sample. The simulation programme used a standardised patient portrayed by a nurse with mental health experience. RESULTS: After simulation, statistically significant stigma improvements were found in six out of nine dimensions; anger and help obtained larger effect sizes (r = 0.392 and 0,307, respectively). Regarding gender, the intragroup analysis revealed that simulation improved stigma among women in six dimensions and among men in four dimensions, with anger and fear showing the highest effect size (r = 0.414 and 0.446, respectively). Regarding previous contact with mental illness among the study participants, the intergroup analysis did not show differences. In the intragroup analysis, simulation improved fear only in the contact group (p = 0,040, r = 0.353). In contrast, simulation changed the response in six dimensions in the no-contact group, similar to the entire group. CONCLUSION: Simulation with a standardised patient is an effective teaching tool for reducing the stigmatisation of people with schizophrenia, thus reducing people's perception of internal causal attribution. It allows for experiencing situations that may be anticipated in clinical practice and reflectively addressing emerging aspects during simulation.

Assessment of the effectiveness of hospital external disaster functional drills on health care receivers' performance, using standardized patients and mass cards simulation: a pilot study from Saudi Arabia.

BACKGROUND: Given the increasing frequency of disasters globally, it is critical that healthcare systems are prepared for these mass casualty events. The Saudi health system's preparedness for mass casualty incidents needs to be more robust, potentially due to limited disaster drills and inadequate standardized patient (SP) simulation training. This study aims to (i) assess the performance of front-line hospital staff in Saudi Arabia through a functional drill and (ii) evaluate the drill's effectiveness using SP and MAC-SIM cards, providing detailed insights into its design and execution. METHODS: A functional drill was conducted at a government hospital in Riyadh, Saudi Arabia, on December 19, 2022, using a cross-sectional approach with two phases. 141 healthcare receivers served as subjects, while 23 volunteers acted as SPs. The scenario simulated a building collapse to assess the emergency department (ED) response, interdepartmental communication, and surge capacity. Data were collected through direct observation of healthcare practitioners' interactions with the SPs, analysis of SP data, and participant feedback. Quantitative data were analyzed descriptively, while qualitative data were examined for patterns and themes related to simulation performance and effectiveness. RESULTS: The hospital receivers' performances demonstrated accurate triage categories. The ED team assessed most patients (67%) in less than 5 min. For patients requiring definitive care, such as intensive care unit, 95% spent less than 2.5 h in the ED. Most patients (65%) required 'other treatments'. Communication was efficient in the triage zone and the yellow treatment area. Participants' feedback on using MAC-SIM cards during the simulation was overwhelmingly positive with 82.61% reporting that MAC-SIM use helped them respond better. Experienced SPs (paramedics) with prior disaster knowledge and experience outperformed inexperienced SPs (nurses) in the functional exercise. CONCLUSION: This groundbreaking study is the first in the Arabic Gulf region to use SPs with MAC-SIM cards in functional drills. The findings highlight the potential of simulation exercises to improve hospital team knowledge and performance when responding to disasters. Multiple evaluation techniques can effectively identify participant strengths and weaknesses, informing future disaster improvement plans. This information is a valuable resource for Arabic and middle-income countries where disaster medicine is still developing.

Enhancing Medical Interview Skills Through AI-Simulated Patient Interactions: Nonrandomized Controlled Trial.

BACKGROUND: Medical interviewing is a critical skill in clinical practice, yet opportunities for practical training are limited in Japanese medical schools, necessitating urgent measures. Given advancements in artificial intelligence (AI) technology, its application in the medical field is expanding. However, reports on its application in medical interviews in medical education are scarce. OBJECTIVE: This study aimed to investigate whether medical students' interview skills could be improved by engaging with AI-simulated patients using large language models, including the provision of feedback. METHODS: This nonrandomized controlled trial was conducted with fourth-year medical students in Japan. A simulation program using large language models was provided to 35 students in the intervention group in 2023, while 110 students from 2022 who did not participate in the intervention were selected as the control group. The primary outcome was the score on the Pre-Clinical Clerkship Objective Structured Clinical Examination (pre-CC OSCE), a national standardized clinical skills examination, in medical interviewing. Secondary outcomes included surveys such as the Simulation-Based Training Quality Assurance Tool (SBT-QA10), administered at the start and end of the study. RESULTS: The AI intervention group showed significantly higher scores on medical interviews than the control group (AI group vs control group: mean 28.1, SD 1.6 vs 27.1, SD 2.2; P=.01). There was a trend of inverse correlation between the SBT-QA10 and pre-CC OSCE scores (regression coefficient -2.0 to -2.1). No significant safety concerns were observed. CONCLUSIONS: Education through medical interviews using AI-simulated patients has demonstrated safety and a certain level of educational effectiveness. However, at present, the educational effects of this platform on nonverbal communication skills are limited, suggesting that it should be used as a supplementary tool to traditional simulation education.

