standardized patient user guidelines sudbury and thunder bay. ... standardized patient user guide...

STANDARDIZED PATIENT USER GUIDELINES

June 2016

Standardized Patient Program

2 STANDARDIZED PATIENT USER GUIDE 2016

CONTACT INFORMATION ......................................................................................................................... 3

RATIONALE FOR USING SPs...................................................................................................................... 4

GETTING TO KNOW NOSM’S SPs ............................................................................................................. 4

TYPES OF LEARNING SESSIONS/ROLES FOR SPs ...................................................................................... 5

REQUESTING AND BOOKING SPs ............................................................................................................. 5

EQUIPMENT/SUPPLIES AND ROOM BOOKINGS ...................................................................................... 6

CASE REQUIREMENTS .............................................................................................................................. 7

SP TRAINING ............................................................................................................................................. 7

SIMULATION DAY EXPECTATIONS............................................................................................................ 8

QUALITY ASSURANCE ............................................................................................................................... 9

CANCELLATION REQUIREMENTS ............................................................................................................. 9

SP COMPENSATION .................................................................................................................................. 9

PROGRAM ADMINISTRATION FEE ......................................................................................................... 10

INVOICING .............................................................................................................................................. 10

PARKING ................................................................................................................................................. 11

CONFIDENTIALITY .................................................................................................................................. 11

SP PROFESSIONAL CONDUCT ................................................................................................................. 11

COMPLAINTS AND CONCERNS ............................................................................................................... 12

APPENDIX A - CASE SPECIFICATIONS AND CASE TEMPLATE .................................................................. 13

APPENDIX B - SP TRAINING TOOL KIT .................................................................................................... 16

FOR THE PURPOSES OF THIS DOCUMENT THE FOLLOWING ACROYNMS ARE USED: NOSM: Northern Ontario School of Medicine SP: Standardized Patient SPP: Standardized Patient Program SCS Coordinator: Structured Clinical Skills Coordinator

TABLE OF CONTENTS



Program Coordinators

Tamara Boyd (Laurentian Campus) Erica Dzuba (Lakehead Campus) Clinical Skills Program Coordinator Clinical Skills Program Coordinator Northern Ontario School of Medicine Northern Ontario School of Medicine Laurentian University, MS-145 Lakehead University, MS-1009 935 Ramsey Lake Road 955 Oliver Road Sudbury, Ontario P3E 2C6 Thunder Bay, Ontario P7B 5E1 Tel: 705-662-7255 Tel: 807-766-7335 Fax: 705-662-7192 Fax: 807-766-7356 Email: [email protected] Email: [email protected] Emergency Only: 705-222-8848 Emergency Only: 807-629-0065

Standardized Patient Trainers

Yolette Brant (Laurentian) Julie Ktytor (Lakehead) Tel: 705-662-7139 Tel: 807-766-7335 Email: [email protected] Email: [email protected]

Administration

Manager, Education Services Northern Ontario School of Medicine Tel: Email:

CONTACT INFORMATION

mailto:[email protected]






SPs are: Valid: SPs are comparable to a real patient; they co-create an imaginary world that feels, sounds and looks as real as if it were the world of an actual patient. Available: SPs can be available at any time and any place. Reliable: SPs can portray the same symptoms, character and give the same information repeatedly, making all aspects of their portrayal stable. Controllable: The setting, level of difficulty and amount of information given or withheld from the learner can be controlled. Adaptable: The simulation can be timed out or portions repeated for different opportunities. Able to give feedback: SPs provide immediate constructive feedback to the learner from the patient’s perspective regarding their communications skills. Risk Free: Using SPs provides a safe environment for the leaners. Learners don’t have to be concerned with inconveniencing, harming or causing discomfort to the patients.

The NOSM SP program continues to grow with over 150 active SPs between the ages of 15-85 in Sudbury and Thunder Bay.

SPs undergo an interview process and a mandatory assessment prior to being hired.

SPs are trained to provide constructive feedback.

For each simulation, SPs are selected based on their demographics, physical traits, availability and experience.

