ASPE News

Compiled by Angela Blood

Below are two award winning abstracts, for the categories of Research and Innovations, from 2011. We have included them for you to review should you be considering submitting an abstract to ASPE’s 2012 conference in San Diego, but have questions about formatting, message, or style. Good luck!

First Place- Research

Use of Standardized Patients and Objective Structured Clinical Examinations in US Pharmacy Programs

Deborah A. Sturpe, University of Maryland School of Pharmacy

Introduction: Increase in use of standardized patients (SPs) in US pharmacy education is growing as evidenced by steady increases in research related to SPs and objective structured clinical examinations (OSCEs) presented at national academic pharmacy meetings.As this growth continues, it is important to assess if pharmacy programs are designing OSCEs in a way that maintains examination reliability and validity and to identify barriers to successful implementation. The objective of this study was to describe current OSCE practices in doctor of pharmacy programs in the United States.

Project Description: Structured interviews were conducted with pharmacy faculty between September 2008 and May 2010. Information about awareness of and interest in OSCE, current OSCE practices, barriers to OSCE, and non-OSCE use of SPs was collected. For the purpose of this study, an OSCE was defined as a multiple station assessment.

Outcomes: All US pharmacy programs were contacted, and interviews were completed by telephone with 88 pharmacy programs that agreed to participate (equivalent to 81.5% of all accredited programs at the time the study was started). Thirty-two pharmacy programs reported incorporating OSCE into the curriculum. Practices within these programs varied, and only 11 of the programs consistently administered examinations of 3 or more stations, required all students to complete the same scenario(s), and had processes in place to ensure consistency of standardized patients’ role portrayal. Of those 32 programs, only 20 hired professional SPs for their OSCE activities. Of the 55 programs not using OSCEs, approximately half were interested in using the technique, and 12 hired professional SPs for non-OSCE teaching and assessment activities. Common barriers to OSCE implementation or expansion were cost, concern over faculty workloads, and lack of access to an SP program.

Conclusions/Discussion: There is wide interest in using SP encounters for teaching and assessment within pharmacy education, particularly as part of an OSCE. However, few colleges and schools of pharmacy conduct OSCEs in an optimal manner, and most do not adhere to best practices in OSCE construction and administration. ASPE can play an important role in assisting pharmacy programs to grow and develop SP and OSCE based initiatives.

References:

1. Meeting abstracts. 107^th Annual Meeting of the American Association of Colleges of Pharmacy, San Diego, California, July 9-12, 2006. Am J Pharm Educ. 2006;70(3):Article 65.

2. Meeting abstracts. 108^th Annual Meeting of the American Association of Colleges of Pharmacy, Orlando, Florida, July 14-17, 2007. Am J Pharm Educ. 2007;71(3):Article 60.

3. Meeting abstracts. 109^th Annual Meeting of the American Association of Colleges of Pharmacy, Chicago, Illinois, July 19-23, 2008. Am J Pharm Educ. 2008;72(3):Article 72.

4. Meeting abstracts. 110^th Annual Meeting of the American Association of Colleges of Pharmacy, Boston, Massachusetts, July 18-22, 2009. Am J Pharm Educ. 2009;73(4):Article 57.

Second Place- Research

The Impact of Improvised Responses on the Ability To Portray and Observe

Elizabeth T Newlin-Canzone,¹ Mark W Scerbo,¹ Gayle Gliva-McConvey,² Amelia M Wallace,² Lorraine Lyman². ¹Department of Psychology, Old Dominion University, ²Theresa Thomas, Professional Skills Teaching & Assessment Center, ¹  Eastern Virginia Medical School.² 

Introduction:

Standardized patients (SPs) perform a demanding job because they must simultaneously portray a character and assess the learner. SPs often improvise case-relevant responses when learners ask unanticipated questions. Research on working memory (Baddeley, 1990) and attention (Wickens, 1984) indicates that people have limited attentional resources to divide among concurrent tasks. The goal of this study was to determine how improvisations affect the ability to observe another’s nonverbal (NV) behaviors. It was hypothesized that participants would observe fewer NV behaviors when actively engaged in improvisational interviews as compared to rehearsed/rote interviews or while passively watching interviews.

Methods:

Thirty-six Old Dominion University (ODU) undergraduates participated in simulated job interviews. There were two types of interviews: one with improvisational responses and another with rehearsed/rote responses. There were also two types of observation: participants were actively engaged in one set of interviews and passively watched another set.

Results:

The proportion of NV behaviors correctly identified was analyzed with a 2 x 2 repeated measures ANOVA. Participants identified fewer NV behaviors during improvisational interviews (M = .32, SD = .01) compared to rote interviews (M = .39, SD = .02), F(1, 35) = 26.96, p < .001. Also, participants identified fewer NV behaviors when they occurred during active observations (M = .27, SD = .02) as compared to passive observations (M = .45, SD = .02), F(1, 35) = 79.12, p < .001.

Conclusions:

Participants had difficulty observing the interviewer’s NV behaviors during improvisational interviews, when they simultaneously performed portrayal and assessment activities. This suggests that SPs may have difficulty dividing their attention between portrayal and observing activities, particularly when improvising. Research is currently underway at Eastern Virginia Medical School (EVMS) and ODU to understand how improvisations affect the abilities of SPs to portray and assess under similar active and passive conditions.

