Applying standardized patients to augment clinical skills in clinical medical students’ national proficiency test

Applying standardized patients to augment clinical skills in clinical medical students’ national proficiency test | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Applying standardized patients to augment clinical skills in clinical medical students’ national proficiency test Haihong Wang, Hanbing Lv, Shuwen Shi, Jingyu Yang, Liujuan Zheng, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4257263/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose : To examine the impact of standardized patient encounters (SPEs) on clinical thinking ability and skills of clinical medical students. Methods : Fourth-year medical students admitted from 2016 and 2017 received curriculum that was not included SPEs while from 2018 and 2019 started to complete a clinical thinking ability and skills curriculum that was expanded to include SPEs. Learners completed 6 SPEs clinical cases. Faculty observers and standardized patients completed checklists focused on history-taking, counseling, and interpersonal communication, and provided learner feedback after each case. The curriculum was evaluated by comparing clinical skills scores in clinical medical students’ national proficiency test each year. National proficiency test included 6 skills stations: 2 stations assessing history collection, 2 stations assessing physical examination and 2 stations assessing basic clinical skills. Changes in clinical skills scores were assessed. Results : In the study, there were 757 students admitted from 2106 and 2017 received curriculum that was not included SPEs (SPEs group) and 731 students admitted from 2018 completed the skills curriculum that was expanded to include SPEs (Normal group). Learners’ overall clinical scores improved by 2.8 (confidence interval [CI]: 2.29-3.25; P<0.0001) in SPEs group compared with normal group. Similar improvements in station 2, 3, 4 and 5 scores were occurred in SPEs group. Conclusions : The combination of SPEs with clinical skills curriculum is effective at improving national proficiency test scores for clinical medical students. The comprehensive curriculum allowed learners to better apply knowledge and practice skills. clinical skills medical education standardized patients national proficiency test Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction Developing clinical thinking ability and skills are of great importance for medical undergraduate education 1 . Standardized patient encounters (SPEs) have been demonstrated to improve self-efficacy, knowledge, and skills in various clinical areas for undergraduate, graduate, and professional learners 2 – 8 . However, there is no study focus on the effect of SPEs on clinical skills scores on national level test in China. Thus, we redesigned our curriculum to support medical students to develop clinical thinking ability and skills in interacting with patients. To meet this goal, we reevaluated learning objectives and added SPEs to our curriculum. Furthermore, we designed SPE experiences presenting with questions regarding medical clinical case. For this study, we evaluate the impact of SPEs on clinical thinking ability and skills. Specifically, we aim to determine the expanded curriculum’s impact on national professional level test among medical students. We hypothesize that adding the SPEs would further augment clinical skills of medical students. Materials and methods Curricular component and target learners The curriculum “Clinical thinking ability and skills” is compulsory for medical undergraduate in Zhejiang University at the fourth year. This curriculum consists of 6 clinical cases for learners to practice normal procedure and operation in clinic. Cases are based on typical presentations of clinical skill operation. 6 cases included pleural effusion, seroperitoneum, pelvic mass, pediatric asthma, hematological system disease and nervous system disease. Fourth-year medical students admitted from 2016 and 2017 received curriculum that was not included SPEs while from 2018 and 2019 started to complete a clinical thinking ability and skills curriculum that was expanded to include SPEs. Learners completed 6 SPEs clinical cases. Faculty observers and standardized patients completed checklists focused on history-taking, counseling, and interpersonal communication, and provided learner feedback after each case. The curriculum was evaluated by comparing clinical skills scores in clinical medical students’ national proficiency test each year 9 . The total score of national professional level test was 100. National proficiency test was evaluated by the Objective Structured Clinical Examination that included 6 skills stations: 2 stations assessing history collection (Station 1–2), 2 stations assessing physical examination (Station 3–4) and 2 stations assessing basic clinical skills (Station 5–6). Station 1–4 included SPEs cooperation. Station 3–4 contained basic examination, head and neck examination, chest examination, abdominal examination, spine, limbs and anus examination, and nervous system