What is a standardized patient?

Standardized patients are highly-trained actor-educators. Broadly, the role of the standardized patient is to support a healthcare professional’s acquisition and practice of history-taking and interviewing skills, physical examination skills, communication and patient–health professional interaction skills, and patient education and information-sharing skills (1). 

 

What is a teaching associate?

Standardized patients who instruct in and assess physical exam skills are commonly referred to as Physical Exam Teaching Associates (PETAs), or Teaching Associate (TA) for short (2). Teaching Associates are often used to prepare learners for applicable board examinations, specifically those where they will be expected to examine a patient (2). A significant benefit of using a Teaching Associate for teaching physical exams and skills is the standardization of the approach and the opportunity for learners to practice and receive feedback. Keep in mind, while Teaching Associates are trained to provide feedback to learners on physical examination and other relevant skills, faculty or other clinical experts are still required to provide clinical context for the performance of techniques (2). A key benefit of the Teaching Associate over a faculty educator is that Teaching Associates have experienced the technique being performed on themselves by hundreds, if not thousands, of health professional learners. As such, Teaching Associates provide feedback both as an expert and as a standardized patient. 

 

What is the role of a standardized patient or teaching associate?

In the past, faculty educators have had the major responsibility for providing feedback to the learners, but standardized patients are increasingly being used to provide feedback, taking on the role of an instructor as well as an evaluator (3). Standardized patients and teaching associates lead both instructional workshops and assessment sessions (see below). Health professional training programs such as medical schools, nursing schools, and allied health professional training programs, use standardized patients to assess communication, interpersonal skills, and appropriate or correct technique performance (4). 

 

Workshops vs. Assessment Sessions

An instructional workshop is a small group session where learners can practice physical examination and related skills (2). These sessions allow for demonstration by the teaching associate and repeated practice by the learners. Feedback may be provided by the teaching associate, but this is not the focus of an instructional workshop (2). 

In these assessment sessions (such as an OSCE or a LiquidGoldConcept Telesimulation), the participant performs the techniques and is then assessed based on how they were performed during the standardized patient encounter (2). Teaching Associates and standardized patients alike can address how learners applied their physical examination skills and techniques as part of the standardized patient encounter.

 

Why is feedback important?

Standardized patients and Teaching Associates provide learners with formative assessment, which is designed to help learners refine, practice, and reflect on their communication and clinical skills. Feedback enables the learners to know how they are performing, in a timely manner, and is considered an essential component of clinical education (3). In one randomized controlled trial, students were randomly assigned to receive no feedback (control group), written feedback only, or both written and oral feedback. The students who received both written and oral feedback performed significantly better in subsequent simulations and reported higher levels of perceived learning compared to both of the other groups (3).

 

On-Demand Telesimulation at LiquidGoldConcept?

At LiquidGoldConcept, actor-educators in the On-Demand Telesimulation program have received rigorous, blended training so that they can provide subjective and objective feedback on communication, interpersonal skills, and certain clinical lactation techniques (eg., hand expression of breast milk, breast massage for engorgement, breast massage for plugged duct resolution, assembly and effective utilization of double-electric multi-user and single-user breast pumps, assembly and effective utilization of “hands free” breast pumps like the Elvie or Willow, and newborn positioning and attachment). 

 

LiquidGoldConcept actor-educators have been trained using a very specific rubric that was developed and approved by multiple clinical lactation experts (MD, DO, NP, IBCLC). The LiquidGoldConcept actor-educators can recognize whether a learner or team of learners have effectively communicated certain clinical knowledge points. For example, for the statement “I know why my breasts are engorged,” the actor-educator has been trained to recognize that intravenous fluids administered during labor/delivery increase the risk of severe breast engorgement. The actor-educator will not award full credit for a knowledge point if there is, for example, significant disagreement among a team of learners resulting in poor communication of a concise plan to the patient. The actor-educator uses the phrases “I felt confused” and  “It is my understanding that…” to provide guidance to learners when they missed a knowledge point. For example, “I felt confused when you told me that IV fluids contributed to a delay in lactogenesis II because it is my understanding that IV fluids given during labor/delivery contribute to the severity of breast engorgement, not delayed lactogenesis II.”

 

Some of the actor-educators have received additional training by LiquidGoldConcept and serve as Teaching Associates in the Foundations Workshops. The Teaching Associates have received additional training on the performance of the breast assessment and foundational guidance as to the underlying principles of each technique. For example, a Teaching Associate would be expected to explain to learners that the majority of the lymphatic system in the human breast drains into the axillary lymph nodes. For this reason, massage techniques for engorgement should be directed away from the nipple and towards the armpit. 

 

Citations

  1. May W. Training standardized patients for a high-stakes Clinical Performance Examination in the California Consortium for the Assessment of Clinical Competence. Kaohsiung J Med Sci. 2008;24(12):640-645. doi:10.1016/S1607-551X(09)70029-4
  2. Weaks C, Hopkins H, Lyman L, George SW. Broader Applications of Communication: Using the Human Body for Teaching and Assessment. In: Gliva-McConvey G, Nicholas CF, Clark L, eds. Comprehensive Healthcare Simulation: Implementing Best Practices in Standardized Patient Methodology. Comprehensive Healthcare Simulation. Springer International Publishing; 2020:221-240. doi:10.1007/978-3-030-43826-5_12
  3. Park JH, Son JY, Kim S, May W. Effect of feedback from standardized patients on medical students’ performance and perceptions of the neurological examination. Medical Teacher. 2011;33(12):1005-1010. doi:10.3109/0142159X.2011.588735
  4. Jha V, Setna Z, Al‐Hity A, Quinton ND, Roberts TE. Patient involvement in teaching and assessing intimate examination skills: a systematic review. Medical Education. 2010;44(4):347-357. doi:https://doi.org/10.1111/j.1365-2923.2009.03608.x