Shawn Galin became director of the Clinical Skills Center last winter and is overseeing its transition to a campus-wide resource and a place for a variety of health professions students to interact. Since becoming director of the UAB Clinical Skills Center last December, Associate Professor of Medicine Shawn Galin Ph.D., has been overseeing a change that will bring the center under the governance of UAB’s new Center for Interprofessional Education and Simulation (CIPES).
The Clinical Skills Center is where medical students taking Introduction to Clinical Medicine practice skills such as taking patient medical histories and performing physical examinations. It is also the testing space for medical students taking their Objective Structured Clinical Exams (OSCE). The Center has 20 exam rooms outfitted with audio and visual recording equipment. During medical simulations, instructors watch students’ performances on TV monitors in a nearby room. Afterward, students are debriefed and offered instruction on how to improve their clinical skills and bedside manner.
In recent years, the Schools of Nursing and Health Professions have begun using the facility to train their students on how to interact with patients and to practice alongside medical students. CIPES was established last year under the direction of Robert R. Rich, M.D., Associate Vice Provost for Interprofessional Education and former School of Medicine dean, to give students in the health professions more opportunities to learn how to work collaboratively, just as they will in the real world. Its mission is in keeping with UAB’s Quality Enhancement Program, which promotes team-based learning across the entire campus.
The Human Touch
The Clinical Skills Center employs standardized patients, or SPs, to act as patients during medical simulations. SPs are people from the local community who act as patients with a specific set of symptoms in order to give health profession students a sense of what it is like to examine a real patient.
Unlike regular patients, SPs in the Clinical Skills Center work from scripts, portraying the same symptoms and complaints to all of the students they encounter, whether they are participating in simulation exercises or undergoing their OSCE. Once the simulated patient interaction ends, the SPs offer feedback on how well the students performed from a patient’s perspective. “The most important role of the SP is to assess and help in the development of effective, interpersonal skills or communication skills,” Galin says.
The use of SPs has grown exponentially over the past decade. Twenty years ago, medical students often practiced clinical skills using fellow students as mock patients before going into clinics for their first encounters with real patients. But with SPs, students can practice their clinical skills in a more formalized way before treating real patients.
Zachery Babb started working as a standardized patient in 2005 at the suggestion of a girlfriend who worked part time as an SP. “She thought I would be interested and asked that I come down to see what they were doing,” Babb says. “Quite frankly, the first night I came to the training class I had a full-on panic attack and thought that I would never be able to walk through those doors again. I had never done anything like that, but I came back the next day.”
Over time, Babb’s skills as an SP so impressed the instructors that two years later, the School of Medicine hired him as an SP case trainer for the Clinical Skills Center. By 2014, he had worked his way up to become the Center’s standardized patient educator.
Galin says people who would like to become an SP must undergo an interview process. Among other qualities, candidates must demonstrate a genuine interest in education, be able to portray a patient exhibiting specific symptoms, and be able to stay in character throughout a simulation. Formal acting training is beneficial but not required. Those selected must attend training workshops and an annual development training session to hone their abilities to portray their roles and deliver effective feedback. The center pays SPs for their time.
Medical student Mark Pepin performs an exam on a standardized patient at the Clinical Skills Center.Training for SPs has evolved over the years, says Babb. A decade ago, SPs often provided feedback to students based only on their own personal observations and impressions. “When I first started, we didn’t really understand everything we needed to about giving feedback,” he says. “We realized that personal feedback from an SP didn’t always translate to what would make things better for all patients. People were slipping in their own personal preferences into the feedback. But just because something bothers me does not mean that it’s going to bother someone else. So we started to look at behaviors that were more important universally, such as the eye contact and empathy, solid communication skills, and tone and inflection during an encounter.”
Today, Babb says SPs are required to give more refined and detailed feedback on specific student behaviors that are observable and changeable. Mark Pepin, of Davis, Calif., who is in his fourth year in the M.D./Ph.D. program, says feedback from the SPs during the simulated doctor-patient interactions has helped him improve his communication skills.
“The physical exams are pretty straightforward, but there are a lot of the unspoken things that the SP can show us,” says Pepin. “It’s more about the rapport and trust that we’re supposed to build, and to watch our nonverbal communication like eye contact and posture, and making sure the patient is comfortable. For example, an SP told me that, when I summarized the encounter by reiterating her responses to my questions, she felt listened to and respected. That feedback cemented to me the importance of summarizing what I’ve heard at the end of my encounters. As another example, I never realized how much I nervously click my pen until the SP brought it up to me.”
Despite the challenges of being an effective SP, Babb says the ability to help medical students and other health professionals has inspired him. “When you see the light go off in their heads, and they say, ‘Wow, this is real—this isn’t just something off a page in a book,’ that’s what really keeps me in it, seeing the reaction of the students.”
Teaching Teamwork
In nearly every health care setting, it takes a team—doctors, nurses, physical therapists, respiratory therapists, radiologists, nutritionists, social workers, and others—to provide quality patient care. To ensure that School of Medicine and other students in the health professions gain experience working in interprofessional teams, CIPES will also administer the Office of Interprofessional Simulation for Innovative Clinical Practice (OIPS) and the Office for Interprofessional Curriculum (OIPC).
The OIPS is a joint effort between UAB Health System and the health schools. It organizes interprofessional simulation experiences for students from different health professions programs. Services include facilitator development courses and simulation administrative, educational, and technical expertise. The OIPC, on the other hand, develops interprofessional educational curriculum for undergraduate and post-graduate students.
Galin and Associate Dean for Undergraduate Medical Education Kevin J. Leon, M.D., say plans are in the works between the Schools of Medicine and Nursing to design a co-enrolled, semester-long course that medical and nursing students can take together. Leon has also organized interprofessional simulation experiences for fourth-year students in his “Preparation for Residency” course. In the class, students learn how to take advantage of the skill sets of other health care professionals, says Leon.
“We focus on communication and teamwork,” he says. “We want them to not be afraid to ask for help from other professions. It’s important to start working in teams almost from day one of medical school rather than waiting until they get to the clinical years when they haven’t had the opportunity to work with anyone outside of medicine.”
By Gail Allyn Short