GETTING TO KNOW NOSM’S SPs

RATIONALE FOR USING SPs



Medical history Physical exams Counselling Management Hybrid mannequin procedures High fidelity simulations Clinical exam (ie. OSCEs)

SPs are NOT to be used for invasive procedures

We have a variety of SPs who are experienced in portraying patients in the following areas:

Mental health (eg. depression, anxiety, manic, schizophrenic)

Breaking bad news

Difficult patient

Cross-cultural interviewing (eg. interpreter, religion, indigenous)

Domestic violence

Informed consent

Medical error disclosure

Sexuality

Who may request SPs?

Any faculty member, tutor, preceptor affiliated with an accredited program within the Northern Ontario School of Medicine. The request must be supported and approved by their program director (or equivalent)

External health organizations and/or programs (e.g. University, Medical Council of Canada, Hospital).

Each request will be reviewed to determine our involvement. The SPP reserves the right to decline any request based on scheduling conflicts, lack of resources or failure to meet request deadlines.

Requesting Specific SPs We will accept requests for specific SPs, however, we may not be able to guarantee their availability. In the event that the requested SP is not available, we will choose an alternate SP who we feel is suitable.

TYPES OF LEARNING SESSIONS/ROLES FOR SPs

REQUESTING AND BOOKING SPs



Booking SPs

All SP booking requests must be submitted electronically, using our SP Booking Form.

We require minimum notice of four (4) weeks for booking SPs. This time frame is necessary for recruitment and training. Requests sent with less than four (4) weeks notice may be declined.

Confirmation: Once the request is received, the SCS Coordinator will review your needs and respond to the requester. Once the SP has been recruited, you will be notified by email with

the name of the scheduled SP. If you are conducting your own training the SP’s email will be provided to arrange a training time to suite your schedules.

SP Scenarios and Props: We may or may not be able to support your request for SP props

depending of the nature of the request. We have a small collection of props, therefore, please contact the SCS Coordinator to discuss this collection.

SP Makeup/Moulage Application: We can apply simple make up applications such as bruises,

burns, scars, rashes, pallor, abrasions, redness and swelling. Should you require anything more significant, contact the SCS Program Coordinator to discuss whether we can support your request.

Clinical Skills Equipment and Room Bookings

If you require specific clinical equipment or a room booking, contact: Ally Norton, NOSM Learning Activities Coordinator – Laurentian Campus 705-662-7232 [email protected] Lee Shewchuk, NOSM Learning Activities Coordinator – Lakehead Campus 807-766-7389 [email protected]

EQUIPMENT/SUPPLIES AND ROOM BOOKINGS

http://www.nosm.ca/uploadedFiles/Education/UME/Standardized_Patient_Program/SP%20Request%20Form.pdf





It is the responsibility of the requestor to provide their own case. NOSM does not have a bank of cases that can be shared.

If SPP staff is training the SP, a case needs to be provided to us three (3) weeks prior to the simulation day.

Refer to Appendix A for case specifications and a case template that outlines all the necessary information that a case requires. It is in a format that is organized and easy to follow for patients. Please contact the SCS Coordinator to request an electronic copy.

NOTE SPs ARE TO BE TRAINED FOR ONE (1) HISTORY/INTERVIEW CASE AT A TIME. HAVING SPs LEARN MULTIPLE CASES FOR ONE SIMULATION EVENT WILL LEAD TO CASE CONFUSION. HOWEVER, SPs CAN PORTRAY A HISTORY/INTERVIEW CASE AND PARTICIPATE IN A PHYSICAL EXAM SESSION AT THE SAME TIME. SHOULD YOU HAVE MORE THAN ONE HISTORY/INTERVIEW CASE TO BE PORTRAYED AT ONE TIME, YOU WILL BE REQUIRED TO BOOK ADDITIONAL SPs.

You have the option to request the SPP to conduct the SP training or have a trainer from your Program/facility conduct the training.

SPP Case Training

SPs are trained according to the scenario that is provided.

SPs are trained to stay in role at all times when in the presence of learners.

Training will take place no less than 1 week prior the simulation.

All SPs are informed that they are not to change their portrayal from that which they were trained.

Should a change of case information be required, the requestor must make the change in writing to the trainer/coordinator no later than 3 days prior to the simulation.

