Using Unannounced Standardized Patients to Explore Variation in Care for Patients With Depression

Zabar, Sondra; Hanley, Kathleen; Watsula-Morley, Amanda; Goldstein, Jenna; Altshuler, Lisa; Dumorne, Heather; Wallach, Andrew; Porter, Burdett R.; Kalet, Adina; Gillespie, Colleen

doi:10.4300/jgme-d-17-00736.1

Cited by 6 publications

(5 citation statements)

References 20 publications

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“…After deduplication (n=3,676), the abstracts of 8,226 articles were reviewed and 34 potentially eligible articles were identified. 13 articles (20,21,30,(40)(41)(42)(43)(44)(45)(46)(47)(48)(49) were included eventually (Figure 1).…”

Section: Literature Search Resultsmentioning

confidence: 99%

Developing evidenced-based quality assessment checklist for real practice in primary health care using standardized patients: a systematic review

Wang¹,

Zhao²,

Xu³

et al. 2021

Ann Palliat Med

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Background: The aim of this review was to explore the quality assessment checklists development methods in previous researches using standardized patients (SPs), as well as to propose an evidence-based checklist development procedure for quality assessment of common conditions in primary health care (PHC) settings.Methods: We conducted a systematic review of studies that described checklist development method and extracted the methodology in terms of the developer, the basis and processes. Based on that, we formulated the development procedure according to the recommendations of the WHO Handbook for Guideline Development. Results: We identified a total of 13 articles, and proposed the following five key steps: (I) Forming a multidisciplinary team; (II) Selecting and evaluating relevant references; (III) Extracting medical information and forming the basic items; (IV) Clinical expert consensus on the items; and (V) Pre-testing the item pool and determining final items.Discussion: SP has been proven to be an effective method to assess performance in practice. There are still some deficiencies in the developing of case-specific checklists using SPs. To ensure the validity and reliability of checklists, the development processes need to be more standardized and procedural.

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Section: Literature Search Resultsmentioning

confidence: 99%

Developing evidenced-based quality assessment checklist for real practice in primary health care using standardized patients: a systematic review

Wang¹,

Zhao²,

Xu³

et al. 2021

Ann Palliat Med

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“…In our USP program, telephone calls to the clinic after a visit afforded information about the accessibility of the care team for follow-up questions and behaviorally specific information and actionable improvement targets for the site and staff. In prior work, we describe the impact of systematic USP data about the implementation of patient-centered care and patient safety measures for improving outcomes ( 12 , 24 – 27 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Primary Care Patients’ and Unannounced Standardized Patients’ Perceptions of Care

Altshuler

Fisher

Wilhite

et al. 2023

Journal of Patient Experience

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The objective of this study was to compare unannounced standardized patient (USP) and patient reports of care. Patient satisfaction surveys and USP checklist results collected at an urban, public hospital were compared to identify items included in both surveys. Qualitative commentary was reviewed to better understand USP and patient satisfaction survey data. Analyses included χ2 and Mann-Whitney U test. Patients provided significantly higher ratings on 10 of the 11 items when compared to USPs. USPs may provide a more objective perspective on a clinical encounter than a real patient, reinforcing the notion that real patients skew overly positive or negative.

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“…Senior level residents may benefit from additional responsibility during training, such as by bringing clinical examples, relating material to specific clinic encounters, directing learning with prepared questions, or taking the place of the co-facilitator to support discussion and technical assistance. Our curriculum could also be integrated with other forms of skill application for senior level residents, such as through facilitated role play, recorded encounters with subsequent self-rated practice ( 17 , 20 , 41 ), pediatric simulation ( 60 ), or unannounced standardized patients ( 20 , 21 ) for formative or summative assessment ( 7 , 28 ). Further, residents may be better engaged with other adaptations, such as inclusion of a familiar faculty member or a more senior resident, in order to more effectively support trainees in their exploration of knowledge gaps or feelings of vulnerability regarding difficult cases.…”

