Standardized Patients

Context: Researchers have reported that interacting with standardized patients (SPs) is a worthwhile and realistic experience for athletic training (AT) students. These encounters enhance students' interviewing skills, confidence as a clinician, clinical skill development, and interpersonal communication.

Objective: To determine how SP encounters impacted students' confidence in performing clinical evaluations.

Design: Pretest-posttest survey design.

Setting: Athletic training simulation lab.

Patients or Other Participants: Thirty-five students from the junior (n = 20) and senior (n = 15) AT cohorts from a public liberal arts institution in the Southeast.

Intervention(s): Athletic training students completed 2 SP encounters per semester throughout an academic year in the AT program, totaling 4 SP encounters.

Main Outcome Measure(s): Each student completed a 17-item Likert scale (1 = strongly disagree, 5 = strongly agree) that rated confidence levels immediately before and after each SP encounter. The confidence rating assessed students' confidence regarding how the SP encounter affected their confidence in completing patient evaluations (eg, identifying history questions, interpreting results of special tests). We computed descriptive statistics for all items Wilcoxon signed rank tests determined differences in pre-encounter and should be postencounter confidence ratings.

Results: Overall, students from both cohorts reported that the SP encounter improved confidence in completing clinical evaluations. Specifically, students reported a significant increase from pre-encounter to postencounter confidence ratings after nutrition-based (Z = −2.991, P = .004), knee (Z = −3.261, P = 0.001), concussion (Z = −3.294, P = .001), psychosocial intervention (Z = −3.062, P = .002), and general medical (Z = −3.524, P > .001) SP encounters.

Conclusions: The authenticity and fidelity of the SP encounter provided the AT students a real-time clinical evaluation in a nonthreatening environment. Students reported that their confidence improved after each encounter. By providing these experiences, AT students can become comfortable interacting with patients in clinical evaluations.

This article examines the clinical staging of simulations using actors to perform as standardized patients (SPs) in a nursing simulation laboratory. Detailed multimodal analysis of video-recordings of SP training shows how the perceiving body of standardized patient is transformed as a map that systematizes, organizes, and classifies novices’ knowledge into a unified system of clinical practice. I develop a “gesture-touch clusters" framework to illustrate how embodied practices are mobilized as a systematic activity to provide scaffolding for the performance of standard nursing interventions. By calling attention to mapping the use of clinical practice onto the live body of the standardized patient this article considers standards as residing in the bodily and interactive practices, not in their discursive articulations in clinical scripts, protocols, and checklists.

Birey ve toplum ruh sağlığı ile ilgili alanlardan biri olan ruh sağlığı ve psikiyatri hemşireliği, XVIII. ve XIX. Yüzyıllardan günümüze gelene dek (Rungapadiachy, Madill ve Gough, 2004) çok gelişmiştir. Bilimsel ve teknolojik gelişmelerin hız kazanmasına bağlı olarak (Tuğrul ve Denat, 2019) ruh sağlığı ve psikiyatri hemşireliği kuramsal ve pratik eğitiminin nasıl olması gerektiği konusunda çeşitli fikirler ortaya atılmıştır. Bu fikirlerden en önemlisi, klinik uygulama stajı olan diğer birçok hemşirelik dersi öncesinde olduğu gibi ruh sağlığı ve psikiyatri hemşireliği dersi klinik uygulama stajı öncesinde de öğrencilerin hasta bireyler ile bir araya gelmeden deneyim edinebilecekleri ve temelde standart hasta uygulamasına dayanan simülasyon eğitim teknikleriyle eğitim görmeleri şeklindeki sistemi savunur (Bradley, 2006; Schoening, Sittner ve Todd, 2006). Bu makalede söz konusu eğitim teknikleri, ruh sağlığı ve psikiyatri hemşireliğinin Türkiye’deki eğitim ve uygulama aşamaları dikkate alınarak değerlendirilmiştir.
Anahtar kelimeler: hemşirelik, psikiyatri hemşireliği, ruh sağlığı, simülasyon teknikleri, standart hasta uygulaması

This article reports on the quality of care delivered by private and public providers of primary health care services in rural and urban India. To measure quality, the study used standardized patients recruited from the local community and trained to present consistent cases of illness to providers. We found low overall levels of medical training among health care providers; in rural Madhya Pradesh, for example, 67 percent of health care providers who were sampled reported no medical qualifications at all. What’s more, we found only small differences between trained and untrained doctors in such areas as adherence to clinical checklists. Correct diagnoses were rare, incorrect treatments were widely prescribed, and adherence to clinical checklists was higher in private than in public clinics. Our results suggest an urgent need to measure the quality of health care services systematically and to improve the quality of medical education and continuing education programs, among other policy changes.

