Standardized Patients

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'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' 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.

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.

Objective: the study evaluated the clinical and echocardiographic data, before and after percutaneous mitral commissurotomy (PMC) in patients with calcific mitral stenosis. Materials and methods: this is a retrospective study of 215 patients divided into two groups: 148 patients with calcific mitral stenosis (Group 1), and 67 patients without mitral calcifications (Group 2). The study period is between January 2011 to July 2015.Results: the group 1 was significantly older than the group 2 (49,7±12,2 (group 1) versus 42,7±12,8(group 2) , p<0,001), and had significantly more men than women (female gender:75% in group 1 vs.88,1% in group 2, p<0,05). Before PMC: group 1 had significantly higher Wilkins (9,3±0,8(group 1) vs. 8,5±0,6 (group 2) p <0,001) and smaller mitral valve area (0,91±0,20 (group1) vs.0,99±0,20 (group 2), p<0,05). After PMC: the final valve area was significantly smaller in patients with, than, without calcifications (2,10±0,26 vs.2,20±0,22 p<0,05). However , the rate of good immediate results, defined as valve area ≥1,5 cm² with no mitral regurgitation >2/4 (97,9%vs.100% , p> 0,05), and the rate of post PMC mitral regurgitation (MR≥3/4) (2% vs.0% , p>0,05), were no different between the 2 groups.Conclusion: PMC can be used for the treatment of patients with calcific mitral stenosis safety, with good immediate results.

ABSTRACT
Background: Limited resources of healthcare system and high use of antidepressants have raised some serious concerns regarding proper surveillance system of prescribed medicines. Not much literature is available from Pakistan regarding the potential drug-drug interactions (pDDIs) associated with antidepressants.
Objective: The objective of this study was to assess the frequency of pDDIs associated with antidepressants, their severity, significance and their association with patient characteristics.
Materials and Methods: A prospective, observational study was conducted in two major hospitals of Karachi for the period of three months. Patient profiles, medication charts, and physician notes were thoroughly reviewed to gather all the relevant information. Inclusion and exclusion criteria were set prior to data collection. The collected data was then analysed using Micromedex Drug-REAX System. Descriptive and binomial logistic regression analysis was used to express results.
R
esults: Of 245 prescriptions reviewed, 141 prescriptions had at least one pDDI (57.5%). A total of 181 pDDIs were identified in prescription containing antidepressant. The ratio of pDDI per prescriptions was 0.78. 42.5% interactions were moderate in severity, 30% of interactions were rapid in onset, and 43% were considered as significant interactions. Polypharmacy (OR=3.41, p<0.001) and presence of chronic problems (OR=2.14, p=0.002) were significantly associated with the occurrence of pDDIs. Citalopram and diclofenac (11.6%) was commonly prescribed interacting pair in this study.
C
onclusion: The findings of this study recorded high frequency of antidepressants associated pDDIs. Our results confirm the significant association of polypharmacy with the occurrence of pDDIs with antidepressants. Future studies are warranted to establish these results by including hospitals in different parts of the country.

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.

Simulated / standardized patients (SPs) have become one of the significant components in today’s medical education and students ’ assessment. Some differences exist in the training method of SPs for psychiatry examinations compared to other medical disciplines. This brief report highlights the challenges encountered in the training process and methods to overcome those challenges. A well-structured, intensive training remains as one of the most important factors in ensuring standardization of SPs for psychiatric examinations.

Simulated/ standardized patients (SPs) have become one of the significant components in today’s medical education and students’ assessment. Some differences exist in the training method of SPs for psychiatry examinations compared to other medical disciplines. This brief report highlights the challenges encountered in the training process and methods to overcome those challenges. A wellstructured, intensive training remains as one of the most important factors in ensuring standardization of SPs for psychiatric examinations.

Current revisions to the accreditation standards for occupational therapy (OT) education include proposed changes to experiential learning. e AOTA Fieldwork/Experiential Learning Ad Hoc Commi ee recommends that eldwork Level I experiences be replaced with a new model of experiential education that includes the use of standardized patients and simulation (AOTA, 2017). e purpose of this article is to present critical perspectives about standardized patient simulation and disability simulation to support informed decision-making about the integration of experiential learning in OT professional education. In standardized patient simulation, actors play the roles of clients and important others in therapeutic scenarios; in disability simulation, students act out impairments in a variety of se ings. While these forms of simulation are commonly used within OT education, they are critiqued for failing to present participants with authentic lived experiences of disability. is paper presents ...