examination. Station 5–6 included operation such as surgical brush manipulation, surgical area disinfect and towels spread, gown put-on and taken-off, sterile gloving, sutures and ligations, dressing change and stitches removing, venipuncture, cardio-pulmonary resuscitation and self inflating bag usage. National professional level test is compulsory and comprehensive test for medical students in China that can reflect theoretical and practical level. Analyses The data were analyzed using Stata SE 15.1 for Windows (Stata Corp, College Station, TX). We used t test to compare curriculum scores. P < 0.05 is considered to have significance. Results Overall scores In SPEs group, there were 757 students admitted from 2016 and 2017, and 731 students recruited from 2018 and 2019 in normal group. The analyses for overall clinical scores were provided in Fig. 1 . The overall scores improved by 2.8 (confidence interval [CI]: 2.29–3.25; P < 0.0001) in SPEs group compared with normal group. Station 1 score SPEs group had no statistically significant improvement in station 1 results from examiner. Of note, the station 1 results from SPE improved by 1.57 (95% confidence interval [CI]: 1.38–1.76; P < 0.0001) in SPEs group compared with normal group (Fig. 2 ). Station 2 score Changes in station 2 scores from examiners and SPEs are demonstrated in Fig. 3 . Notably, there were statistically significant improvements comparing normal group and SPEs group. Station 3 score The similar improvement was also happened among station 3 scores from SPEs (Fig. 4 ). Comparing the station 3 scores between two groups, there was a statistically significant difference between means +/- SEM (4.686+/-0.433). Station 4 score When analyzed station 4 scores, scores had a similar progression from SPEs group that were statistically significant compared with normal groups (Fig. 5 ). Station 5 score Moreover, analyses for station 5 scores demonstrated that scores in SPEs group increased by 1.88 (95% confidence interval [CI]: 1.179–2.582; P < 0.0001) (Fig. 6 ). Station 6 score Interestingly, the station 6 scores in SEP group were significantly lower than the scores in normal group (P = 0.0003) (Fig. 7 ). Discussion In this study, we built upon our clinical skills curriculum with SPEs, which have previously shown to be effective in improving students-related knowledge and thinking abilities. We augmented our curriculum for learners to achieve a higher level of learning by adding SPEs and thereby allowing learners to practice with SPEs and get feedback from SPEs. The most salient results of our study included that medical students improved national proficiency test scores after the curriculum with SPEs. In details, they increased station scores in history-taking, physical examination and clinical basic operation through participating in these SPEs. Utilizing standardized patients to clinical skills curriculum allowed learners to have repetitive practice in communication in a low-stakes setting while being observed and subsequently provided with formative feedback and an opportunity for self-reflection 10 . Through this curriculum combined with SPEs, our learners’ observed skills improved from the scores of national proficiency test. They demonstrated an increase in scores from station 1 and 2, which focused on history-taking skills and skills in counseling and communication. They increased scores from station 3 and 4, which focused on patient’s physical examination and collection. Additionally, their clinical basic operation in national professional level test through the SPEs increased. Considering the potential reasons of increased scores with combination of SPEs, the learning enthusiasm of students may be enhanced and students get better communication skills after training with SPEs, that can contribute to improve humanistic communication literacy score in national test 11 – 12 . Our study suggests a combination of SPEs is helpful. To our knowledge, there are no descriptions in the literature of utilizing SPEs to enhance national proficiency test in China. Despite the innovation and impact of our findings, our study has limitations. Our study was conducted only among medical students in Zhejiang University with a relatively small number, which may limit the study’s generalizability. Because of the small number of students, we could not assess changes in educational domains for this learner group. Additionally, we did not measure clinical specific educational activities outside of the curriculum, which could potentially influence our findings. However, it is unlikely learners would participate in activities that would significantly contribute to the improvement in clinical thinking and activity skills found in our study. The study offers potential directions for university educators intending to use SPEs in clinical skills curriculum. And, learners will further benefit from the curriculum with SPEs. For the next phase of our curriculum evaluation, we plan to further collect validity evidence of the checklists and assessments from faculty observer and SPEs. In addition, we plan to track learners’ long-term