October 27, 2022By Lance Baily

How Healthcare Simulation Technology Specialists Work with Standardized Patients

“Comprehensive Healthcare Simulation: Operations, Technology, and Innovative Practice” is the leading medical simulation book for healthcare professionals starting or expanding their use of the emerging methodology to improve learning, training, and patient safety outcomes. From basic theories to advanced practices, this healthcare simulation book has been praised as a “must-read” by leading medical simulation experts around the world. This HealtyhSimulation.com article takes a closer look at chapter 18 which focuses on “The Healthcare Simulation Technology Specialist and Standardized Patients.” Written by Karen L. Lewis, Ph.D., CHSE, is Director of Administration, Clinical Learning and Simulation Skills Center, School of Medicine and Health Sciences, GWU, this chapter provides insight into the role and function of standardized patients.

Lewis begins this chapter by first defining what a standardized patient is (Agency for Healthcare Research and Quality): “A person who has been carefully coached to simulate an actual patient so accurately that the simulation cannot be detected by a skilled clinician.” Using this definition, she explains how SP-based work has increased significantly over the last three decades. Affirming this, she shared that 96% of U.S. medical schools now report integrating SPs into their curricula for teaching and assessment.

“Concurrent with the rise in SP-based simulation has been the development of the educators who train them,” Lewis explained. “In 2001, the Association of Standardized Patient Educators (ASPE) was created to support this new profession. ASPE’s mission is to promote the best education, assessment, and research practices in the application of SP methodology; disseminate SP methodology research and scholarship, and advance the knowledge and skills of its members.”

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With more educators and learners relying on SP-based simulation, healthcare simulation technology specialists (HSTSs) have come to interact with SPs in varying degrees depending on their individual contexts. Further, Lewis believes that the collaboration between these professionals is bound to increase in the coming years, largely due to the development of hybrid scenarios, wearable simulators designed for SPs, and technology designed to give SPs physi-
cal findings.

“To aid in that work, it is important for HSTSs to be familiar with the role and function of SPs, guidelines for recruiting and training them, the challenges of giving voice to the manikin, and the ways the simulation setting and scene offer opportunities for collaboration,” Lewis explained.

To be familiar with the role, the healthcare simulation community must also become familiar with the role title. As the meaning of SP has broadened over the last two decades, SP can now stand for standardized patient, simulated patient, or simulated participant – and all of the terms have distinct nuances. Lewis noted that the ASPE Standards of Best Practice (SOBP) explain that the term standardized and simulated patient (SP) is “often used interchangeably and refer to a person trained to portray a patient in realistic and repeatable ways.”

Lewis breaks down standardized patient scenarios into two categories: formative and summative. Formative is a term to describe an activity meant to provide information or instruction with minimal consequence to grading or performance and is often used to describe activity meant for teaching and feedback. Alternatively, summative is a term to describe high-stakes educational decisions, such as testing, which is common with objective structured clinical examinations (OSCEs) used for clinical licensing.

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“The consistency and accuracy, or standardization, of an SP role portrayal, depends upon the context in which the SP is working,” Lewis explained.

Alternatively, summative is a term to describe high-stakes educational decisions, such as testing, which is common with objective structured clinical examinations (OSCEs) used for clinical licensing. In a summative assessment, individual SPs as well as SPs portraying the same role are trained to behave in a repeatable manner to ensure consistency and fairness to all learners. In this context, they are standardized patients, Lewis explained.

“In Formative simulation activities, SPs may play roles that allow them to respond to the learner with flexibility and authenticity depending on the needs of the learners. In this context, the patient behavior is that of a simulated patient.”

Regarding the role and function of SPs, she says they are well suited for inclusion in a wide range of simulation scenarios that address the learning needs of healthcare professionals at all stages of their training. Lewis adds that SPs are ideal for scenarios that focus on communication exchange such as history taking, developing management plans, sharing bad news, teaching patients about self-care, teamwork, error disclosure, conflict resolution, and ethical dilemmas.

“In the last decade, the roles that SPs may play have grown in scope to include clients, family members, and healthcare professionals, and there is evidence that SP methodology can be applied successfully when working with any individuals portraying humans in simulations,” Lewis said. “As a result, the term simulated participant is beginning to gain recognition as a more inclusive term.”

Demonstrating this inclusivity, Lewis states that clinical reasoning, physical examination, and procedural, and operative skills are also within the scope of SP work. Additionally, SPs can serve as teachers when trained to give feedback to learners on communication, physical examination, or procedural skills. This has led to a number of benefits of including SPs in health professions training. She shared a list of advantages, including that:

  • SPs in health professions training are many. First and foremost is that with proper training, their patient presentations are highly authentic.
  • SP portrayals are not limited by place. They can participate in simulations wherever healthcare professionals in training work and learn.
  • SPs can simulate a broad range of clinical presentations and a variety of characters.
  • SPs can lend authenticity to manikin-based simulations by portraying family members, bystanders, or the voice of the patient.
    Faculty can create exactly the kind of SP scenario they need to accomplish their teaching objectives.
  • SPs can provide feedback to learners from a patient perspective which is a unique feature of SP-based work.
  • SPs can portray the same patient at various points in time to provide learners with continuity of practice experiences.
    Including SP scenarios in healthcare professions training reduces the risk to real patients from repeated exposure from novice learners and protects learners from the anxiety created when practicing skills on real patients.
  • SPs can be trained to reproduce the simulation for multiple learners.
  • SPs can provide evaluation data on learner competencies.
  • Standardized SP encounters reduce the possibility of bias and allow for equitable treatment of learners.
  • Including SPs in teaching physical examination and procedural skills training can provide cost savings by freeing up faculty time.

Lewis concluded that what is unique about working with SPs is that they are actual people. They are not educational tool for educators to use. Instead, they are part of a dynamic educational team engaging in a simulation scenario. SPs are “educational allies and contributors” to the simulation field and health professions education,” she said.

“As the field grows and SP-based technology advances, SPs and the HSTS will have more opportunities to collaborate to create credible scenarios,” Lewis predicted. “Together they can advance new ideas and techniques that will inform both of their scopes of practice and improve the quality of healthcare simulation.”

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More key takeaways from the Latest Simulation Operations book include:

  • A practical guide helps prepare professionals for the broad scope of simulation in healthcare
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  • Focuses on the development of the healthcare simulation technology specialist
  • Written and edited by leaders in the field of clinical simulation

Written and edited by leaders in the field, Comprehensive Healthcare Simulation: Operations, Technology, and Innovative Practice is optimized for a variety of learners, including healthcare educators, simulation directors, as well as those looking to pursue a career in simulation operations as healthcare simulation technology specialists. Grab your copy today through the following affiliate-commissioned links.

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