By Wendy Sarubbi | July 22, 2013 12:42 pm

We all enjoy feedback, but a patient’s constructive, specific feedback helps physicians-in-training learn the art of medicine – how to communicate with another person in a compassionate, simple and compelling way. Improving students’ communications skills is part of the focus of the UCF College of Medicine’s Clinical Skills and Simulation Center, a place where students gain real-world patient-care experiences from the first weeks of medical school.

In addition to faculty and staff, students are taught by standardized patients or SPs, dedicated people from all walks of life and academic backgrounds who play the role of a sick or injured person. Their feedback is key in helping medical students understand how bedside manner impacts a patient. For that reason, the Clinical Skills team recently held a training session for about 25 SPs on ways to give students specific, meaningful feedback that will help them learn.

“Every time I see the blackboard in the hall that the Dean creates about the traits of The Good Doctor, I think about how we teach medical students,” said Bob Craig, SP trainer. “The board has traits like rapport and caring and compassion. The standardized patients are committed to being part of the team that imparts those traits that will make our students better doctors.”

To be meaningful, feedback must be specific. Telling a first-year medical student he or she was “awesome” during a simulated exam may help the ego, but it doesn’t tell give the students specifics or anything to think about. So during the training, SPs were encouraged to use “I” language, such as “I felt comforted when you said …” or “I felt interrogated when you peppered me with questions before we had a chance to get to know each other.”

While second and third-year students generally appreciate written feedback, beginning M.D. students are eager to hear verbally from their standardized patients, “How did I make you feel?” explained SP educator Katrina Hayne.

For that reason, the recent training included specific positive and negative words that SPs can use for providing feedback and had SPs watch videotaped student sessions and practice giving feedback.

“It’s all about the students and helping them understand the importance of communication, how to manage and place themselves with each individual patient to communicate effectively,” Hayne said. For example, simple words that young people use every day – like “okay” and “gotcha” can be too flip for a clinical setting. Does the student call the patient by their first name and how does that sit with patients of different generations? How does a student learn to provide information but not overwhelm a patient with what their symptoms could mean? When and how do you bring up tough topics like cancer as a possible diagnosis?

Standardized patients give the students an opportunity to practice their communication and scientific skills in a variety of situations. The center’s 70 SPs range in age from 20 to 80. They are trained and follow scripts on conditions from chest pain to anxiety. Some SPs play the role of distraught family members accompanying a patient to the doctor’s office. Others pretend to suffer from addictions and withdrawal. Feedback they provide should be based on how the patient in the scenario felt – not what an individual actor felt, Hayne said, and SPs may use only one-tenth of what they learned about their temporary medical condition. If a student doesn’t ask a specific question about a symptom, the actors cannot volunteer that information. That’s because part of Clinical Skills training is knowing what questions to ask. k

With help from their SPs, students learn those lessons in a safe environment, before they work with real patients. As Craig explains, “The standardized patients all want to give back by helping the students be the best they can be when it comes to patient care. Feedback is the process and improving patient care is the goal.”

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