Accuracy of a Commercial Large Language Model (ChatGPT) to Perform Disaster Triage of Simulated Patients Using the Simple Triage and Rapid Treatment (START) Protocol: Gage Repeatability and Reproducibility Study.

BACKGROUND: The release of ChatGPT (OpenAI) in November 2022 drastically reduced the barrier to using artificial intelligence by allowing a simple web-based text interface to a large language model (LLM). One use case where ChatGPT could be useful is in triaging patients at the site of a disaster using the Simple Triage and Rapid Treatment (START) protocol. However, LLMs experience several common errors including hallucinations (also called confabulations) and prompt dependency. OBJECTIVE: This study addresses the research problem: "Can ChatGPT adequately triage simulated disaster patients using the START protocol?" by measuring three outcomes: repeatability, reproducibility, and accuracy. METHODS: Nine prompts were developed by 5 disaster medicine physicians. A Python script queried ChatGPT Version 4 for each prompt combined with 391 validated simulated patient vignettes. Ten repetitions of each combination were performed for a total of 35,190 simulated triages. A reference standard START triage code for each simulated case was assigned by 2 disaster medicine specialists (JMF and MV), with a third specialist (LC) added if the first two did not agree. Results were evaluated using a gage repeatability and reproducibility study (gage R and R). Repeatability was defined as variation due to repeated use of the same prompt. Reproducibility was defined as variation due to the use of different prompts on the same patient vignette. Accuracy was defined as agreement with the reference standard. RESULTS: Although 35,102 (99.7%) queries returned a valid START score, there was considerable variability. Repeatability (use of the same prompt repeatedly) was 14% of the overall variation. Reproducibility (use of different prompts) was 4.1% of the overall variation. The accuracy of ChatGPT for START was 63.9% with a 32.9% overtriage rate and a 3.1% undertriage rate. Accuracy varied by prompt with a maximum of 71.8% and a minimum of 46.7%. CONCLUSIONS: This study indicates that ChatGPT version 4 is insufficient to triage simulated disaster patients via the START protocol. It demonstrated suboptimal repeatability and reproducibility. The overall accuracy of triage was only 63.9%. Health care professionals are advised to exercise caution while using commercial LLMs for vital medical determinations, given that these tools may commonly produce inaccurate data, colloquially referred to as hallucinations or confabulations. Artificial intelligence-guided tools should undergo rigorous statistical evaluation-using methods such as gage R and R-before implementation into clinical settings.

Impact of simulated patient-based communication training vs. real patient-based communication training on empathetic behaviour in undergraduate students - a prospective evaluation study.

BACKGROUND: Empathy is a key competency and is essential for doctor-patient relationships. Studies have proven a continuous reduction of empathy in medical students during their study period. The use of SPs is positively evaluated for competency acquisition and real patient communication training has positive effects on empathy empowerment. Therefore, the present study focusses on the impact of simulated patient (SP) vs real patient (RP) communication training on empathetic behaviour in undergraduate medical students. METHODS: The prospective evaluation took place during a 210-minute skills lab unit on medical communication for 3rd year medical students. Study participants were allocated in advance to one of three groups: one group trained with an SP (SP-group) and was informed about the fact that it was an SP; another group trained with an SP but assumed to encounter an RP (incognito patient group (IP-group)); the last group trained with an RP and was correctly informed about it (real patient group (RP-group). Self-assessed empathy was measured by using Jefferson Scale of Physician Empathy (JSPE) and Interpersonal Reactivity Index (IRI), as these are the most commonly used instruments for assessing empathy. Study participants were evaluated on empathetic behaviour by their group-associated patient using the Consultation and Relational Empathy (CARE) scale. RESULTS: 146 students participated. There was no significant difference in self-assessed empathy between groups for JSPE and IRI. External assessment via CARE showed a statistically significant difference between SP-group and IP-group , as well as between SP-group and RP-group. There was no significant difference between IP-group and RP-group. This means that students training with real patients (or who believed them to be real) did receive significantly lower performance ratings on their empathy. CONCLUSION: The results demonstrate a significant lower external empathy rating for students who had trained with a real patient or if they were in the belief of having encountered a real patient; this may be due to inhibitions and a lack of routine. Therefore, we recommend implementing SPs in the early study period with the gradual integration of RPs in the student's further course of study.