Feedback o When requesting SPs to provide feedback for an simulation, please provide the

following: Objectives of the session

Guidelines on what areas or communication skills you would like the SP to focus on and provide feedback to

o All SPs are trained to provide feedback to the learner in relation to the learner’s communication skills and how the learner made the patient feel.

o The SPs are trained to first state what they observed and then follow it up with how that observation made them feel.

CASE REQUIREMENTS

SP TRAINING



o SPs do not evaluate or give advice, they only describe how they feel. o SPs provide positive and constructive feedback

o SPs always give feedback from the patient’s perspective while staying in role

If a variance is required in how the SPs provide feedback, please contact the SP Coordinator

Dry Run Training

o Additional training to provide opportunity for the SP to practice their case and ensure standardization to the satisfaction of the simulation lead/tutor

o Used for more difficult scenarios and clinical examinations

o Needs to be requested at the time of booking

o SP trainer and simulation lead/tutor need to be present

o Should a dry run be requested, the SP trainer and simulation lead will coordinate a time for training via email. It is essential that each SP have the opportunity to complete a FULL run through of the scenario with the simulation lead/tutor.

o Dry run training should occur no more than 1 week after training and 7-10 days prior to the simulation.

Non SPP Case Training There are a variety of methods to train SPs, your decisions regarding the necessary amount and type of training will depend on:

the objective(s) of the session,

requirements of the SP,

experience and abilities of the SP,

the number of SPs being trained at one time,

the difficulty of the case

whether the patient will be proving feedback as part of the session

Refer to Appendix B as a guide to help you train the SPs. The SP Training Tool Kit is based on best practices.

Call Time: If not specified, SPs will arrive 30 minutes prior to the scheduled simulation.

SPs need to know who to report to when they arrive. Please advise when booking.

Simulation lead/tutor must always be present.

If SPs are not comfortable during a simulation, they may request to stop the simulation.

SPs have the right to decline if asked to portray something other than that which they were booked.

It is unacceptable to give SPs additional content or an additional case on the day of the simulation.

SIMULATION DAY EXPECTATIONS



SP Performance: A quality assurance form will be sent to the simulation lead/tutor prior to the

simulation in order to aid us in monitoring the SPs preparedness, portrayal and professionalism. The form will be reviewed by the SCS Coordinator and issues identified will be addressed as necessary. On occasion, the SCS Coordinator/Trainer may request to view sessions to ensure quality of our SPs.

SP Experience: Our SPs are asked to complete a quality assurance feedback form with respect to

their simulation experience. This feedback will be compiled and sent to the simulation lead/tutor for your information. If any “red flags” are noted, we will contact you to discuss.

If cancelling SPs with less than 24 hours notice, the SP will receive full compensation for the hours they were scheduled for, and therefore, the requestor will be invoiced for that amount. SP compensation rates are determined by the SPP and are subject to change. You will be notified of

any changes to compensation via email. Current rates are as follows:

TRAINING PAYMENT Case Training and Dry Run Training $35.00 (flat fee) for all sessions

- 1-3 hour maximum

Objective Structured Clinical Examination $40.00 (flat fee) (OSCE) Case Training

- 1-3 hour maximum

ENCOUNTERS PAYMENT History/Interview encounter $15.00/hr Physical exam encounter $20.00/hr History/Physical exam encounter $20.00 /hr Female Breast Exam session $28.50/hr Male Pelvic/digital rectal/prostate exam $52.00/hr

SP COMPENSATION

QUALITY ASSURANCE

CANCELLATION REQUIREMENTS



SPs will be paid a minimum of 1 hour when working as a SP; payment will be calculated to the nearest .25 (¼) hours. Example 1: If the SP works for 1 hour and 10 minutes, the SP would be paid for 1 hour and 15 minutes; Example 2: If the SP works 1 hour and 5 minutes, the SP will be paid 1 hour. If the SP arrives earlier than their scheduled time, the SP will not be compensated for that additional time. Hours will be adjusted if an SP is required to stay longer, however, will not be reduced if a simulation session does not run as long as originally booked. SIMULATIONS OUTSIDE NOSM When participating in any simulation outside of NOSM, SPs will be responsible to have a SP time card

completed by the lead/tutor of the simulation session.