The design of facilities that deliver cancer care profoundly affects patients, families, clinicians, administrators , and other stakeholders. These facilities are expensive to build and, once built, exist for decades. Their design is constrained not just by physical space but also by the often competing demands of operational efficiency, safety, and finances. Despite extraordinary focus on patient safety, preventable adverse events and other patient harms persist. 1,2 Shortcomings in facility design contribute to these lingering challenges. 3 Facility design endeavors often violate the cardinal principle of system coproduction, whereby users actively participate in the design process. Without that participation , trust and the delivery of safe, value-driven care are undermined. 4 Indeed, financial considerations often are prioritized over patients' and staffs' needs, even though each is critical to achieve optimal results. This choice can cause, for example, an overemphasis on maximizing space, resulting in mazes of small rooms and in the missed opportunity to orient waiting areas and other common spaces toward exterior views of nature that can have a calming effect on facility occupants. The research team believes that a well-designed cancer center can prioritize the patient and family's experience while still achieving operational excellence. This argument is rooted in evidence-based principles of design, 5 and the team offers context-sensitive suggestions for improvement and implementation. The aim is to guide oncology clinicians, health care leaders, and facility experts as they work with designers of cancer centers to align their efforts with emerging care trends that can benefit all stakeholders. Just as the evidence base matters when diagnosing, treating, and caring for patients with cancer, it also is crucial to the design of cancer care facilities. Design professionals, facility managers, and health care leaders can consult an extensive literature on evidence-based design of health care facilities, 5-9 registry data on quality and safety, and stakeholder knowledge to inform optimal facility design. Rigorous evidence on how physical, social, and symbolic environments affect care must be 897406A JMXXX10.1177/1062860619897406American Journal of Medical QualityBerry et al research-article2020 Abstract The nuts and bolts of planning and designing cancer care facilities-the physical space, the social systems, the clinical and nonclinical workflows, and all of the patient-facing services-directly influence the quality of clinical care and the overall patient experience. Cancer facilities should be conceived and constructed on the basis of evidence-based design thinking and implementation, complemented by input from key stakeholders such as patients, families, and clinicians. Specifically, facilities should be designed to improve the patient experience, offer options for urgent care, maximize infection control, support and streamline the work of multidisciplinary teams, integrate research and teaching, incorporate palliative care, and look beyond mere diagnosis and treatment to patient wellness-all tailored to each cancer center's patient population and logistical and financial constraints. From conception to completion to iterative reevaluation, motivated institutions can learn to make their own facilities reflect the excellence in cancer care that they aim to deliver to patients.

Study Objective: To evaluate the incidence of perioperative minor adverse events and to analyze patient satisfaction based on potential explanatory variables.

Design: Structured, face-to-face interview of 25% of all patients undergoing surgery during the period from January 2003 through June 2006. Setting: Academic university medical center. Patients: 12,276 patients (5,793 men and 6,483 women) from all surgical disciplines: 7,440 patients had general anesthesia, 4,236 patients had regional anesthesia, and 600 patients had a combined general-regional anesthetic technique.

Measurements: Occurrence of perioperative minor adverse events was assessed during the interview. Patient satisfaction was measured with a 4-point Likert scale. Main Results: 3,652 (30%) patients reported at least one perioperative complaint and 737 (6%) patients reported multiple minor adverse events. Overall, a total of 4,475 minor adverse events were reported. Leading adverse events included postoperative nausea and vomiting (1,705 complaints), sore throat (1,228 complaints), and hoarseness (802 complaints). Patient satisfaction with anesthetic care was generally high (97% satisfied or highly satisfied). Patients were significantly more satisfied following regional than general anesthesia (P < 0.001). Patient dissatisfaction was also associated with the occurrence of at least one minor adverse event (P < 0.001) or with increasing ASA physical status (P < 0.001).

Conclusionw: Minor events occur with a surprisingly high incidence and are significantly associated with patient dissatisfaction. Regional anesthesia is associated with fewer patient complaints and significantly higher postoperative patient satisfaction.

