Simulated or Standardized Patients or ParentsSimulated patients are a well-accepted educational and assessment tool. Recently, the Federation of State Medical Boards and the National Board of Medical Examiners, which jointly administer the national licensing examination for physicians, announced that a clinical skills examination including standardized patients would be added to the examination (FSMB, 2002).

Use of standardized patients is more challenging in pediatric than in adult settings. Lane and colleagues, however, describe the use of child standardized patients in an evaluation of a pediatric clinical skills assessment tool and reported that their use proved feasible for the evaluators, enjoyable for the children, and acceptable to the children’s real and standardized parents (Lane et al., 1999). Educators might, however, be hesitant to use child actors or volunteers to portray gravely ill or dying children. If their use was part of research to evaluate the strategy, an institutional review board, which must approve most human research, might object.

Use of standardized family members presents fewer complications (see generally Clay et al., 2000). In a project exploring ways to increase organ donation, Williams and colleagues have studied the standardized families, in this case, people trained to behave as family members being confronted with bad news, decisions about end-of-life care, and requests for organ donation (Williams et al., 2001b; 2002). These sessions were intended to improve the communication skills of physicians, nurses, clergy, and transplant coordinators participating as a team The standardized families did not operate from explicit scripts and the sessions could be interrupted to discuss and even restart “problem” conversations. The families, trainers, and other participants provided feedback. The rate of consent to organ donation requests rose from 25 percent before to 75 percent after the intervention but then fell back with staff turnover (Personal communication, Michael Williams, M.D., Johns Hopkins Medical Institutions, March 11, 2002). The researchers are still preparing their final report and are seeking another grant to study the strategy in two to four community hospitals.

In another project, researchers at George Washington University videotaped and evaluated skills of pediatric residents and emergency department fellows in communicating news of a child’s death to standardized parents and then provided feedback to the residents and fellows (Greenberg et al., 1999). During a similar exercise several weeks later, the researchers found improvements in information and counseling skills.

Hospice and Inpatient Palliative Care ExperiencesAs noted earlier, some hospices offer educational programs not only to their own staffs and volunteers but also to health professions students and community providers. Gomez (1996) described one inpatient hospice program that was linked to



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