Ready for take-off: Use of standardized patient encounters to determine readiness for clinical education 1
Purpose: Describe the use of simulation through standardized patient encounters to evaluate development of knowledge, skills, and professional behaviors in student physical therapists at two points in a DPT curriculum as a mechanism to determine readiness for clinical education experiences. 1Methods and/or Description of Project: Physical therapy education has commonly adopted the use of simulation as a means to engage in interprofessional educational activities often with an acute care focus. During these simulation activities, the student learner is focused on communication with other healthcare professionals and safe completion of specific skills/tasks in a simulated environment.1-6 These simulation activities tend to utilize technical mannequins to create artificial situations and are void of communication with the most important team member, the patient/client. Incorporation of standardized patient encounters (SPE) into entry-level preparation provides students and faculty opportunities to observe student’s readiness for clinic through knowledge, skills, and professional behaviors observed and demonstrated during the SPE.7 Standardized patients (SP) are trained to portray the roles of patients thus allowing student physical therapists to practice history taking, examination, intervention, communication, and professional behaviors. Medical education has utilized SPE through an Objective Structured Clinical Examination (OSCE) to ensure that medical students demonstrate competence in both technical and non-technical/behavioral skills.8 Use of SPE has been shown to be an effective means to evaluate knowledge, skills, and professional behaviors in a variety of healthcare education programs7,9-11; however, no evidence of this exists in the realm of physical therapy education. Although artificial in nature, the environment for a SPE best replicates the clinical setting for students as they independently engage in patient care tasks. Stress responses for participating in SPE are similar to those experienced by student physical therapists during clinical education experiences.12 Therefore, utilizing SPE as another method to gather data to evaluate student’s readiness for clinical education makes logical sense. In our entry-level program, we have incorporated two SPE into our professionalism series. Our SPE are not considered OSCEs as the learning activities are meant to provide opportunities to develop observational skills, practice comprehensive coursework, and increase confidence. Outcomes of the SPE include formal patient documentation assignments and information debriefing sessions with SPs, peers, and academic faculty. Student performance during SPE is triangulated between self-assessment, peer-evaluation, and feedback from trained community SPs. Information obtained through this triangulation process is used to identify potential deficits that could impact student success during full-time clinical education experiences. This data is combined with information obtained from professional behavior assessments and academic performance to ultimately determine each student’s readiness for clinic. Students identified with deficits remediate prior to the start of full-time clinical education experiences. 1 1Results/Outcomes: Quantitative data will be shared from the previous three years standardized patient experience with qualitative remarks from student debriefing sessions, focus groups, and SPs. Results from surveys of student learners will be presented. Three case studies will be presented with longitudinal data related to the success of the remediation process from “at-risk” behaviors identified during the SPE. 1Conclusions/Relevance to the conference theme: Our Leadership Landscape: Perspectives from the Ground Level to 30,000 Feet: Per accreditation guidelines, academic faculty are responsible for evaluating thresholds of knowledge, skills, and professional behaviors to determine that students are ready to engage in the clinical education aspects of the curriculum. Often, evaluation of professional behaviors is determined by observation in an academic classroom or laboratory setting. A novel approach to evaluating students’ readiness for clinic can be completed by utilizing standardized patient encounters to evaluate skills, knowledge, and professional behaviors. This unique approach allows for feedback on student’s professional behaviors from individuals within (peers and academic faculty) and beyond (trained community simulated patients) the academic PT program. Our previous ground-level approach to assessing the readiness of clinical education has been elevated by included the insight of the most valuable player in the healthcare encounter…the patient/client. 1References: 1. Pritchard SA, Blackstock FC, Nestel D, Keating JL. Simulated patients in physical therapy education: systematic review and meta-analysis. Phys Ther. 2016;96(9):1342–53. 2. Shoemaker MJ, Beasley J, Cooper M, Perkins R, Smith J, Swank C. A method for providing high-volume interprofessional simulation encounters in physical and occupational therapy education programs. J Allied Health. 2001;40(1):15–21. 3. Shoemaker MJ, Riemersma L, Perkins R. Use of high fidelity human simulation to teach physical therapist decision-making skills for the intensive care setting. Cardiopulm Phys Ther J. 2009;20(1):13–8. 4. Blackstock FC, et al. Simulation can contribute a part of cardiorespiratory physiotherapy clinical education: two randomized trials. Sim Healthc. 2013;8(1):32–42. 5. Smith N, Prybylo S, Conner-Kerr T. Using simulation and patient role play to teach electrocardiographic rhythms to physical therapy students. Cardiopulm Phys Ther J. 2012;23(1):36–42. 6. Silberman NJ, Litwin B, Panzarella K, Fernandez-Fernandez A. Student clinical performance in acute care enhanced through simulation training. J Acute Care Phys Ther. 2016;7(1):25–36. 7. Riley S, Kumar N. Teaching medical professionalism. Clin Med (Lond). 2012;12(1):9-11 8. Yudkowsky R, Alseidi A, Cintron J. Beyond fulfilling the core competencies: an objective structured clinical examination to assess communication and interpersonal skills in a surgical residency. Curr Surg. 2004;61(5):499-503. 9. Multak N. Development and assessment of professionalism in physician assistant education using technology. J Physician Assist Educ 2017;28(1):59–61 10. Fernandez GL, Lee PC, Page DW, D’Amour EM, Wait RB, Seymour NE. Implementation of full patient simulation training in surgical residency. J Surg Educ. 2010;67(6):393-399. 11. Levine IA, Swartz HM. Standardized patients: the “other” simulation. J Crit Care. 2008;23(2):179-184. 12. Judd BK, Alison JA, Waters D, Gordon CJ. Comparison of psychophysiological stress in physiotherapy students undertaking simulation and hospital-based clinical education. Sim Healthcare. 2016;11:271-277. 1Course Objectives: 1. Discuss the prevalence and impact of simulation on academic preparation 2. Compare benefits and barriers to incorporating SPE 3. Describe how the SPE has been used as part of the determination of readiness for clinical education; including learning outcomes, participant outcomes, community partner outcomes, case studies, and process evaluation. 4. Discuss learning outcomes, focus group and survey data, and evaluate student performance after remediation resulting from identified “at-risk” behaviors during SPE. 5. Identify and utilize resources to incorporate simulations in your academic, clinical, and/or community setting. 1 1 1Instructional Methods: Lecture, Case studies, Videos, Discussions, Questions/Answer 1Tentative Outline/Schedule: 5 minutes – Welcome, introductions, and session overview. 10 minutes – Background of SPE in healthcare educational programs 20 minutes – The evolution and process implementation of simulation training within our PT program 20 minutes – Outcomes of focus groups, debriefing sessions, and survey results from SPEs 20 minutes – Case studies 5 minutes – Resources available to assist others interested in developing similar programs. 10 minutes – Conclusion; Q/A 1