The aim of our study was to present the structure, process and results of the objective structured video exam and One-Station standardized patient exam that have been used to assess second year medical students’ communication skills.Scores of 1137 students between the years 2007 and 2010 were analyzed. Means and standard deviations were calculated for scores and ratings. Internal consistency was assessed using Cronbach's alpha coefficient. To analyze reliability and generalizability, multivariate generalizability theory was employed.Students’ total and item scores on the objective structured video exam (60.5–68.8) were lower than on the One-Station standardized patient exam (90.4–96.6). Internal consistencies of both exams were moderate. Generalizability analysis and D-study results showed that both the objective structured video exam and the One-Station standardized patient exam need improvement.Both exams need measures to improve them, such as increasing the number of video cases or stations, and further standardization of raters.This study might encourage medical teachers to consider assessing validity and reliability of written and performance exams on the basis of generalizability theory, and to find out feasible actions to improve assessment procedures by conducting a D-study.

Introduction
As a response to the anti-malarial drug resistance situation, the
World Health Organisation (WHO) recommends that treatment
policies for falciparum malaria  in all countries experiencing
resistance to monotherapies should be combination therapies,
preferably those containing an arteminisin derivative (ACT-artemisinin-based combination therapy).
Methodology
A retrospective quantitative study was designed to examine case
records of patients treated for malaria in a tertiary health hospital
in Jos, Northern part of Nigeria between August and December
2012. Questionaires were also distributed to doctors working
within the hospital environment. Data on demographic, clinical
features of disease, diagnostic procedures and drug administration
were collected from the patients' records.
Results
Case record files of 130 patients were selected, 80.7% of the
patients were prescribed antimalarial drugs. 55.2% of patients
admitted for malaria were males, 44.8% were between 21-50 years
of age. Fever (35.2%) was the most common presenting symptom,
71.4% of the patients had diagnostic blood slides. Antimalarial
drugs were prescribed for malaria and malaria associated with
other disease conditions, artemisinin and lumefantrine was the
most prescribed antimalarial agent. 44.0% of these drugs were
prescribed by trade names, 29.0% were administered orally. The
most antimalarial drug prescribed for prevention of malaria in
pregnant women was sulfadoxine-pyrimethamine, all the
practitioners followed current WHO guidelines  , half of the
clinicians would prescribe parenteral antimalarial drugs for severe
and cerebral malaria, laboratory and clinical assessment were used
for malaria diagnosis, 71.4% of the physicians adhered to hospital
guidelines.
Conclusion
This study indicates the implementation of artemisinin
combination therapy in a public health facility; however the
success of this new treatment policy would depend on patient
adherence to recommendations and provision of ACTs at
subsidized costs in Nigeria.

The aim of the present study was to investigate the Quality of Life of patients suffering from IBD and the factors that might be affecting it.
The idiopathic Inflammatory Bowel Diseases (IBD) are chronic nosological entities negatively affecting the Quality Of Life of patients suffering
from IBD in relation to the total population. Evaluating their Quality of Life is the basic constitution for evaluating their needs and for designing
the suitable health care system to be provided. In the province of Larnaca the SIBDQ questionnaire translated in the Greek language was used
to evaluate 100 patients suffering from Ulcerative Colitis and Crohn’s disease. We studied the Quality of Life as a dependent variable correlated
with the independent variables that are the demographic and general characteristics of this patient group.

Background: An undergraduate nursing health assessment course provided three experiential modalities for practicing health assessment skills: high-fidelity human simulators (HFS), standardized patients (SP) and community volunteers (CV). Previous research has examined the impact of each distinct modality on learning outcomes. However, few studies have compared these learning strategies. This study investigates learners' satisfaction, self-efficacy and performance behaviors among three learning approaches. Method: Forty-four undergraduate nursing students were randomly assigned to perform focused respiratory assessments on a HFS, SP or CV. Participants completed the Health Assessment Educational Modality Evaluation (HAEME) survey to assess self-efficacy and modality satisfaction. A performance checklist evaluated assessment skills. Results: Performance behaviors were significantly greater with HFS, but learners were significantly less satisfied with this modality. Significant differences in students' self-efficacy were not found across the three modalities. Conclusions: Significantly lower satisfaction with HFS may reflect learners' perceived lack of realism. However, HFS may provide a low-stress opportunity for novice learners to practice skills. Results support the integration of distinct experiential learning modalities in an undergraduate nursing health assessment course. Crown