A program administration fee only applies to organizations outside of NOSM.

A quote will be prepared for you based on the following criteria:

Number of SPs requested

Training or not training SPs

Length of training and number of trainings required

Complexity of case

Moulage requests

SIMULATIONS WITHIN NOSM Laurentian Campus: The SCS Coordinator will complete a batch payment and pay the SPs in

accordance with the budget number you provide. Lakehead Campus: The SCS Coordinator will complete a batch payment and request a budget

transfer from your program to UME or you may provide your budget number. SIMULATIONS OUTSIDE NOSM

A billing name and address needs to be provided at the time of the booking request.

NOSM’s finance department will invoice your program, at most, 30 days post completion of the simulation event.

INVOICING

PROGRAM ADMINISTRATION FEE



Currently, parking costs are absorbed with the SPP if on site an NOSM.

Parking expenses will be billed to requesting program when off campus.

SPs are expected:

To exhibit professional and ethical behavior at all times.

To respect the authority and knowledge of other professionals.

To exhibit sensitivity and respect for other beliefs, opinions, gender, race, culture, religion, sexual preference, and status.

To refrain from speaking with learners “out of role” before or during the session. SPs should not be seen by any of the learners unless in role.

To refrain from interacting with the medical learners on a personal level since SPs are in a position of assessing the learner’s performance.

To not take any advice or recommendations during the course of any sessions as constituting individual medical care or advice from a physician tutor. Should something abnormal be found on physical exam, SPs can expect to be informed of the finding and be advised to seek medical evaluation and treatment from the SP’s personal physician/healthcare provider. Neither the learners nor the faculty should provide any medical advice to SPs nor should SPs seek medical advice from them.

To keep all scenarios, cases, procedures, communications and other related information of the SPP confidential.

To not discuss learner performance, behaviours, or interactions outside of simulation.

To not consume food or drink in ANY SP simulation, unless required by the scenario. SPs may only bring a water bottle into a scenario.

To leave personal effects out of sight within the room.

To turn off all cell phones and electronics during simulation session. Any SP expecting an important telephone call while on duty is welcome to leave his/her telephone with staff and, depending on the nature of the incoming call, will be notified at the first available opportunity at the discretion of the simulation lead/tutor.

To maintain good hygiene, proper grooming, and cleanliness at all times.

To understand and agree that drinking alcohol or consuming drugs prior to or during a simulation session are expressly prohibited.

CONFIDENTIALITY PARKING

SP PROFESSIONAL CONDUCT



If you are experiencing any difficulties with an SP, please address these concerns in a timely manner and in detail to the Clinical Skills Program Coordinator. If you are experiencing any difficulties with the Clinical Skills Program Coordinator, please address these concerns to the Manager of Education Services.

COMPLAINTS AND CONCERNS



APPENDIX A - CASE SPECIFICATIONS AND CASE TEMPLATE Case Specifications

Include only what the patient has. Do not include negatives or non-pertinent information. SPs are trained to answer “no” to a question if the information is not stated in the case.

Use language that a layperson would understand and use. Refrain from using medical terminology.

When writing the case, use “you” rather than “the patient”; this helps the SP get into character.

List events in chronological order

Use bullet points

Use bold type and underlying for important information.

Provide SP instruction as to what information can be : o Offered spontaneously without being specifically asked o Given with general questioning o Given only if asked a specific question

Include o General appearance of the patient (type of clothing, condition of hair and finger nails,

etc) o Body language of the patient (eye contact, slouched, etc) o Mood/Affect (hostile, worried, calm, exited, depressed, self-confident, etc.) o Communication (articulate, talkative/forthcoming, withdrawn, etc) o Positive physical findings (limp, tremor, abdominal pain, etc)

We advise that you NOT require the patient to have actual positive findings because recruiting them is usually much more difficult than expected. Many signs can be simulated, such as:

Aphasia Gait abnormalities Perspiration Acute abdomen Headache Phobic disorders Backache Hoffman's Sign Pneumothorax Black eye Imbalance Restricted range of motion Brudzinski's sign Incoordination Rigidity Chorea Jaundice Sensory loss Coma Joint tenderness Shortness of breath Confusion Kidney stones Tenderness Congestion Nervousness TIA signs COPD Nosebleeds Tremor Dementia Numbness Twitching Depression Panic disorders Vision abnormalities Exhaustion Paralysis Weakness Fatigue Parkinsonism Wheezing



SP Training Notes

Case Purpose List the objectives of what you want the learners to achieve

Case Name and Age

Presenting Situation

List the location of the situation ( clinic, office, ER) and why patient is seeking care (i.e. abdominal pain)

Psychosocial Profile

Give a little background on the patient situation (ie, abdominal pain, recent divorce, high stress job, having financial problems)

Opening Statement

Create a patient response to the learner’s opening question “ How can I help you today or why have you come in today”

History of Present Illness

Include any information about why the patient is in, be a descriptive as possible about symptoms and only include the things the patient does have, there is no need to include negatives (i.e. no dizziness, no headaches). Include the following information about the symptoms if applicable.

Location of pain

Onset of pain (when pain started)

Duration of pain

Frequency of pain

Quality of pain (describe how pain feels, eg. dull ache, sharp pain)

Severity of pain (pain scale)

Radiation of pain

Alleviating factors (things that make it better) and aggravating factors (things that make it worse)

Other associated symptoms (ie. complain of chest pain, but also feeling out of breath and tired all the time)

Review of systems questions related to the complaint of pain. May include the following: (Only input positive responses, if the SP gets asked a question and it is not in the case, they will respond NO)

General – changes in weight, fatigue, fever

Skin – rashes, lumps, dryness, hair and nail changes

Head/Eyes/Nose/Throat – Headaches, dizziness, blurriness, eye pain, eye discharge, hearing problems, ringing in ear, earaches, frequent colds, stuffiness, nosebleeds , problems swallowing

Neck – swollen glands, lumps, pain, stiffness

Breast – lumps, pain, discharge from nipples

Respiratory – cough, sputum, wheezing, last chest x-ray, asthma, etc

Cardiovascular – heart trouble, high/low blood pressure, cholesterol, murmurs, palpitations, chest pain

Gastrointestinal – heartburn, appetite, nausea, bowel movements (when, color, etc), abdominal pain, bloating

Urinary – frequency, at night, burning, dribbling, infections, etc.

Genital Male – Hernias, discharge, redness, sexual habits, scrotal pain, swelling



Peripheral Vascular – leg cramps, varicose veins, swelling, change in color or extremities.

MSK – muscle and joint pain, stiffness, arthritis, back ache

Psychiatric – nervousness, tension, mood, anxiety, depression, suicide

Neurologic – changes in mood, speech, memory loss, headache, dizziness, seizures, weakness, numbness or loss of sensations, tremors, pins and needles.

Hematologic – anemia, easy bruising, bleeding

Endocrine – thyroid trouble, heat or cold tolerance, excessive sweating, thirst or hunger, etc.

FIFE SP only responds if asked directly

Include the following information about the patient’s perspective

What are your fears/feelings about what is going on?

What do you think is going on, your idea(s)?

How has this affected/impacted your life, impacted your function in life?

What are your expectations for this visit?

Past Medical Hx

Include the following information about the patient’s past medical history, again only include positives.

Hospitalizations, Surgeries

Illnesses and Injuries

Current medications including alternate kinds

Last breast mammogram, colonoscopy, doctor’s visit

AllergiesPsychiatric problems

Heath Maintenance ( diet, exercise, immunizations, flu shot, other age related shots)

Social Hx

Include the following about the patient

Interpersonal relationships ( married, divorced, kids, home life)

Leisure activities ( work, school, volunteer)

Lifestyle habits (drinking, smoking, drugs)

Family Medical Hx

Include the following about the patient’s family

Parent’s health history

Sibling’s health history

Physical Exam Findings If the students are performing an exam – include what you want the SP to portray in the exam (eg. loss of feeling in hands, rebound pain in abdomen)

Special Instructions

Include here items such as:

Character attributes you want the SP to portray (eg. nervous, angry)

Make-up and dress applications needed

Instructions such as – don’t open up with information until student states confidentiality or be withdrawn at the beginning but once student establishes a rapport and you feel comfortable you can open up, at the end of the interview as the student is walking out, tell them you forgot to mention something. (these are just a few examples)



APPENDIX B - SP TRAINING TOOL KIT

COMMON SP TRAINING QUESTIONS Who should train SPs? At minimum, have someone present who is familiar with SP methodology as well as case content so that they can serve as your “experts”. Beyond this, other personnel (both familiar with and unfamiliar with SPs and the case) can be of great help during role‐play.