clinical skills and experiences. Conclusion This study presents a modification of the standard model of clinical thinking ability and skills curriculum, which we successfully improve medical students’ national proficiency test. Future observation of clinical skills curriculum will need to be done to demonstrate that SPEs applications have impacted the clinical skills of medical undergraduate. We recommend further evaluation of this approach as a potential teaching method for medical education. Declarations Author Contribution Haihong Wang and Hanbing Lv wrote this manuscript, Shuwen Shi and Jingyu Yang collected the data, Liujuan Zheng and Xiangming Fang planned this study's protocol. Declaration of interest statement The authors confirm no conflict of interest in this study. Protocol approvement The study protocol conforms to exemption from ethical approvement, and is also not subject to review according to current ethical standards of Ethics Committee of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. The proof from ethics committee is found in attachment. The informed consent was obtained from all students. Availability of Data and Materials The datasets generated during the current study are not publicly available but are available from the corresponding author on reasonable request. Funding Curriculum Ideological and Political Education Research Project, The First Batch, Zhejiang Province: Research on the clinical thinking and skills course oriented by medical practitioners in the new era References Papp KK, Huang GC, Lauzon LM, et al. Milestones of critical thinking: a developmental model for medicine and nursing. Acad Med. 2014;89:715–20. Downar J, McNaughton N, Abdelhalim T, et al. Standardized patient simulation versus didactic teaching alone for improving residents’ communication skills when discussing goals of care and resuscitation: a randomized controlled trial. Palliat Med. 2017;31:130–9. Downar J, Knickle K, Granton JT, et al. Using standardized family members to teach communication skills and ethical principles to critical care trainees. Crit Care Med. 2012;40:1814–9. Fallowfield L, Jenkins V, Farewell V, et al. Efficacy of a cancer research UK communication skills training model for oncologists: a randomised controlled trial. Lancet. 2002;359:650–6. Lorin S, Rho L, Wisnivesky JP, et al. Improving medical student intensive care unit communication skills: a novel educational initiative using standardized family members. Crit Care Med. 2006;34:2386–91. Tulsky JA. Interventions to enhance communication among patients, providers, and families. J Palliat Med. 2005;8(suppl 1). Woods JL, Pasold TL, Boateng BA, et al. Adolescent health care and the trainee: roles of self-efficacy, standardized patients, and an adolescent medicine rotation. Simul Healthc J Soc Simul Healthc. 2013;8:359–67. Motola I, Devine LA, Chung HS, et al. Simulation in healthcare education: a best evidence practical guide. AMEE guide 82 Med Teach. 2013;35:e1511–30. Zhang JY, Liu YJ, Shu T, et al. Factors associated with medical students’ self-regulated learning and its relationship with clinical performance: a cross-sectional study. BMC Med Educ. 2022;22:128. Wang WD, Yang PC, Chen CY, et al. Using senior residents as standardized patients for evaluating basic clinical skills of medical students. J Formos Med Assoc. 2004;103:519–25. Chunharas A, Hetrakul P, Boonyobol R, et al. Medical students themselves as surrogate patients increased satisfaction, confidence, and performance in practicing injection skill. Med Teach. 2013;35:308–13. Mounsey AL, Bovbjerg V, White L, et al. Do students develop better motivational interviewing skills through role-play with standardized patients or with student colleagues? Med Teach. 2006;40:775–80. Additional Declarations No competing interests reported. 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Standardized patient encounters (SPEs) have been demonstrated to improve self-efficacy, knowledge, and skills in various clinical areas for undergraduate, graduate, and professional learners\u003csup\u003e\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. However, there is no study focus on the effect of SPEs on clinical skills scores on national level test in China. Thus, we redesigned our curriculum to support medical students to develop clinical thinking ability and skills in interacting with patients. To meet this goal, we reevaluated learning objectives and added SPEs to our curriculum. Furthermore, we designed SPE experiences presenting with questions regarding medical clinical case. For this study, we evaluate the impact of SPEs on clinical thinking ability and skills. Specifically, we aim to determine the expanded curriculum\u0026rsquo;s impact on national professional level test among medical students. We hypothesize that adding the SPEs would further augment clinical skills of medical students.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eCurricular component and target learners\u003c/p\u003e \u003cp\u003eThe curriculum \u0026ldquo;Clinical thinking ability and skills\u0026rdquo; is compulsory for medical undergraduate in Zhejiang University at the fourth year. This curriculum consists of 6 clinical cases for learners to practice normal procedure and operation in clinic. Cases are based on typical presentations of clinical skill operation. 