Introduction
As a response to the anti-malarial drug resistance situation, the
World Health Organisation (WHO) recommends that treatment
policies for falciparum malaria in all countries experiencing
resistance to monotherapies should be combination therapies,
preferably those containing an arteminisin derivative (ACTartemisinin-
based combination therapy).
Methodology
A retrospective quantitative study was designed to examine case
records of patients treated for malaria in a tertiary health hospital
in Jos, Northern part of Nigeria between August and December
2012. Questionaires were also distributed to doctors working
within the hospital environment. Data on demographic, clinical
features of disease, diagnostic procedures and drug administration
were collected from the patients' records.
Results
Case record files of 130 patients were selected, 80.7% of the
patients were prescribed antimalarial drugs. 55.2% of patients
admitted for malaria were males, 44.8% were between 21-50 years
of age. Fever (35.2%) was the most common presenting symptom,
71.4% of the patients had diagnostic blood slides. Antimalarial
drugs were prescribed for malaria and malaria associated with
other disease conditions, artemisinin and lumefantrine was the
most prescribed antimalarial agent. 44.0% of these drugs were
prescribed by trade names, 29.0% were administered orally. The
most antimalarial drug prescribed for prevention of malaria in
pregnant women was sulfadoxine-pyrimethamine, all the
practitioners followed current WHO guidelines , half of the
clinicians would prescribe parenteral antimalarial drugs for severe
and cerebral malaria, laboratory and clinical assessment were used
for malaria diagnosis, 71.4% of the physicians adhered to hospital
guidelines.
Conclusion
This study indicates the implementation of artemisinin
combination therapy in a public health facility; however the
success of this new treatment policy would depend on patient
adherence to recommendations and provision of ACTs at
subsidized costs in Nigeria.

How did I learn to understand that there can never ever be any acceptable alternative to immortality and living indefinitely forever young?

Is there any better way to learn and permanently remember the understanding that any possibly imaginable alternative to reverse all adverse effects of aging and happily live indefinitely forever young, healthy and energetic would have the same long-term negative consequences as intentionally committing suicide than I have described in this authentic experience report?

When I was only 6 years old, I went through an emotional trauma, from which I am still suffering today and that has led me to come here and be the only one working in the EIT building during Christmas break. On October 2nd, 1980, only one day before my daddy’s birthday, my aunt Frieda, who I liked a lot because she paid lots of attention to my long stories and actually took them serious, suffered from a sudden heart attack. My daddy succeeded to bring her back to life with CPR and my mom called the emergency doctor in the mean time. The doctor was a quiet man from Romania. He had short back hear and looked like being around 30 years old. His voice was very quiet and emotionally detached when he asked my grandma about the age of my aunt. My grandma replied: "She is 83 years old." And then something happened, which I never expected, i.e. the doctor went on in his empathy-lacking quiet voice to say the few German words, which I still remember as if my aunt had died yesterday. He said “Ich denke, wir hoeren auf.” In English this means, “I think, we are going to quit.” He meant going to quit any efforts and even medical interventions at our disposal to bring my aunt Frieda back to live and to make sure she’ll stay alive. When the doctor said this, it was spooky quiet, as if a ghost would kill my aunt. I felt like screaming into the face of the doctor, YOU MUST DO YOUR JOB AS EMERGENCY DOCTOR, TO DO EVERYTHING IN YOUR POWER TO MINIMIZE MY AUNT’S RISK TO DIE FROM THIS PARTIAL HEART ATTACK REGARDLESS OF HER AGE!!!! But I was only six. I was scared and confused. It was my first real encounter with death. I helplessly looked at my parents and looked at my grandma. I wanted them to demand from the doctor not to use my aunt Frieda’s advanced age against her. Although I was only six years old I strongly felt that no medical provider has the moral right and should be punished harshly when using his patient’s age as a shallow absolutely unjustified excuse for refusing to save their lives. But it was so quiet this time, which I recall must have been around 7.30 p.m. on October the 2nd, 1980, when my aunt laid diagonally across the carpet on the floor of the children’s room. Neither my mom nor my daddy nor my grandma nor my 2 younger siblings opened their mouth.

