education using sps

7/31/2019 Education Using SPs

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Medical EducationUsing SPs

International Research Center for Medical Education,

University of Tokyo

Hirotaka Onishi


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Topics1. What is SP?

2. How to plan educational sessions

3. Training for SPs: How to give feedback

4. Recruit and maintenance of SPs


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Outline of Outcome-based

Education (OBE) SystemEducational environment

Support

Assessment

How to learn(Methods)

What to learn(Contents)

Trainee

Outcome

Progress


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1. WHAT IS SP?


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Examples of OBE (1) 6 outcomes of Postgraduate training:

ACGME (Accreditation Council for

Graduate Medical Education)ACGME Outcome Project: http://www.acgme.org/Outcome/

Patient Care

Medical Knowledge

Practice-Based Learning and Improvement Interpersonal and Communication Skills

Professionalism

Systems-Based Practice
http://localhost/var/www/apps/conversion/current/tmp/scratch28613/ACGMEhttp://localhost/var/www/apps/conversion/current/tmp/scratch28613/ACGME


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Examples of OBE (2)The Scottish Deans Medical Curriculum Groups

Three circle model (Simpson et al. Med Teach 2002, 24, 136-143)

Medical informatics

Patient management

Patient investigation

Clinical skills

Communication

Practical procedures

Health promotion and

disease prevention

Personaldevelopment

Role of the doctor withinthe health service

Attitudes, ethical

understanding and

legal responsibilities

Decision-making skills

and clinical reasoning

and judgement

Basic, social and clinicalsciences and underlying

principles


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Simulation Teaching In 2000s, it became difficult to involve

patients in the practical training in Japan

Expansion of simulation teaching

Development of simulated/standardized

patients

Development of simulators

Development of team simulation program


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Definition of SPs A person trained to portray specific sets

of health problems and symptoms that

will aide students in learning the propertechniques and procedures for taking

medical histories, performing medical

examinations, determining diagnosesand learning the appropriate way to

educate and inform patients of

diagnoses


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1964: Dr. Barrows: Demonstration of neurological findings

Programmed Patient Simulated Patient

1976: Dr. Barrows & Ms. Tamblyn: Demonstration of SP 1988: Kawasaki Medical School began SP training

1992: Kawasaki started first OSCE

1992: Canadian license exam started OSCE

2001: Common Achievement Test (CAT) OSCE trial started

2004: USMLE Step2 CS started 2005: CAT OSCE has fully implemented 2009: Korean Medical License Examination started CPX

(clinical performance examination)


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Year No of Groups No of SPs

1998 15 108

2000 21 200-2502001 34

2002 40 450

2003 50 550

2004 60

2006 80

2008 120

2010 135 1200-1400


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Teaching and AssessmentItem Teaching Assessment

Reality More Less

Scenario structure Less More

Focus of training How to give FB Standardization


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Simulated? Standardized? No essential difference

The name of standardized patients is

preferred for assessment

Standardization

SPs become too rigid to scenarios

SPs feel they are prohibited ad-lib

Both are called SP !!


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2. HOW TO PLANEDUCATIONAL SESSIONS


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Assessment in Curriculum

Development Process 6-step approachKern

2. Needs assessment

for targeted learners

3. Goals and objectives

4. Educational strategy

5. Implementation

6. Assessment

1. Problem identification and

general needs assessment


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Common Goals and Points Teaching for communication skills

Students learn from dialogue with and FB

from SPs

Dialogue is determined by a case scenario

Teaching for physical examinations

Students learn from demonstration, practiceand FB from SPs

Some SPs understand good or poor

examination techniques


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Scenario Writing Blueprint for communication skill and

physical examination training

For which part do you need SPs?

Detailed blueprint for communication

skill training

Clinical areas, diseases, patient description

(age, sex, job, food, exercise, hobby, etc)


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How to Write Scenarios Teachers and SPs should collaborate

Some discussion is needed

SPs: good at information about family or job

Teachers: good at consistency between the

disease and SPs symptoms and findings

Avoid unrealistic situation e.g. SP is 50yo and her son is 40yo

Brush up after its use


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3. TRAINING FOR SPS:HOW TO GIVE FB


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Feedback Give information of KR to the student

KR: knowledge of result what is well done

and what is not properly done This will work as a formative assessment

Give advise to the student

Points for improvement

Better technique: ask questions to students

if the understanding is OK or not


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Principles 1: Timeliness Give FBs to students ASAP

Before they forget the experiences

If timely FBs may embarrass students,

personal FBs should be selected

Some students are sensitive to negative

comment in front of other students


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Principle 2: Specific Do not give general impression. Give

specific advise to improve

Your communication skills were bad!

The student doesnt know how to improve

You did not respond to the SPs concern

When to show empathy


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Technique 1: I Message If you use I in your FB, it sounds softer

Your abdominal palpation is too deep

I think your abdominal palpation was toodeep


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Technique 2: Playback If you use videotaping, you can show

the playback to the actor students and

audience for reflection Especially useful for non-verbal

communication skills because students

do not notify it during simulation


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4. RECRUIT ANDMAINTENANCE OF SPS


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RecruitmentCharacteristics Advertise to the

publicPersonal

communications

No of applicants More Less

Qty of members Mixed Better

Competitiveness Higher Lower


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Japanese Experiences Too strong leader

Activist against the power of physicians

Some SPs give harsh FBs to students

Independence

Some SPs do not want to work with a

specific university


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Payment SPs are sometimes paid for teaching or

assessment

If the rule of payment is not so clear,SPs will be angry

Department in charge of SPs and

administrative office of the universitymight have gap


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Status Are SPs professional or volunteers?

Some SPs show inappropriate attitude

Rules and regulations might be specific


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Autonomous Management Schools with large number of SPs tend

to use autonomous management

Those who work long, dedicate more orwork actively become SP coordinators

A few leaders may even become SP

trainers or faculty members

Such system will motivate SPs

education using sps

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