Developing standardized patient-based cases for communication training: lessons learned from training residents to communicate diagnostic uncertainty

Abstract

Health professions education has benefitted from standardized patient (SP) programs to develop and refine communication and interpersonal skills in trainees. Effective case design is essential to ensure an SP encounter successfully meets learning objectives that are focused on communication skills. Creative, well-designed case scenarios offer learners the opportunity to engage in complex patient encounters, while challenging them to address the personal and emotional contexts in which their patients are situated. Therefore, prior to considering the practical execution of the patient encounter, educators will first need a clear and structured strategy for writing, organizing, and developing cases. The authors reflect on lessons learned in developing standardized patient-based cases to train learners to communicate to patients during times of diagnostic uncertainty, and provide suggestions to develop a set of simulation cases that are both standardized and diverse. Key steps and workflow processes that can assist educators with case design are introduced. The authors review the need to increase awareness of and mitigate existing norms and implicit biases, while maximizing variation in patient diversity. Opportunities to leverage the breadth of emotional dispositions of the SP and the affective domain of a clinical encounter are also discussed as a means to guide future case development and maximize the value of a case for its respective learning outcomes.

Enhancing General Surgery Clerkships: The Application and Value of Standardized Patient-Based Situational Simulation Teaching

“…Through rich emotional experiences, students gained comprehensive psychological development. Our satisfaction survey indicated that students are highly interested in the scenario-based teaching model with SPs [9,28]. This may be because this teaching model allows students to experience the significance of being a doctor-feeling the joy of using their knowledge to alleviate patients' suffering and the pain caused to patients by improper diagnosis and treatment [29].…”

“…This study innovatively combines SP and scenario-based teaching methods, applying a scenario-based teaching model in the whole diagnosis and treatment process with SPs in the clinical internship of general surgery [9,10]. The results of a prospective randomized single-blind controlled study showed that scenariobased teaching with SPs outperforms TT methods in terms of post-internship theoretical scores and the quality of medical record writing [11,12].…”

Communicating Diagnostic Uncertainty at Emergency Department Discharge: A Simulation-Based Mastery Learning Randomized Trial

“…We designed cases to have equal complexity as determined by team members with simulation expertise, but varied them across 5 chief complaints (abdominal pain, dizziness, shortness of breath, headache, back pain), various combinations of diagnostic testing completed (e.g., with or without lab or imaging testing), and 4 patient emotional states (nervous/anxious, reassured, confused, inquisitive/inquiring). 29 In each case, physicians were given the same instructions: (1) update the patient on his/her results and (2) discharge the patient from the ED. We pilot tested and refined cases before the trial.…”

ASCO Policy Statement on Biosimilar and Interchangeable Products in Oncology

“…Good oncology communication and interpersonal skills are paramount in relating to and educating patients. 86,87 Skills include both verbal and nonverbal behaviors to help build good relationships with patients, successfully communicate treatment options, deliver difficult news, and support patients and their caregivers. However, communicating with patients about biosimilars as an alternative treatment is often hindered by other factors such as a lack of clinician understanding of and confidence in biosimilars and decisions made by PBMs, payers, and hospital and cancer center administrators that are often outside of clinicians' control.…”