Background: The practice of Evidence-based Medicine requires that clinicians assess the validity of published research and then apply the results to patient care. We wanted to assess whether our soon-to-graduate medical students could appraise and apply research about a diagnostic test within a clinical context and to compare our students with peers trained at other institutions.

Methods: 4th year medical students who previously had demonstrated competency at probability revision and just starting first-year Internal Medicine residents were used for this research. Following an encounter with a simulated patient, subjects critically appraised a paper about an
applicable diagnostic test and revised the patient's pretest probability given the test result.

Results: The medical students and residents demonstrated similar skills at critical appraisal, correctly answering 4.7 and 4.9, respectively, of 6 questions (p = 0.67). Only one out of 28 (3%) medical students and none of the 15 residents were able to correctly complete the probability
revision task (p = 1.00).

Conclusions: This study found that most students completing medical school are able to appraise an article about a diagnostic test but few are able to apply the information from the article to a patient. These findings raise questions about the clinical usefulness of the EBM skills possessed by graduating medical students within the area of diagnostic testing.

Extensive scholarship has described the historical and ethical imperatives shaping the emergence of the brain death criteria in the 1960s and 1970s. This essay explores the longer intellectual history that shaped theories of neurological consciousness from the late-nineteenth century to that period, and argues that a significant transformation occurred in the elaboration of those theories in the 1960s and after, the period when various disturbances of consciousness were discovered or thoroughly elaborated. Numerous historical conditions can be identified and attributed to the production of the new theories that emerged from
that period-on, not least in the broader social and cultural transformations that occurred with decolonialization, pro-democracy movements, and civil and disability rights advocacy, all contexts which exerted pressures on the institutions and professions of medicine. In this telling, the discovery of the locked-in patient is thus the exploration
of a transformed vision of medical patients – one that moved them from a liminal indefinite space into a firmly grounded epistemological existence – in a backdrop in which medical professionals in particular and society in general was beginning to see the body differently. With this new vision, came a relational theory of consciousness to, a reading of a body and it signs, that shifted consciousness from an internally-derived state into a relationally-constructed object. The ontology of consciousness, whatever it was, thereby became entangled with the social condition of consciousness, one that bridged the worlds of close relationship with the social movements and anxieties about personhood that emanated out of that fraught period.

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’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 students’ performances with real SPs. After obtaining informed consent, 20 students underwent voice recognition training followed by a videotaped VP encounter. Immediately after the virtual scenario, students completed a technology and SP questionnaire (Maastricht Simulated Patient Assessment).All participants had prior experience with real SPs. Initially, the VP correctly recognized approximately 60% of the student’s questions, and improving the script depth and variability of the VP responses enhanced most incorrect voice recognition. Student comments were favorable particularly related to feedback provided by the virtual instructor. The overall student rating of the virtual experience was 6.47 ± 1.63 (1 = lowest, 10 = highest) for version 1.0 and 7.22 ± 1.76 for version 2.0 (4 months later) reflecting enhanced voice recognition and other technological improvements. These overall ratings compare favorably to a 7.47 ± 1.16 student rating for real SPs.Despite current technological limitations, virtual clinical scenarios could provide students a controllable, secure, and safe learning environment with the opportunity for extensive repetitive practice with feedback without consequence to a real or SP.

Objective: Background reliable information about the prevalence of
dyslipidemia in hypertensive and non hypertensive diabetic patients
in local region is essential to the development of regional health
policies for prevention and control of this condition. An attempt was
made in Puducherry region to examine the lipid profile parameters in
the diabetic patients with and without hypertension and thereby to
create awareness on the importance of closely watching their lipid
parameters frequently from the age of 30-70.  Method:  Totally case
sheets of 105 Puducherry patients are referred covering hypertensive
and non hypertensive diabetic patients. To ascertain the significance
of each parameters student’s t-test has been done. Results: It is found
that el evated serum triglycerides (TG), very low density lipoprotein
(VLDL) and Cholesterol/High density lipoprotein Ratio
(CHOL/HDL) but normal cholesterol, low density lipoprotein (LDL)
and HDL in diabetic patients of all age groups. In both gender Serum
triglycerides are significantly elevated in diabetics of all age groups
compared to non diabetics. Plasma VLDL is significantly elevated in
female diabetic patients between the age group of 30-40 years and
60-70 years compare to non diabetics and other age groups. Plasma
VLDL is significantly elevated in male diabetic patients also between
the age group of 30-50 years compare to non diabetics and other age
groups.  Conclusion:  Serum TG and VLDL was found to be more
significantly increased in diabetic patients with  hypertension
compared to without hypertension. Similarly serum TG is also
elevated in non diabetic hypertensive patients.