Although I was furious beyond anyone’s imagination, the fact that my otherwise very confident parents and even my grandma, who was best friends with my dying aunt, i.e. all three adults in the room, who’d I expect to fight for my life if I ever needed urgent medical care, and who’d otherwise readily expressed their opposition to anything they did not agree with or considered unfair, did not even attempt to pressure the doctor on a mental, emotional emphatic, moral, medical or legal level, to take his job seriously regardless how he personally felt about my aunt’s advanced age. When something totally unexpected like this happens, i.e. in case of such kind of second degree murder due to medical neglect and intentionally withholding readily available medical interventions without any apparent rational reason for not even trying to save my aunts life, when we still had a chance, I became speechless. I felt like screaming to my parents to not allow the doctor to let my aunt die, after my daddy had brought her back to life already. My daddy is very good in CPR. He’ll fight for everyone’s life as if it was his own. My daddy waited for the doctor’s instructions on how to proceed after restoring my aunts consciousness to the point where she had her eyes opened and could hear every single word, which was spoken by anyone in the children’s room. When all this happened I stood about 4 feet away from my aunt. I was afraid to move any closer because I was worried of accidentally bump into something I could not see but which would kill here. Now something happened that I can never forget. My daddy got up from the carpet and stopped CPR! I felt like screaming “NOOOOOOOOOOOOO!!!!!!!!!” “WHYYYYYYYYYY???” “DON’T!!!!!!” “KEEP BREATHING MORE AIR IN HER MOUTH!!!!! Don’t listen to this evil doctor. He has no respect for life! He does not deserve to be an emergency doctor!!! What if she were his aunt???? She is conscious and will most likely fully come back to life if you’ll just give her enough time to get over this medical crisis!!!! Actually, she was already over the hump because apparently her heart was beeping already independently and all my daddy was still doing, was breathing air in my aunt’s mouth. I wanted my mom to call another doctor. I wanted him to be a German doctor, who treats our aunt as if she was his aunt. I felt that this Rumanian doctor had no empathy for Germans because when my entire family looked up to him for help, he indirectly killed by neglect.

Even if is negative medical intuition should turn out to be true and all of our medical interventions were doomed to fail this evening, I felt he should at least try anyways or else there would have been no point in the doctor making the trip to our home. Then he could have stayed in his killer-hospital. At least that way he would not have had the opportunity to encourage my daddy from reviving my aunt with CPR. When I was six, my daddy was still very powerful. He would have kept performing CPR for hours to save my aunt’s life, if this disguised killer-doctor, would not have instructed him to stop and let her die, just because he felt no old people deserve resources intensive medical care, unless they are his own relatives. Would he let his aunt or grandmother dies like that if he had good chances to prevent or at least postpone death? This I felt would have certainly give my aunt enough time to get over the fear, which is an inherent feature of anyone surviving a heart attack, especially when the doctor is instructing my daddy to stop keeping her alive. I felt like being in a madhouse. I could not speak. My otherwise very attentive parents and grandmother did not seem to be aware that I felt so much emotional pain with such a mental intensity that I almost felt as if I was the one dying instead of my aunt. This god dam Rumanian doctor! Why did he have to be on duty when my aunt needed dedicated professional medical help to get over her heart attack? Why did the hospital not send a German doctor with a strong voice, who’d be much more assertive in his speech and actions to instruct my parents to do everything in their power to save my aunt’s life? Why did my aunt deserve such an indecisive foreign doctor, who lacks the kind of strong loud confidence inducing voice, patients and their relatives need in their struggle of succeeding in overcoming any medical crisis? Why did this stupid hospital send us this absolutely useless and even counterproductive foreign physician, who refused to even say a single word when my parents and grandma looked up to him and expected rational life-saving medical advice? What was he thinking when he condemned my aunt with the only very ambiguous sentence, I still remember verbatim from this cursed Rumanian doctor, “I think we are going to quit.”? Was he asking my parents, whether they’d approve his proposal to quit saving my aunt’s life? Did he order my daddy to quit CPR and let my aunt die? This doctor showed lack of leadership when everyone is expecting him to take charge of the medical crisis at hand and to maximize the odds for the best possible medical outcome.

I remember not being able to feel anything that evening. My aunt laid dead diagonally across the carpet in the children’s room when I started to understand that everyone expects me to go to sleep as usual. I hid under my blanket and wanted to die. I cried so hard. What if I had a heart attack? Would my parents and grandma follow the medical advice of the doctor, if he told them that he thinks, we should quit saving my life? Luckily, I only was 6 and no doctor would even dream about using my age as an excuse for letting me die. But, what about 80 years from now? From then onward, I wanted to become strong, innovative, energetic and knowledge to defeat death before it would inevitably kill me only about 80 years later. That is why I came to America.

Transgender people report high rates of discrimination and substandard care in many health care settings. This is attributed to a lack of provider training about, experience with, and knowledge of the needs of transgender patients. To address this, we developed a simulation experience for primary care residents to interact with transgender patients and learn to address their unique health needs.