6 cases included pleural effusion, seroperitoneum, pelvic mass, pediatric asthma, hematological system disease and nervous system disease. Fourth-year medical students admitted from 2016 and 2017 received curriculum that was not included SPEs while from 2018 and 2019 started to complete a clinical thinking ability and skills curriculum that was expanded to include SPEs. Learners completed 6 SPEs clinical cases. Faculty observers and standardized patients completed checklists focused on history-taking, counseling, and interpersonal communication, and provided learner feedback after each case.\u003c/p\u003e \u003cp\u003eThe curriculum was evaluated by comparing clinical skills scores in clinical medical students\u0026rsquo; national proficiency test each year\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. The total score of national professional level test was 100. National proficiency test was evaluated by the Objective Structured Clinical Examination that included 6 skills stations: 2 stations assessing history collection (Station 1\u0026ndash;2), 2 stations assessing physical examination (Station 3\u0026ndash;4) and 2 stations assessing basic clinical skills (Station 5\u0026ndash;6). Station 1\u0026ndash;4 included SPEs cooperation. Station 3\u0026ndash;4 contained basic examination, head and neck examination, chest examination, abdominal examination, spine, limbs and anus examination, and nervous system examination. Station 5\u0026ndash;6 included operation such as surgical brush manipulation, surgical area disinfect and towels spread, gown put-on and taken-off, sterile gloving, sutures and ligations, dressing change and stitches removing, venipuncture, cardio-pulmonary resuscitation and self inflating bag usage. National professional level test is compulsory and comprehensive test for medical students in China that can reflect theoretical and practical level.\u003c/p\u003e \u003cp\u003eAnalyses\u003c/p\u003e \u003cp\u003eThe data were analyzed using Stata SE 15.1 for Windows (Stata Corp, College Station, TX). We used \u003cem\u003et\u003c/em\u003e test to compare curriculum scores. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 is considered to have significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOverall scores\u003c/p\u003e \u003cp\u003eIn SPEs group, there were 757 students admitted from 2016 and 2017, and 731 students recruited from 2018 and 2019 in normal group. The analyses for overall clinical scores were provided in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The overall scores improved by 2.8 (confidence interval [CI]: 2.29\u0026ndash;3.25; P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) in SPEs group compared with normal group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eStation 1 score\u003c/p\u003e \u003cp\u003eSPEs group had no statistically significant improvement in station 1 results from examiner. Of note, the station 1 results from SPE improved by 1.57 (95% confidence interval [CI]: 1.38\u0026ndash;1.76; P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) in SPEs group compared with normal group (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eStation 2 score\u003c/p\u003e \u003cp\u003eChanges in station 2 scores from examiners and SPEs are demonstrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Notably, there were statistically significant improvements comparing normal group and SPEs group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eStation 3 score\u003c/p\u003e \u003cp\u003eThe similar improvement was also happened among station 3 scores from SPEs (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Comparing the station 3 scores between two groups, there was a statistically significant difference between means +/- SEM (4.686+/-0.433).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eStation 4 score\u003c/p\u003e \u003cp\u003eWhen analyzed station 4 scores, scores had a similar progression from SPEs group that were statistically significant compared with normal groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eStation 5 score\u003c/p\u003e \u003cp\u003eMoreover, analyses for station 5 scores demonstrated that scores in SPEs group increased by 1.88 (95% confidence interval [CI]: 1.179\u0026ndash;2.582; P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eStation 6 score\u003c/p\u003e \u003cp\u003eInterestingly, the station 6 scores in SEP group were significantly lower than the scores in normal group (P\u0026thinsp;=\u0026thinsp;0.0003) (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we built upon our clinical skills curriculum with SPEs, which have previously shown to be effective in improving students-related knowledge and thinking abilities. We augmented our curriculum for learners to achieve a higher level of learning by adding SPEs and thereby allowing learners to practice with SPEs and get feedback from SPEs. The most salient results of our study included that medical students improved national proficiency test scores after the curriculum with SPEs. In details, they increased station scores in history-taking, physical examination and clinical basic operation through participating in these SPEs.