Objective Structured Clinical Exam

Report
The Importance of Being Authentic
Utilizing Persons with Disabilities as Standardized Patients
THE ALLIANCE FOR DISABILITY IN HEALTH CARE EDUCATION
University of South Florida
Laurie Woodard, M.D.
UMDNJ - New Jersey Medical School
Kenneth Robey, Ph.D.
Tufts University
Paula Minihan, Ph.D., M.P.H.
University of South Carolina
Catherine Leigh Graham, MEBME
University of Massachusetts, Tufts University
Linda M. Long-Bellil, Ph.D., J.D.
State University of New York, Buffalo
Andrew Symons, M.D., M.S
Persons with Disabilities (PWD) as Standardized
Patients (SP)
• SP Purpose:
– to teach or assess clinical skills or assess while encouraging
perspective taking and reflection
• SP model: suited for teaching about PWD
–
–
–
–
control clinical scenario
create teachable moments
promote self assessment/reflection
appreciate PWD expertise re living with disability
• PWD as SP Results: Most programs have found that PWD
are very effective teachers
PWD as SP
A very effective way to teach students/residents about
PWD
• Actors feigning disability are not credible faking:
– Atrophied muscles
– Dysarthric/slurred
speech
– Deafness
– Devices used for
– Blindness
communication
– Contractures
– Communication
– Spasticity
patterns often used by
– Ptyalism/drooling
a person with an
– Poor head control
intellectual disability
USF – Education/SP Experiences
• Disability module integrated into required 3rd year
primary care clerkship, can be modified for Residents
– PWD incorporated into module in various ways:
• Home visits, panel discussion, service learning projects, as SPs
• PWD as SP used in 2 separate experiences
– Model Patients – Educational session
• Hands-on session in a simulated exam room that promotes reflection
– OSCE – Evaluative session
• One of several OSCE experiences providing formative feedback during
clerkship
Prior to the OSCE
• Students watch a vignette from the movie
“Rolling”
– A pt with SCI goes to ortho for shoulder pain and
tx is suboptimal.
– After vignette, group discusses how physicians
could help the doctor in the movie be a more
effective clinician.
USF - Model Patient Experience
• Students/Residents interview & briefly examine PWD in
simulated clinical exam room
• PWD/caregiver briefed on program goals, then tell their
stories, guide students in appropriate etiquette
• Each student/resident sees 4 patients
• Pt & Medical faculty observe: live video/one way mirrors
• Concludes with learning circle & written reflection
• PWD are recruited from USF medical practice & by other
PWD
USF –OSCE
• Based on shoulder case developed by Tufts Medical
School:
– PWD is a manual chair user who presents with a painful
shoulder
• Shoulder pain symptoms worsening over past few weeks
• Earlier episode had resolved with rest & PT
• Overuse from occupation, care-taking responsibilities,
disability-related use
• Refusal to return to previous doctor because she seemed
uncomfortable with patient’s disability
• Social supports essential to treatment plan
• Patient fears eventual loss of function and independence if
problem becomes chronic
OSCE
• SPEs with ASD & parent play out scenario as close
to real life as they want/can handle (no script)
• Student/Resident interviews and examines PWD
• Evaluated on medical + functional history, PE adapted for
PWD, patient centered plan
• SP and faculty observer give immediate feedback, using
check list – formative evaluation
USF - Students Examining Patients during
Model Patient Session
USF - Primary Care Clerkship
“Patients with Disabilities” Module
Common Themes
• Teaching students/residents how to communicate
appropriately and effectively
• Providing students/residents with an opportunity to
interact with and become more comfortable with PWD
• Debunking common notions about PWD
– Inability to speak for themselves
– Poor quality of life
– Poor health inevitable
Benefits
• Authenticity: Actors without disabilities…
– Cannot mimic
– May reinforce negative stereotypes especially off script
• Recognition of patient expertise about own condition
– Rich lives, jobs, families, responsibilities, future plans
• Understanding disability ≠ poor health
– Concepts of thinner margin of health, secondary conditions
• Provides special teachable moments
– Communication devices, transferring patients to exam tables,
talking with caregivers present
Challenges
• Evaluation can be tricky
– Consistency - script vs. telling own story
– Lack of consensus regarding competencies that are observable
– SPs who evaluate must be trained
• Attendance of PWD
– Recruitment of people with requisite skills may already have full
time employment
– Stamina
– Fluctuating health status
– Transportation difficulties

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