IntroductionDetermining whether antibiotic prescriptions are inappropriate requires knowledge of patients’ underlying conditions. In low-income and middle-income countries (LMICs), where misdiagnoses are frequent, this is challenging. Additionally, such details are often unavailable for prescription audits. Recent studies using standardised patients (SPs) offer a unique opportunity to generate unbiased prevalence estimates of antibiotic overuse, as the research design involves patients with predefined conditions.MethodsSecondary analyses of data from nine SP studies were performed to estimate the proportion of SP–provider interactions resulting in inappropriate antibiotic prescribing across primary care settings in three LMICs (China, India and Kenya). In all studies, SPs portrayed conditions for which antibiotics are unnecessary (watery diarrhoea, presumptive tuberculosis (TB), angina and asthma). We conducted descriptive analyses reporting overall prevalence of antibiotic overpres...

BackgroundAntimicrobial resistance is a global health emergency, and one of the contributing factors is overuse and misuse of antibiotics. India is one of the world’s largest consumers of antibiotics, and inappropriate use is potentially widespread. This study aimed to use standardised patients (SPs) to measure over-the-counter antibiotic dispensing in one region.MethodsThree adults from the local community in Udupi, India, were recruited and trained as SPs. Three conditions, in both adults and children, were considered: diarrhoea, upper respiratory tract infection and acute fever. Adult SPs were used as proxies for the paediatric cases.ResultsA total of 1522 SP interactions were successfully completed from 279 pharmacies. The proportion of SP interactions resulting in the provision of an antibiotic was 4.34% (95% CI 3.04% to 6.08%) for adult SPs and 2.89% (95% CI 1.8% to 4.4%) for child SPs. In the model, referral to another provider was associated with an OR 0.38 (95% CI 0.18 to 0...

At most institutions, medical students learn communication skills through the use of standardized patients (SPs), but SPs are time and resource expensive. Virtual patients (VPs) may offer several advantages over SPs, but little data exist regarding the use of VPs in teaching communication skills. Therefore, we report our initial efforts to create an interactive virtual clinical scenario of a patient with acute abdominal pain to teach medical students history-taking and communication skills. In the virtual scenario, a life-sized VP is projected on the wall of an examination room. Before the virtual encounter, the student reviews patient information on a handheld tablet personal computer, and they are directed to take a history and develop a differential diagnosis. The virtual system includes 2 networked personal computers (PCs), 1 data projector, 2 USB2 Web cameras to track the user&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s head and hand movement, a tablet PC, and a microphone. The VP is programmed with specific answers and gestures in response to questions asked by students. The VP responses to student questions were developed by reviewing videotapes of…

Context: Providing students reliable objective feedback regarding their clinical performance is of great value for ongoing clinical skill assessment. Since a standardized patient (SP) is trained to consistently portray the case, students can be assessed and receive immediate feedback within the same clinical encounter; however, no research, to our knowledge, has documented the reliability of the SP at assessing student performance.

Objective: To determine if SPs provide a reliable assessment of athletic training students’ performance in obtaining a patient history and completing a physical examination relative to athletic training faculty.

Design: Reliability study.

Setting: Athletic training simulation lab.

Patients or Other Participants: Two SPs and 2 athletic training faculty assessed 35 students (n ¼ 20 junior; n ¼ 15 senior) in athletic training cohorts from a public liberal arts institution in southeast United States.

Intervention(s): Athletic training students completed 2 SP encounters per semester throughout 1 academic year in the athletic training program, totaling 4 SP encounters.

Main Outcome Measure(s): After each SP encounter, athletic training faculty and SPs completed the same clinical performance checklist developed specifically for each encounter. The checklist included yes/no items related to obtaining a patient history (10–12 items each) and completing a physical examination (12–15 items each). For each SP encounter, composite scores were computed for both history and physical examination items from the athletic training faculty and SPs. Intraclass correlation coefficients (ICC) determined interrater reliability between athletic training faculty and SPs for history and physical exam items.

Results: Reliability coefficients between the SP and athletic training faculty indicated fair to strong agreement for most history and physical examination items. Significance was found for history items in the cervical spine emergency (ICC ¼ 0.671, P ¼ .002), knee (ICC ¼ 0.696, P ¼ .003), low back (ICC ¼ 0.622, P ¼ .002), concussion (ICC ¼ 0.764, P ¼ .004), general medical (ICC ¼ 0.571, P ¼ .008), and psychosocial intervention (ICC ¼ 0.572, P ¼ .008) encounters. The reliability coefficients were significant regarding physical exam items for the cervical spine emergency (ICC ¼ 0.588, P ¼ .01), low back (ICC¼0.766, P . .001), concussion (ICC¼0.792, P¼.001), and general medical (ICC¼0.878, P . .001) encounters.