\u003c/p\u003e \u003cp\u003eUtilizing standardized patients to clinical skills curriculum allowed learners to have repetitive practice in communication in a low-stakes setting while being observed and subsequently provided with formative feedback and an opportunity for self-reflection\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Through this curriculum combined with SPEs, our learners\u0026rsquo; observed skills improved from the scores of national proficiency test. They demonstrated an increase in scores from station 1 and 2, which focused on history-taking skills and skills in counseling and communication. They increased scores from station 3 and 4, which focused on patient\u0026rsquo;s physical examination and collection. Additionally, their clinical basic operation in national professional level test through the SPEs increased. Considering the potential reasons of increased scores with combination of SPEs, the learning enthusiasm of students may be enhanced and students get better communication skills after training with SPEs, that can contribute to improve humanistic communication literacy score in national test\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Our study suggests a combination of SPEs is helpful.\u003c/p\u003e \u003cp\u003eTo our knowledge, there are no descriptions in the literature of utilizing SPEs to enhance national proficiency test in China. Despite the innovation and impact of our findings, our study has limitations. Our study was conducted only among medical students in Zhejiang University with a relatively small number, which may limit the study\u0026rsquo;s generalizability. Because of the small number of students, we could not assess changes in educational domains for this learner group. Additionally, we did not measure clinical specific educational activities outside of the curriculum, which could potentially influence our findings. However, it is unlikely learners would participate in activities that would significantly contribute to the improvement in clinical thinking and activity skills found in our study.\u003c/p\u003e \u003cp\u003eThe study offers potential directions for university educators intending to use SPEs in clinical skills curriculum.\u003c/p\u003e \u003cp\u003eAnd, learners will further benefit from the curriculum with SPEs. For the next phase of our curriculum evaluation, we plan to further collect validity evidence of the checklists and assessments from faculty observer and SPEs. In addition, we plan to track learners\u0026rsquo; long-term clinical skills and experiences.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study presents a modification of the standard model of clinical thinking ability and skills curriculum, which we successfully improve medical students\u0026rsquo; national proficiency test. Future observation of clinical skills curriculum will need to be done to demonstrate that SPEs applications have impacted the clinical skills of medical undergraduate. We recommend further evaluation of this approach as a potential teaching method for medical education.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eHaihong Wang and Hanbing Lv wrote this manuscript, Shuwen Shi and Jingyu Yang collected the data, Liujuan Zheng and Xiangming Fang planned this study's protocol.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDeclaration of interest statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors confirm no conflict of interest in this study. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProtocol approvement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol conforms to exemption from ethical approvement, and is also not subject to review according to current ethical standards of Ethics Committee of\u0026nbsp;Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. The proof from ethics committee is found in attachment.\u003c/p\u003e\n\u003cp\u003eThe informed consent was obtained from all students.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during the current study are not publicly available but are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCurriculum Ideological and Political Education Research Project, The First Batch, Zhejiang Province: Research on the clinical thinking and skills course oriented by medical practitioners in the new era\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePapp KK, Huang GC, Lauzon LM, et al. Milestones of critical thinking: a developmental model for medicine and nursing. Acad Med. 2014;89:715\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDownar J, McNaughton N, Abdelhalim T, et al. Standardized patient simulation versus didactic teaching alone for improving residents\u0026rsquo; communication skills when discussing goals of care and resuscitation: a randomized controlled trial. Palliat Med. 2017;31:130\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDownar J, Knickle K, Granton JT, et al. Using standardized family members to teach communication skills and ethical principles to critical care trainees. Crit Care Med. 2012;40:1814\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFallowfield L, Jenkins V, Farewell V, et al. Efficacy of a cancer research UK communication skills training model for oncologists: a randomised controlled trial. Lancet. 