Hi everyone. My name is Karen Lewis, and I've been involved in SP education for 20 years. Currently, I oversee the clinical learning and simulations skills also known as class center at the George Washington University School of Medicine and Health Sciences. For Howard Barrows, the physician who invented the concept of the standardized patient or SP in the 1960s. A standardized patient is a person who has been carefully coached to simulate an actual patient so accurately that the simulation cannot be detected by a skilled clinician. What I enjoy most about this kind of simulation is the power of the interaction. The richness of the communication between the participant and the SP that really drives learning. The goal of this module is to introduce you to some basic concepts concerning SPs and give you some tools to help you implement them. It consists of four lectures. I will start in Lecture 1 by clarifying the term SP which has broadened since Barrows first introduced it. Then I will introduce you to the association of standardized patient educators or SP and their standards of best practice, which you should read before viewing the lectures. Then I will discuss the advantages of creating SP simulations. When is it appropriate to include them and why? The second lecture will focus on developing SP scenarios or cases and introduce you to a case template that will make case writing easier for you to develop and standardize. The third lecture will focus on recruiting SPs. Who are they? Where do you find them? It will also focus on techniques you can use for training them for role portrayal. In the last lecture, I will discuss SP program management and identify opportunities for professional development for those training SPs and administering SP activities. Here are the objectives. Upon completion of the module, participants will be able to explain the nuances of the term SP, describe at least three techniques to use when training SPs for role portrayal, describe at least three SP-specific policies needed for SP programs, and identify methods of developing expertise as an SP educator, and finally identify the domains and principles of the SP standards of best practice. To prepare, please read the following before each lecture. For Lecture 1, read the ASPE standards of best practice introduction, process, terms, and discussion sections. Lecture 2, ASPE case development template and the ASPE standards of best practice domains 1&2. For Lecture 3, read the ASPE standards of best practice domain 3, and for Lecture 4, read ASPE standards of best practice domains 4&5. You can access the standards from the online journal advances in simulation free of charge. You can also find a downloadable essential reading list in the additional files section at the end of the article. I recommend this list for everyone who works with SPs. There's a lot to cover. So let's get started. Welcome to session one, terminology, standards, and the role and function of SPs in simulation. We'll begin this session by clarifying the term SP and introducing the association of standardized patient educators hereafter referred to as ASPE, and their standards of best practice which will be referenced throughout all the sessions. Then I will discuss the role and function of SPs in simulation. Here are objectives for session one. Describe the term SP, identify the five ASPE standard of best-practice domains, and list at least three kinds of scenarios SPs are well-suited for. Let's start with terminology. In the introduction, I mentioned how Howard Barrows defined the term standardized patient. Over time, the meaning has broadened. SP can stand for standardized patient, simulated patient, or simulated participant. All of the terms have distinct nuances. The ASPE standards of best practice explain that the term standardized patient and simulated patient or SP are often used interchangeably and refer to a person trained to portray a patient in realistic and repeatable ways. The consistency and accuracy or standardization of an SP role portrayal depends on the context in which the SP is working. Informative or teaching simulation activities, SPs may play roles that allow them to respond to the learner with flexibility and authenticity depending on the needs of the learners. In this context, the patient behavior is that of a simulated patient. In a summative assessment, individual SPs as well as SPs portraying the same role are trained to behave in repeatable manner to ensure consistency and fairness to all learners. In this context, they are standardized patients. In the last decade, the roles that SPs may play has grown in scope to include clients, family members, and healthcare professionals, and there is evidence that SP methodology can be successfully applied when working with any individuals portraying humans and simulations. As a result the term simulated participant is beginning to gain recognition as a more inclusive term. References to SPs in this module include all nuances of the term. The patient training SP is referred to as an SP educator. This trainer may be someone who exclusively works with SPs or the trainer may be a faculty or staff member who trains SPs in addition to performing other clinical, administrative, and simulated related roles. Regardless, they all work to develop expertise in SP methodology. SP-based work has increased significantly since Dr. Barrows