Can Unannounced Standardized Patients Assess Professionalism and Communication Skills in the Emergency Department?

Authors

  • Sondra Zabar MD,

    1. From the New York University School of Medicine (SZ, TA, CG, AH, AK, EK, JM, LR), New York, NY; and The Johns Hopkins University School of Medicine (LR), Baltimore, MD.
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  • Tavinder Ark MSc,

    1. From the New York University School of Medicine (SZ, TA, CG, AH, AK, EK, JM, LR), New York, NY; and The Johns Hopkins University School of Medicine (LR), Baltimore, MD.
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  • Colleen Gillespie PhD,

    1. From the New York University School of Medicine (SZ, TA, CG, AH, AK, EK, JM, LR), New York, NY; and The Johns Hopkins University School of Medicine (LR), Baltimore, MD.
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  • Amy Hsieh MPA,

    1. From the New York University School of Medicine (SZ, TA, CG, AH, AK, EK, JM, LR), New York, NY; and The Johns Hopkins University School of Medicine (LR), Baltimore, MD.
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  • Adina Kalet MD,

    1. From the New York University School of Medicine (SZ, TA, CG, AH, AK, EK, JM, LR), New York, NY; and The Johns Hopkins University School of Medicine (LR), Baltimore, MD.
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  • Elizabeth Kachur PhD,

    1. From the New York University School of Medicine (SZ, TA, CG, AH, AK, EK, JM, LR), New York, NY; and The Johns Hopkins University School of Medicine (LR), Baltimore, MD.
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  • Jeffrey Manko MD,

    1. From the New York University School of Medicine (SZ, TA, CG, AH, AK, EK, JM, LR), New York, NY; and The Johns Hopkins University School of Medicine (LR), Baltimore, MD.
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  • Linda Regan MD

    1. From the New York University School of Medicine (SZ, TA, CG, AH, AK, EK, JM, LR), New York, NY; and The Johns Hopkins University School of Medicine (LR), Baltimore, MD.
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  • Presented at The Gold Foundation Symposium, “How Are We Teaching Humanism in Medicine and What is Working?” September 27–29, 2007, Chicago, IL; and the 9th Annual International Meeting on Simulation in Healthcare (IMSH), January 10–14, 2009, Lake Buena Vista, FL.

  • Supported by Picker Institute Challenge Grant 2007.

Address for correspondance and reprints: Sondra Zabar, MD; e-mail: sondra.zabar@nyumc.org.

Abstract

Objectives:  The authors piloted unannounced standardized patients (USPs) in an emergency medicine (EM) residency to test feasibility, acceptability, and performance assessment of professionalism and communication skills.

Methods:  Fifteen postgraduate year (PGY)-2 EM residents were scheduled to be visited by two USPs while working in the emergency department (ED). Multidisciplinary support was utilized to ensure successful USP introduction. Scores (% well done) were calculated for communication and professionalism skills using a 26-item, behaviorally anchored checklist. Residents’ attitudes toward USPs and USP detection were also surveyed.

Results:  Of 27 USP encounters attempted, 17 (62%) were successfully completed. The detection rate was 44%. Eighty-three percent of residents who encountered a USP felt that the encounter did not hinder daily practice and did not make them uncomfortable (86%) or suspicious of patients (71%). Overall, residents received a mean score of 60% for communication items rated “well done” (SD ± 28%, range = 23%–100%) and 53% of professionalism items “well done” (SD ± 20%, range = 23%-85%). Residents’ communication skills were weakest for patient education and counseling (mean = 43%, SD ± 31%), compared with information gathering (68%, SD ± 36% and relationship development (62%, SD ± 32%). Scores of residents who detected USPs did not differ from those who had not.

Conclusions:  Implementing USPs in the ED is feasible and acceptable to staff. The unpredictability of the ED, specifically resident schedules, accounted for most incomplete encounters. USPs may represent a new way to assess real-time resident physician performance without the need for faculty resources or the bias introduced by direct observation.

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