When should training be scheduled?

SPs need time to study and practice their case, therefore, training should be scheduled no less than 1 week prior to the simulation event.

If training is scheduled more than 2 weeks in advance of the simulation event a refresher training is a must because it is too easy to forget certain nuances in performance and content.

Avoid training on the same day if at all possible. This is especially important for summative examinations since maintaining exam standardization is critical.

How long should a training last?

There is no absolute right answer to this question as total training time required may be impacted by the experience of the SP with your program and students, previous experience with the case, etc. In general, don’t plan on less than 2 hours training time per case –and in many instances even longer training sessions are required. The more time you invest in training, the more standardized your SP will be which will improve the reliability of your simulation.

Limit any one session to no more than 3 hours; SPs will start to fatigue and be unable to concentrate.

Don’t assume that once trained, behavior won’t change – keep an eye on the SPs on the day of the session and intervene as necessary.

If I have more than one SP portraying the same case, should I train them as a group?

Absolutely! This creates a single-minded understanding of the patient among all SPs.

It provides for consistency of information

Try to avoid separate trainings if at all possible. Separate trainings create extra work. It is cumbersome and difficult to remember all the insights that we and each SP discover during each training and then to share those insights with the other SPs.

How do I test the SPs portrayal of the case? Your decision on how to test the SPs will depend on the SPs experience, whether they have played the role before and the complexity of the case. There are various methods such as:

Role play the scenario individually with each SP. During each role play, the goal is to present the SP with new situations and scenarios (confident, distracted, shy, distant, intense learners) in order to make sure he/she reacts in a standardized manner. Focusing on complicated aspects of the case and easily confused concepts is helpful.



Conduct a round robin where you ask questions of each patient as you go around the table.

Have the SPs interview each other.

Create test or quiz questions about the case content to test their content knowledge. Other Important Training Tips

Provide a copy of the case to the SPs a few days prior to the scheduled training so they can review the details and come more prepared.

Introduce SPs when they arrive

Confirm important dates and times

Review the session learning objectives

Ask the SPs how they envision the character when they read the case and then provide a brief description of how you envision the character and would like the character played.

Conduct a table read of the case. o Even though the SPs might have received the training materials prior to the session, it

is still essential to have them read through them again together. By going through the materials out loud together – everyone is thinking about the details of the case together.

Repeatedly ask if they have questions about the content

Use patient language

Develop the story of the patient

Train the SP on what they have, not what they don’t have

Use SPs own experience when possible

Make them feel the case, not just learn it.

If they ask a question about information that was not in the case, instruct them the answer is always “no”.

Sometimes patients will need to ad-lib. Instruct them to keep things as normal as possible and within the character of the patient they are portraying.

Set the standard of the portrayal by playing the role yourself to show them what you expect.

Use video of actual patients as a training tool.

Review of learner objectives and discussion with respect to what non-verbal and verbal communication skills SPs should be focusing on during the encounter

Have SPs practice giving feedback

Cases with physical exam findings o Provide a step by step instruction on the physical exam that will be performed. o Show a video of the exam if possible o Instruct the SP on how a normal patient with no physical finding would react then

instruct them on how they should be reacting with a finding o Be an example for them and show them what you expect o Use a clinician as a resource when necessary to learn the correct manifestation of the

signs.



Suggested Readings 1. Barrows, Howard S. (1999). Training Standardized Patients to Have Physical Findings. Southern Illinois University School of Medicine. 2. Wallace, Peggy, (2007). Coaching Standardized Patient for Use in the Assessment of Clinical Competence. Springer Publishing Company.

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