Reference List:

Baddeley, A. D. (1990). Human memory: Theory and practice. London: Erlbaum.

Wickens, C. D. (1984). Processing resources in attention. In R. Parasuraman & D. R. Davies (Eds.), Varieties of attention (pp. 63-102). Orlando FL: Academic Press.

First Place- Innovations

End of Life Simulation of Therapeutic Communication and Care Using Standard Patients and SimMan®

Kelly Tomaszewski, Carol Robinson, RuthAnn Brintnall, KCON, Simulation Center, Grand Valley State University.

Introduction:

Clinical simulation of end-of-life (EOL) scenarios can give students the opportunity to learn the vital concepts of EOL care in a safe environment. Rarely does the student have the privilege of caring for someone who is actively dying. Using AACN and ELNEC competencies and course outcomes as a guide, simulations can provide the student insights into elements of care that seem to provide the most emotional distress for students: emotional support to patients who are dying (and their families), physical care, and postmortem care. At Grand Valley State University, we have conducted a simulation of therapeutic communication for EOL discussion with standard patients, and simulation of an actively dying patient, using one standard patient (family member) and SimMan®.

Project Description:

The simulations were part of an elective EOL class, consisting of various undergraduate majors. A doctorate of nursing (DNP) student taped an interview of a model patient couple processing the recent bad news of a terminal diagnosis. The video was shown to the class, followed by a live interaction of the students with the model patients as they discussed which communication techniques were helpful. Three weeks later, the patient (now SimMan) was readmitted to our simulation lab with our model patient wife, and students were invited to participate in the care of the patient and his family while he died. Students originally were reticent to volunteer to participate in the death simulation. The DNP proceeded with the simulation, then offered to perform the simulation again with any student volunteers. Two undergraduate nursing students volunteered at that point. During the debriefing, barriers to participating in the simulation, given the safe environment, were discussed. Feedback included discomfort with caring for the dying without more experience. Pre and Post Simulation questions were asked, based on the National League for Nursing tools for student satisfaction, educational practices and simulation design.

Outcomes:

The results from the Pre/Post questions demonstrated a strong satisfaction with the simulation and the need for further experience in this area.

Conclusions/Discussion:

This simulation underscored the need for further education for undergraduate nurses in palliation and EOL care.

Reference List:

Leighton, K. & Dubas, J. (2009). Simulated death: An innovative approach to teaching end of life care. Clinical Simulation in Nursing, 5(6), e223-e230.

Schlairet, M.C. (2009). End of life nursing care: Statewide survey of nurses’ education needs and effects of education. Journal of Professional Nursing, 25 (3), 170-177.

Smith-Stoner, M. (2009). Using high-fidelity simulation to educate nursing students about end of life care. Nursing Education Perspectives, 30(2), 115-120.

Sperlazza, E. (2009). The power of pretend: Using simulation to teach end of life care. Nurse Educator, 34(6), 276-280.

Thompson, G.T. (2005). Effects of end of life education on baccalaureate nursing students. AORN Journal, 82(3), 434-440.

Second Place- Innovations

One Patient, Four Clerkships: An Integrated, Multi-Disciplinary Approach

Mary Donovan, MA, MFA; Marguerite Duane, MD; Rebecca Evangelista, MD; Maria Marquez, MD; Michele Wylen, M.D.; Shyrl Sistrunk, MD.

Introduction:

Most clerkships use Standardized Patients (SPs) in discrete, clerkship-specific exercises to assess their core clinical competencies.  While this may be efficient for each discipline, it can leave students with “tunnel vision” rather than a holistic approach to clinical practice.

Providing a separate event by clerkship can be costly in compensation, time and space.  Longitudinal clinical experience provides variable patient exposure, which may result in defined knowledge gaps, which offers challenges in educating generalist physicians-in-training.

Question: Does an integrated approach to clinical cases academically enhance clinical experience and continuity of care, and decrease educational costs?

Project description:

 Simulation of continuity clinic for third-year students with a two-case sequential scenario, representing synergy among:  General Surgery / Obstetrics-Gynecology / Family Medicine / Pediatrics.

The OSCE requires skills from all above specialties.  The first office visit involves a 17-year-old female with stomach pain; students should recognize an acute abdomen and generate an appropriate differential (Surgery and OB-Gyn).  “Six weeks later” the same teenager returns for a sports physical.  New doorway information directs students to perform an adolescent risk assessment and counseling (Pediatrics and Family Medicine). The final post-encounter is a self-assessment tool mirroring the SP checklist.  Our 200 students participate over ten days after completing the first quarter of core clerkships

Outcomes:

This approach provides a meaningful experience for students to synthesize multi-disciplinary skills and knowledge, in addition to an opportunity to self-evaluate and self-reflect. The Office of Medical Education gains valuable feedback about both individuals’ skills and overall program evaluation.  SPs appreciate that the same student may demonstrate variable interpersonal skills based on the acuity of presentation.  Costs are minimal compared with those we would incur using separate SPs in specialty events, case development and space allocation.*

Conclusions/discussion:

 If efficient evaluation of an integrated approach to clinical care is a school competency, such a longitudinal SP project across clerkships provides a valuable multi-disciplinary educational experience.

*Table 1 – More for Less

One integrated clerkship exercise vs. four specialty clerkship exercises

Posted on October 24, 2011 at 5:02 pm in Member News   |  RSS feed