2002;359:650\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLorin S, Rho L, Wisnivesky JP, et al. Improving medical student intensive care unit communication skills: a novel educational initiative using standardized family members. Crit Care Med. 2006;34:2386\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTulsky JA. Interventions to enhance communication among patients, providers, and families. J Palliat Med. 2005;8(suppl 1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWoods JL, Pasold TL, Boateng BA, et al. Adolescent health care and the trainee: roles of self-efficacy, standardized patients, and an adolescent medicine rotation. Simul Healthc J Soc Simul Healthc. 2013;8:359\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMotola I, Devine LA, Chung HS, et al. Simulation in healthcare education: a best evidence practical guide. AMEE guide 82 Med Teach. 2013;35:e1511\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang JY, Liu YJ, Shu T, et al. Factors associated with medical students\u0026rsquo; self-regulated learning and its relationship with clinical performance: a cross-sectional study. BMC Med Educ. 2022;22:128.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang WD, Yang PC, Chen CY, et al. Using senior residents as standardized patients for evaluating basic clinical skills of medical students. J Formos Med Assoc. 2004;103:519\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChunharas A, Hetrakul P, Boonyobol R, et al. Medical students themselves as surrogate patients increased satisfaction, confidence, and performance in practicing injection skill. Med Teach. 2013;35:308\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMounsey AL, Bovbjerg V, White L, et al. Do students develop better motivational interviewing skills through role-play with standardized patients or with student colleagues? Med Teach. 2006;40:775\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"clinical skills, medical education, standardized patients, national proficiency test","lastPublishedDoi":"10.21203/rs.3.rs-4257263/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4257263/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: To examine the impact of standardized patient encounters (SPEs) on clinical thinking ability and skills of clinical medical students.\u003cbr\u003e\n\u003cstrong\u003eMethods\u003c/strong\u003e: Fourth-year medical students admitted from 2016 and 2017 received curriculum that was not included SPEs while from 2018 and 2019 started to complete a clinical thinking ability and skills curriculum that was expanded to include SPEs. Learners completed 6 SPEs clinical cases. Faculty observers and standardized patients completed checklists focused on history-taking, counseling, and interpersonal communication, and provided learner feedback after each case. The curriculum was evaluated by comparing clinical skills scores in clinical medical students’ national proficiency test each year. National proficiency test included 6 skills stations: 2 stations assessing history collection, 2 stations assessing physical examination and 2 stations assessing basic clinical skills. Changes in clinical skills scores were assessed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: In the study, there were 757 students admitted from 2106 and 2017 received curriculum that was not included SPEs (SPEs group) and 731 students admitted from 2018 completed the skills curriculum that was expanded to include SPEs (Normal group). Learners’ overall clinical scores improved by 2.8 (confidence interval [CI]: 2.29-3.25; P\u0026lt;0.0001) in SPEs group compared with normal group. Similar improvements in station 2, 3, 4 and 5 scores were occurred in SPEs group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: The combination of SPEs with clinical skills curriculum is effective at improving national proficiency test scores for clinical medical students. The comprehensive curriculum allowed learners to better apply knowledge and practice skills.\u003c/p\u003e","manuscriptTitle":"Applying standardized patients to augment clinical skills in clinical medical students’ national proficiency test","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-07 15:24:24","doi":"10.21203/rs.3.rs-4257263/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"75ab7b75-a5f4-47ee-8cc1-91ae1e223ebe","owner":[],"postedDate":"May 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-18T10:54:17+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-07 15:24:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4257263","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4257263","identity":"rs-4257263","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}