Conclusions: Overall, the SPs provided a reliable assessment of the athletic training students’ clinical performance for obtaining a patient history and completing a physicalexamination. Given these results, devoting additional time during SP training should increase the reliability of the SP.

Nutrition education is not an integral part of either undergraduate or postgraduate medical education. Computer-based instruction on nutrition might be an attractive and appropriate tool to fill this gap. The study objective was to assess the degree to which computer-based instruction on nutrition improves factual knowledge and practice behavior of general practitioner (GP) trainees. We carried out a controlled experimental study, using a 79-item knowledge test and 3 incognito standardized patients&#39; visits in a pre- and posttest design with 49 first-year GP trainees. The experimental group (n = 25) received an average of 6 h of a newly developed computer-based instruction on nutrition. The control subjects (n = 24) took the standard vocational training program. The percentage of correct answers on the knowledge test increased from 30% at pretest to 42% at posttest in the experimental group, and from 36% to 37% in the control group. Analysis of covariance, with the pretest scores...

TR
Amaç: Ankara Üniversitesi Tıp Fakültesi Dönem-3 öğrencilerine yönelik olarak geliștirilen ve 2004’den beri
sürdürülmekte olan “Uygulamalı Aydınlatılmıș Onam Alma Becerisi (UAOAB)” eğitim programı yıllar içinde
özellikle 2012 yılı sonrasında olmak üzere bazı yapısal değișikliklere uğramıștır. Bu çalıșma, öğrencilerin
program hakkındaki düșüncelerinin, bu değișikliklere paralel olarak zaman içinde farklılık gösterip göstermediğini
ortaya koymak amacıyla tasarlanmıștır.
Gereç ve Yöntem: 2010-14 yılları arasında UAOAB eğitimi kapsamında gerçekleștirilen uygulama oturumlarına
katılan öğrencilerden, ilgili eğitim çalıșmasına ilișkin bir değerlendirme anketi doldurmaları istenmiștir.
Elde edilen veriler istatistiksel olarak analiz edilmiș ve ulașılan bulgular yorumlanmıștır.
Bulgular: Öğrencilerin büyük bölümü “aydınlatılmıș onam” konusunu mesleki yașamları açısından önemli
bulmakta ancak konu ile ilgili bilgi ve becerilerinin yeterli olmadığını düșünmektedir. Öğrenciler, genel
olarak UAOAB eğitiminden memnundurlar (ort. %81,3). Programın mesleki sorumluluk kazandırma ve iletișim
becerilerinin öğretilmesi açısından etkili olduğunu düșünen öğrencilerin oranı 2012-14 yılları arasında
önceki yıllara göre anlamlı olarak daha fazladır.
Sonuç: Öğrenciler, “aydınlatılmıș onam” ve ilgili konular hakkında bilgi ve beceri kazanmaya gereksinim
duymaktadırlar. Öğrencilerin UAOAB eğitim programı hakkındaki olumlu kanılara sahip olması, programın
geliștirilerek sürdürülmesi yönündeki çabaları destekleyici bir bulgudur. Zaman içindeki değișimi gösteren
sonuçlar, standardize hastalar ve simülasyon tekniklerinin etkin kullanımının programı daha etkili kıldığını
düșündürmektedir.

ENG
Aim: Applied education program on “Obtaining Informed Consent Skill (UAOAB)”, which was developed for
Ankara University Faculty of Medicine Grade-3 students and has been continuing since 2004, underwent
some structural changes over the years especially after 2012. This study was designed to reveal whether
students’ thoughts on the program differ parallel to these changes through time.
Material and Method: Students who attended practice sessions as a part of the UAOAB education between
the years of 2010-14 were asked to fill out an evaluation questionnaire about this education study. The data
collected were statistically analyzed and findings were interpreted.
Findings: The great majority of the students consider “informed consent” an important issue with respect to
their professional lives; however, they think that their knowledge and skills are insufficient. They are generally
satisfied with the UAOAB education (mean 81.3%). The ratio of students, who think that the program is
efficient in terms of professional responsibility acquisition and teaching communication skills, is significantly
higher between the years of 2012-14 than previous years.
Results: Students are in need of acquiring knowledge and skills about “informed consent” and related issues.
The finding that students have positive opinions regarding UAOAB education program supports endeavors
to continue the program by developing it progressively. Results showing the change over time
suggest that the use of standardized patients and simulation techniques lead to a more efficient program.