A Language Model-Powered Simulated Patient With Automated Feedback for History Taking: Prospective Study.

BACKGROUND: Although history taking is fundamental for diagnosing medical conditions, teaching and providing feedback on the skill can be challenging due to resource constraints. Virtual simulated patients and web-based chatbots have thus emerged as educational tools, with recent advancements in artificial intelligence (AI) such as large language models (LLMs) enhancing their realism and potential to provide feedback. OBJECTIVE: In our study, we aimed to evaluate the effectiveness of a Generative Pretrained Transformer (GPT) 4 model to provide structured feedback on medical students' performance in history taking with a simulated patient. METHODS: We conducted a prospective study involving medical students performing history taking with a GPT-powered chatbot. To that end, we designed a chatbot to simulate patients' responses and provide immediate feedback on the comprehensiveness of the students' history taking. Students' interactions with the chatbot were analyzed, and feedback from the chatbot was compared with feedback from a human rater. We measured interrater reliability and performed a descriptive analysis to assess the quality of feedback. RESULTS: Most of the study's participants were in their third year of medical school. A total of 1894 question-answer pairs from 106 conversations were included in our analysis. GPT-4's role-play and responses were medically plausible in more than 99% of cases. Interrater reliability between GPT-4 and the human rater showed "almost perfect" agreement (Cohen κ=0.832). Less agreement (κ<0.6) detected for 8 out of 45 feedback categories highlighted topics about which the model's assessments were overly specific or diverged from human judgement. CONCLUSIONS: The GPT model was effective in providing structured feedback on history-taking dialogs provided by medical students. Although we unraveled some limitations regarding the specificity of feedback for certain feedback categories, the overall high agreement with human raters suggests that LLMs can be a valuable tool for medical education. Our findings, thus, advocate the careful integration of AI-driven feedback mechanisms in medical training and highlight important aspects when LLMs are used in that context.

Shock Simulation Day: Medical Decision-Making and Communication Skills for Managing a Hypotensive Adult in a Rapid Response.

Introduction: Shock is a life-threatening condition amongst hospitalized patients and requires urgent management to avoid mortality. Early exposure is vital for educational and patient safety purposes. Methods: We developed a 90-minute shock day session that provided internal medicine interns with a cognitive framework for the initial diagnosis and management of shock, which they applied to two simulations. The first simulation involved a patient with septic shock, and the second involved a patient with cardiogenic shock. Critical action checklists were used to assess learners and guide structured debriefs after each simulation. Medical decision-making and communication frameworks were presented through a presession video and a chalk talk. The curriculum was evaluated using pre- and postintervention surveys to assess knowledge and confidence. Results: Forty-eight interns participated in the session in 2022 and 2023. We observed an increase in the percentage of learners correctly answering a knowledge-based question regarding the amount of fluid administered to a patient in septic shock (pre: 33%, post: 62%, p < .01), as well as increases in learner-reported confidence in leading a rapid response (pre: 9%, post: 62%) and in managing undifferentiated shock (pre: 13%, post: 56%), septic shock (pre: 20%, post: 83%), cardiogenic shock (pre: 2%, post: 54%), hemorrhagic shock (pre: 20%, post: 73%), and anaphylactic shock (pre: 22%, post: 54%, all ps < .01). Discussion: Employing a variety of pedagogical methods, we demonstrated that intern knowledge and confidence regarding the management of a hypotensive patient during a rapid response can be increased through participation in our curriculum.

Effects of a Standardized Patient-Based Delirium Care Education Program.

Background and Purpose: An education program to improve the delirium care competency of nurses is important as they play an integral role in caring for patients with delirium. This study aimed to examine the effects of a standardized patient (SP)-based delirium care education program on new graduate nurses' performance and self-confidence. Methods: A waitlist control group with a crossover design was adopted. The SP-based delirium care education program was designed, implemented, and evaluated. Generalized estimating equations were used to analyze differences in performance and self-confidence scores between the intervention and waitlist control groups. Results: The education program was found to significantly affect rater-assessed performance, SP-assessed performance, and self-confidence when controlled for gender and age. Implications for Practice: An SP-based delirium care education program improved new graduate nurses' performance and self-confidence in caring for patients with delirium. Nurse educators should provide experiential learning opportunities to ensure that recent nurse graduates have achieved optimal delirium care competency.

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.