created the concept. The United States and Canadian SP-based licensing exams that certify physician competencies have been major drivers for this rise in North America. Most US medical schools include SPs in their curricula for teaching and assessment, and SPs are increasingly found in nursing and physician assistant curricula along with many others. Concurrent with the rise in SP-based simulation has been the development of the educators who train them. In 2001, the association of standardized patient educators was created to support this new profession. ASPE's mission is to promote best education, assessment and research practices in the application of SP methodology, disseminate SP methodology research and scholarship, and advance the knowledge and skills of its members. Its membership is comprised of educators from allopathic and osteopathic medicine, allied health, dentistry, nursing, pharmacology, social work, veterinarian medicine, and others. All sessions in this module will reference the ASPE standards of best practice. As you know from preparing for this module, this document was written over time by many experts in the field of SP education from around the world. It provides standards for educators who work with SPs. The standards identify five domains of best practice with their corresponding principles which are similar to the uniaxial criteria. Their principles correspond to key practices which are like the inaxial elements. The first ASPE domain is safe work environment, the second is case development, the third is training for role portrayal, feedback, and assessment, the fourth is program management, and the fifth is professional development. Underlying the domains are the values safety, quality, professionalism, accountability, and collaboration. The standards were designed to be used when including SPs in simulations and simulation programs. They're intended to be used in conjunction with the International Association for clinical simulation and learning or inaxial standards of best practice simulation, which were introduced in our earlier module and addressed broader simulation practices. The standards provide clear and practical guidelines for educators who work with SPs. The guidelines are precise yet flexible enough to address the diversity of varying contexts of SP practice. The standard serve as a roadmap. They give new programs a place to start and they provide existing programs opportunities to grow, and they offer seasoned programs measures for demonstrating appropriate growth. The standards point the necessity for ensuring the psychological and physical safety of all stakeholders in an SP scenario, and they caution that the potential consequences of not following them could compromise the safety of the participants and the effectiveness of the simulation session. I think you will find the standards to be an essential tool as you grow and elevate your SP simulations. Now that I have defined SPs and introduced you to standards, let's discuss the role of SPs in simulation. With training, SPs are well-suited for inclusion in a wide range of simulation scenarios. They address the learning needs of healthcare professionals at all stages of their training. There are many reasons for including SPs in health professions training. First and foremost is that with proper training, their patient presentations are highly authentic. SPs can simulate a broad range of clinical presentations and a variety of characters. So they can fill in gaps in learner experience of common, as well as uncommon clinical presentations. Their roles can be created to match their learner's level of experience, thereby creating a learner-centered safe environment. Furthermore, SPs are available whenever the curriculum objectives require experiences with patients and SP portrayals are portable. Their simulations can take place wherever health care professionals and training work and learn, and research indicates that integrating SPs into consultation skills training is more effective than didactic training. Additionally, SPs conserve as teachers when trained to give feedback to learners on communication, physical examination, or procedural skills. Here are some photos of SPs in action. SPs can portray the same patient at various points in time to provide learners with continuity of practice experiences. Moreover, SP scenarios can provide learners with the experience in environments that would put real patients at risk, such as breaking bad news multiple times. SPs can also provide feedback to learners from a patient perspective, which is a unique feature of SP-based work. For assessments, SPs can be trained to reproduce the simulation for multiple learners and they can provide evaluation data on learner competencies. Including SPs in teaching physical examination and procedural skills can provide cost savings by freeing up faculty time. SPs can lend authenticity to manikin-based simulations by portraying family members, bystanders, or the voice of the patient. Now that we've discussed the definition of an SP, introduced the ASPE standards of best practice, and reviewed the function of SPs and simulations, we will next discuss how to develop SP cases or scenarios. Before proceeding to session two, please take a few minutes to complete the session one quiz and review the ASPE standards case development template, and the ASPE standards domains 1&2.