The dental profession has a high risk of hepatitis B virus (HBV) contamination and can play a crucial role in controlling HBV cross-contamination. In this cross-sectional study we used unique methods to assess Tehran dentists' knowledge, attitude and behaviour regarding HBV. Two simulated HBV-positive patients visited 300 general/specialist dentists in their offices and recorded dentists' willingness to treat them. Later, the dentists were interviewed regarding their knowledge about hepatitis B and attitude to HBV-positive patients. The mean knowledge score of dentists was 14.3 (SD 6.9) out of 44 and the mean attitude score was 20.0 (SD 3.6) out of 39. A majority of dentists (55.6%) were willing to treat a patient with HBV, unconditionally or with conditions. Some individual attitude items correlated with knowledge items concerning transmission of the virus and its prevention. Dentists' willingness to treat patients did not correlate with knowledge or attitude, except for the attitude item on concern about becoming infected.

Connaissances et attitudes des dentistes de Téhéran par rapport à l’hépatite B et disposition de ces derniers à traiter des patients déclarant une infection fictive à l'hépatite B.

La profession dentaire est à haut risque de contamination par le virus de l'hépatite B et peut jouer un rôle crucial dans la lutte contre la contamination croisée par ce virus. Dans cette présente étude transversale, des méthodes uniques ont été adoptée pour évaluer les connaissances, les attitudes et les comportements des dentistes de Téhéran vis-à-vis du virus de l'hépatite B. Deux patients déclarant une infection fictive par le virus de l'hépatite B ont rendu visite à 300 dentistes spécialistes ou généralistes sur leur lieu d’exercice et ont pris note de leur disposition à les traiter. Dans un deuxième temps, les dentistes ont été interrogés sur leurs connaissances en matière d'hépatite B et leur attitude vis-à-vis des patients infectés par le virus. Le score moyen des dentistes pour les connaissances était de 14,3 (ET 6,9) sur 44 tandis que le score moyen pour l'attitude était de 20,0 (ET 3,6) sur 39. La majorité des dentistes (55,6 %) étaient disposés à traiter un patient infecté par le virus de l'hépatite B, avec ou sans conditions. Certains items concernant l'attitude individuelle étaient corrélés aux items concernant les connaissances relatives à la transmission du virus et sa prévention. La disposition des dentistes à traiter des patients infectés n'était pas corrélée aux connaissances ni à l'attitude, à l'exception de l'item concernant l'attitude relative à la crainte de contracter l'infection.

Context: Health care quality has been widely discussed for over 40 years. However, it is still complex to define, understand, and assess it due to the multiple factors it involves, especially in the emergency services.

Aims: To identify the main factors that influence the quality of the medical emergency services provided across the health care network of one of the Health Promoting Entities (abbreviated EPS in Spanish) in Medellín, Colombia.

Methods: An exploratory qualitative study was conducted based on the foundations of the SERVQUAL model. A total of 511 people, selected by means of criterion-based nonprobability sampling, participated in this study.

Results: Three key factors were found to influence users’ perceived quality of emergency services in Medellín. The first factor corresponds to assurance and trust; the second, to institutional infrastructure; and the third, to responsiveness and its impact on expected and experienced service. This latter proves that patient follow-up is important to enhance user perception of such services.

Conclusions: Service quality measurement models are a fundamental tool to identify the real variables that affect patients’ perception of a service. In addition, they help to improve the value chain processes involved in providing a service that fully satisfies user expectations.

This study assessed factors that could predict dentists' knowledge, attitudes and behaviour towards hepatitis B virus (HBV). A total of 300 dentists in Tehran, Islamic Republic of Iran were surveyed and their demographic, educational and office characteristics were analysed in relation to their scores on knowledge about HBV, self-reported attitudes towards treating people infected with HBV and actual behaviour towards treating simulated HBV-positive patients. Having a Master's degree, faculty membership, taking ≥ 3 continuing education courses, wearing eye-shields, spending more time on preparing dental units and higher self-confidence about knowledge predicted better knowledge. A positive attitude was associated with having attended more courses and working in group practice. The number of courses and a shorter dental unit preparation time positively affected dentists' behaviour.