Telehealth, Meet Standardized Patients

As COVID-19 has upended daily life, expectations for health professions have changed, too.

For health care professions students coming from throughout the region to the Wasson Center for Clinical Skills Training, Assessment, and Scholarship at Northeast Ohio Medical University, the process of learning through something called Standardized Patient (SP) training has always offered the chance to practice in a safe, simulated environment before taking on the responsibility of a real-world situation with living, breathing patients.

SPs are community members who have prepared for the student encounter by taking on the role of a patient. They prepare for the role with training and rehearsal of scripts, say, of an elderly woman with heart disease or a middle-aged man whose lifestyle is putting him at risk for diabetes.

Normally, hundreds of these SPs visit the Wasson Center as freelancers each year, working with NEOMED medicine and pharmacy students as well as nursing students and others in health care fields throughout Northeast Ohio. And for a while, following state guidelines, the Center continued bringing in SPs, following social distancing suggestions for COVID-19.  “We limited the number of participants and measured and found we could put the learner and SP six feet apart in an interview or counseling room,” says Holly Gerzina, Ph.D., senior executive director of the Wasson Center.

Social distancing required adjustments. No longer could learners practice offering a friendly handshake when they entered the room and introduced themselves to a patient – or gently touch them on the shoulder when explaining a scary diagnosis.

And within a matter of weeks, Ohio adopted stricter policies and the campus essentially closed, leaving the question: What could be done for the students who still needed practice in this protected, controlled environment?

Enter telemedicine.

As of March 30, the Wasson Center was just starting a new program to use telehealth (also known as telemedicine) training. “Normally you have time to pilot things before you do them live. Here, we’ve done it through mini-pilots. We’re learning the technology — to screen share and others security functionalities — training all staff, faculty, and SPs, and then we go,” says Dr. Gerzina.

Now students are learning the techniques of telehealth, which was developed to extend health care’s reach to rural and underserved urban areas, as they develop their skills at interacting with patients to hear their concerns, take vital signs, ask pertinent follow-up questions and make diagnoses.

The change to remote SP calls for the actor-patients to be trained in additional technology. For example, if the student says, ‘I want to listen to your heart,’ the technology will allow the SP to be trained to play the appropriate recording. The SPs and everyone else on the team have been receptive and enthusiastically embraced the innovative delivery, says Dr. Gerzina.

Cassandra Konen-Butler, M.A., associate director of operations of the Wasson Center and Interprofessional Education, has been overseeing the transition of Wasson and IPES activities from in-person to tele-health. “The Wasson Center staff have been working diligently and have really stepped up to learn new technologies to ensure education continues for the students through SP encounters,” says Konen-Butler.

The Wasson Center’s ability to quickly shift gears has already been noticed by the Association of American Medical Colleges. NEOMED was invited by the AAMC to speak on a session featuring Dr. Gerzina and Mariquita (“Kit”) Belen, M.D., assistant professor of family and community medicine, discussing effective models and approaches to implementing remote Standardized Patient encounters, i.e., tele-SPs, into the medical school curriculum during the pandemic.

Remote Encounters

Here are a few examples of how remote Standardized Patient encounters are helping students learn.

• When a group of second-year College of Medicine students works with an 80-year-old SP, usually they would go to the Wasson Center in person. In April, they did group tele-SP encounters via Zoom, taking turns interviewing the patient remotely, then discussing the interviews and physical exams they had done.
• For a group of third-year students near the end of their clerkships, Erica Stovsky, M.D. (’07), MPH, assistant director of internal medicine and course director, Applications of Clinical Medicine, led them in virtually seeing cases with SPs. Dr. Stovsky typically gives the third-year students combinations of SP cases like pediatrics and OB/GYN or family medicine and psychiatry. Sometimes the SP case involves a pair of patients. Now, If a parent and child pair of actors were in a script – for example, for the story of a pediatric patient brought to a visit by their mother – the SPs would need to actually be in and from the same household (not just pretend to) so they could appear on Zoom together.
• Interprofessional Team Training sessions bring in students from fields including medicine, pharmacy, physical therapy, occupational therapy, nursing and more, from across the region. At an April event, students from medicine, nursing, physical therapy, and nutrition still gathered into interprofessional groups of 7-10, but this time, because it was virtual, more students were able to participate, including students from around the Northeast Ohio region. Together, with a facilitator at times playing the role of the SP (his daughter or son), they worked on solutions to the simulated case of Mr. Bennet, an elderly patient facing a transition in care.

 

“I’ve seen everyone pulling together — the faculty, SPs, staff, students – to be trained because they know it’s for the patient and patient safety. It’s the same thing we are now experiencing see on a societal level,” says Dr. Gerzina.

“We’re taken COVID-19 seriously, and because we had laid the groundwork for remote learning early, we were ready to lead and quickly get to the flip side with remote learning.”

The Wasson Center is growing, and by winter 2021 will have expanded facilities in the Medical Office Building now under construction in the Northeast Ohio Medical University (NEW) Center.