A different approach to teaching pre-clerkship students physical diagnosis: standardized patient instructor-senior medical student teaching teams.

BACKGROUND: Faculty have traditionally taught the physical examination (PE) to novice medical students (pre-clerkship students.), despite recruiting and cost issues and problems standardizing their approach. ACTIVITY: We present a model using standardized patient instructor (SPI)-fourth year medical student (MS4) teams to teach PE to pre-clerkship students, leveraging the benefits of co-teaching and peer-assisted learning. RESULTS: Surveys of pre-clerkship students, MS4s and SPIs indicate positive perceptions of the program, including MS4s reporting significant growth in their professional identities as educators. Pre-clerkship students' performance on the spring clinical skills exams was equivalent to or better than their peer performance pre-program implementation. IMPLICATIONS: SPI-MS4 teams can effectively teach novice students the mechanics and clinical context of the beginners' physical exam.

How Do Standardized Patients Form Their Complex Identities? The Impact of Interactions With Medical Students.

INTRODUCTION: Little is known about the nature of standardized patient (SP) identity and its formation. Understanding identity and formation can have important implications for recruiting, working with, and retaining SPs. Social relational theory explains how identity is formed in a social context in relationship with others. In keeping with social relational theory, this study explored SP identity formation through the SP experience with one of the most important elements of their social context-medical students. METHODS: Using qualitative methods, we conducted four 1-hour semistructured focus group interviews with SPs (N = 18). Interviews were audio recorded and transcribed verbatim. We used a constant comparative approach and consensus development to analyze the data and identify codes, categories, and ultimately themes. We used multiple methods to ensure credibility and trustworthiness of the study, as well as transparency of methods and thick rich descriptions to enable readers to judge transferability of the findings and conclusions. RESULTS: We identified 4 major themes. Through their interactions, SPs experienced: (1) identity transformation toward a new professional identity; (2) self-actualization toward their maximum potential; (3) judgmental reactions to medical student behaviors; and (4) simulation-reality interaction between their simulated and real selves. CONCLUSIONS: Through their interactions with medical students, SPs experienced a transformation into a complex identity composed of multiple roles. Within this identity, they found purpose, fulfillment, and self-actualization through fostering students', as well as their own, personal, and professional growth and through developing a higher sense of social responsibility. Within this identity, they also encountered the challenges of navigating between judging and supporting medical students, and toggling between their real and simulated selves. Guided by the SPs' perspectives, and in conjunction with professional organizational standards, we provide recommendations for training, recruitment, and retention of SPs.

The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP).

In this paper, we define the Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP) for those working with human role players who interact with learners in a wide range of experiential learning and assessment contexts. These human role players are variously described by such terms as standardized/simulated patients or simulated participants (SP or SPs). ASPE is a global organization whose mission is to share advances in SP-based pedagogy, assessment, research, and scholarship as well as support the professional development of its members. The SOBP are intended to be used in conjunction with the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice: SimulationSM, which address broader simulation practices. We begin by providing a rationale for the creation of the ASPE SOBP, noting that with the increasing use of simulation in healthcare training, it is incumbent on ASPE to establish SOBP that ensure the growth, integrity, and safe application of SP-based educational endeavors. We then describe the three and a half year process through which these standards were developed by a consensus of international experts in the field. Key terms used throughout the document are defined. Five underlying values inform the SOBP: safety, quality, professionalism, accountability, and collaboration. Finally, we describe five domains of best practice: safe work environment; case development; SP training for role portrayal, feedback, and completion of assessment instruments; program management; and professional development. Each domain is divided into principles with accompanying key practices that provide clear and practical guidelines for achieving desired outcomes and creating simulations that are safe for all stakeholders. Failure to follow the ASPE SOBP could compromise the safety of participants and the effectiveness of a simulation session. Care has been taken to make these guidelines precise yet flexible enough to address the diversity of varying contexts of SP practice. As a living document, these SOBP will be reviewed and modified periodically under the direction of the ASPE Standards of Practice Committee as SP methodology grows and adapts to evolving simulation practices.

Evaluating oral case presentations using a checklist: how do senior student-evaluators compare with faculty?

PURPOSE: Previous studies have shown student-evaluators to be reliable assessors of some clinical skills, but this model has not been studied for oral case presentations (OCPs). The purpose of this study was to examine the validity of student-evaluators in assessing OCP by comparing them with faculty. METHOD: In 2010, the authors developed a dichotomous checklist. They trained 30 fourth-year medical students (student-evaluators) to use it to assess 170 second-year medical students' OCPs in real time during a year-end objective structured clinical examination. Ten faculty physicians then scored videos of a random sample of these OCPs. After discarding items with poor faculty reliability, the authors assessed agreement between faculty and student-evaluators on 18 individual items, total scores, and pass/fail decisions. RESULTS: The total score correlation between student-evaluators and faculty was 0.84 (P < .001) and was somewhat better than the faculty-faculty intraclass correlation (r = 0.71). Using a 70% pass/fail cutoff, faculty and student-evaluator agreement was 74% (Kappa = 0.46; 95% CI, 0.20-0.72). Overall, student-evaluator scores were more lenient than faculty scores (72% versus 56% pass rates; P = .03). CONCLUSIONS: Senior student-evaluators were able to reliably assess second-year medical students' OCP skills. The results support the use of student-evaluators for peer assessment of OCPs in low-stakes settings, but evidence of leniency compared with faculty assessment suggests caution in using student-evaluators in high-stakes settings. Extending peer assessment to OCPs provides a practical approach for low-resource evaluation of this essential skill.