What should the evaluator, in a simulated learning experience, do when the assessment being scored yields a critical result? We searched for guidance on recommendations or standards for an evaluator becoming a provider and we were unable to find any published work addressing our experiences. There are numerous articles addressing standardized patients. 1,2,3,4 An article by Simon and Dove 5 encourages a professional evaluation of the standardized patient before assessment by learners. Thus, preventing the finding of urgent or emergent results during the skills assessment. Neither of our experiences used standardized patients. One used classmate-partners and the other a family volunteer to serve as the patients. We offer the following two experiences to initiate a discussion centering on serving as an evaluator in skills testing and the added challenge of serving as a remote evaluator for learners in other jurisdictions. Each of these experiences is based on real evaluator interactions but have been modified to protect the identity of the learners.The first assessment was an in-person assessment of basic patient physical assessment skills as a part of a national point-of-care testing certificate training program. Both evaluators were pharmacists, licensed in the jurisdiction of the testing, with assistance from trained student-assessors who had previously achieved the national certificate. During blood pressure assessment, a pharmacy student learner with an unusually high reading (182/94mmHg) was identified. 6 The student-assessor requested help from the pharmacist-evaluator. While taking the patient history, the pharmacist-evaluator identified previous treatment for rhabdomyolysis. 7,8 The student was transported to the emergency department and was subsequently admitted for renal failure. The pharmacist-evaluator accompanied the student to the emergency department and stayed until a family member arrived.The second assessment was a synchronous, online assessment of a diabetic foot examination. The learner was a pharmacist, licensed in the jurisdiction where the testing was being performed, the evaluator, also a pharmacist, was licensed in a different jurisdiction than where the state where the assessment was conducted. The learner was performing a micro-filament test and the simulated patient, a family member, was unable to feel any of the attempts at stimulation with the micro-filament. The simulated patient had no history of diabetes, leg, or spinal injury, and was able to feel digital stimulation when the learner used a finger to create sensation. 9 The pharmacist-evaluator recommended a consultation with the patient's provider at the earliest possible opportunity, this advice was confirmed by the pharmacist-learner.Evaluators do not expect to find problems during simulated skills assessments. Generally, the simulated patients are either healthy students, faculty, staff or standardized patients with known conditions. In these two instances, however, the simulated patient immediately became a real patient. The ...