Section: Discussionmentioning

confidence: 99%

“…Further, residents may be better engaged with other adaptations, such as inclusion of a familiar faculty member or a more senior resident, in order to more effectively support trainees in their exploration of knowledge gaps or feelings of vulnerability regarding difficult cases. Integrating additional tools such as skills checklists for observers to complete while viewing the video models ( 9 , 17 , 21 , 27 , 41 ) may also enhance engagement.…”

Section: Discussionmentioning

confidence: 99%

“…In light of CAP subspecialist shortages in the United States (US), there is an increasing call for primary care physicians in Family Medicine and Pediatrics to address an increasingly broad variety of patient needs, including mental health conditions such as depression and suicidality ( 14 , 17 , 18 ). However, primary care providers ( 18 , 19 ) and residents in primary care residency training programs ( 17 , 20 , 21 ) report inadequate knowledge and skill in the assessment, diagnosis and treatment of these areas. To care for these patient needs, medical providers must acquire basic competence in pediatric mental and behavioral health ( 14 , 22 ), including development of both interpersonal communication skills ( 23 ) and content knowledge ( 24 – 26 ).…”

Section: Introductionmentioning

confidence: 99%

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INteractive Virtual Expert-Led Skills Training: A Multi-Modal Curriculum for Medical Trainees

et al. 2021

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Background: Internationally, pediatric depression and suicide are significant issues. Additionally, in the context of the COVID-19 pandemic, pediatric mental health needs are rising astronomically. In light of Child & Adolescent Psychiatrist (CAP) subspecialist shortages in the United States (US), there is an increasing call for primary care physicians in Family Medicine and Pediatrics to address an increasingly broad variety of patient needs. Here we report on the development and preliminary evaluation of medical student and resident perceptions on the “INteractive Virtual Expert-led Skills Training” (INVEST) medical education curriculum, a virtual synchronous CAP curriculum employing active learning strategies, including expert-led discussion and video modeling, and discussion designed to meet those priorities.Methods: In a standardized 60-min training format, our curriculum leverages audience response system polling, video modeling of key clinical skills, and interactive discussion with an expert subspecialist, over a virtual video conferencing platform. The primary educational strategy relies on use of video modeling to demonstrate best practice with CAP led group discussion to solidify and explain important concepts. Five waves of medical students and residents (N = 149) participated in the INVEST curriculum and completed pre- and post-training surveys regarding knowledge and comfort in the management of pediatric patients with depression and suicidality.Results: Trainee participants reported significant positive gains in perceived likelihood of encountering pediatric suicidality as well as knowledge/comfort with depression screening and suicidality assessment in a primary care setting. Across some competency areas, there was an effect of medical learner level. Learners at lower levels generally reported the highest benefit. Medical students reported significant increases in their comfort interpreting and discussing positive depression screens and evidenced the greatest relative benefit in comfort with discussing suicidality.Conclusion: To our knowledge, INVEST is the first fully virtual, multimodal curriculum led by expert CAP subspecialists. Our findings suggest that INVEST shows promise for equipping medical learners with baseline knowledge for caring for patients with pediatric depression and suicidality. This synchronous, virtually delivered curriculum allows for critical training delivered to diverse medical learners regardless of geographic location, a particular benefit during the current COVID-19 pandemic.

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Using Unannounced Standardized Patients to Explore Variation in Care for Patients With Depression

Abstract: The use of unannounced SPs helps identify targets for training residents to provide evidence-based treatment of depression.

Cited by 6 publications

References 20 publications

Developing evidenced-based quality assessment checklist for real practice in primary health care using standardized patients: a systematic review

Developing evidenced-based quality assessment checklist for real practice in primary health care using standardized patients: a systematic review

Comparison of Primary Care Patients’ and Unannounced Standardized Patients’ Perceptions of Care

INteractive Virtual Expert-Led Skills Training: A Multi-Modal Curriculum for Medical Trainees

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