The Standardized Patient Used for Teaching Patient Selection in Aesthetic Surgery
Brian D. Rinker, MD, Michael Donnelly, PhD, and Henry C. Vasconez, MD
INTRODUCTION: For decades, one of the biggest challenges facing plastic surgery residencies has been to provide quality training in aesthetic surgery while preserving a high standard of patient care. Resident aesthetic clinics have been established in many centers and are of proven value in helping trainees become technically competent in aesthetic surgical techniques (1-3). Equally as important to the trainee, but much more difficult to teach, are the communication and patient selection skills essential to the successful practice of aesthetic surgery (4-5). Additionally, in response to directives arising from the ACGME’s Outcome Project, residency directors are seeking creative ways to teach and assess the more subjective core competencies such as communication skills and professionalism. Standardized patients, actors who reproduce a scripted clinical scenario, have been used in medical education for over 40 years (6-7). The purpose of this study is to determine the effectiveness of a standardized patient program for teaching patient selection in aesthetic surgery.
METHOD: Six residents and four faculty members participated in the program. Actors were selected and given detailed scripts and character descriptions. Each resident was given the opportunity to conduct a 30 minute interview with a standardized patient who modeled a patient presenting to the resident aesthetic clinic for an initial consultation. The residents were instructed to take a history as if they were in an actual clinical setting. They then performed a focused physical examination of the area of concern. The other participants observed, but were not allowed to interrupt the interview. Following the interview, participants completed a questionnaire, rating the effectiveness of the interviewer and the suitability of the patient as a surgical candidate. For each standardized patient, participants completed a Gorney-gram, a previously described tool for assessing the psychological suitability of a surgical candidate (8), which plots the patient’s concern for their deformity against the surgeon’s perception of the deformity. A discussion was then held, during which the patients’ motivations, expectations, and personality were addressed, and the resident was given feedback regarding his or her communication skills. The sessions were videotaped for future viewing. Program effectiveness was measured in three ways. 1) Written cosmetic surgery simulations were administered to the faculty members and residents before and after the educational program. For each simulation, a faculty standard was developed and tested using analysis of variance and Fisher’s PLSD post hoc test. Each resident’s responses were compared to the faculty standard using the single group t-test. An inaccuracy score (0-4) was determined from the number of times the resident’s answers varied significantly from the faculty standard. The pre-test accuracy scores for the 6 residents were compared to their post-test score using a paired t-test. 2) Residents and faculty were asked to evaluate the effectiveness of the program using a 6-item questionnaire. 3) The cost in faculty time and money were assessed.
RESULTS: On three of the four paper simulations, the Fisher’s PLSD post hoc test indicated that one faculty member differed significantly from the other three in his responses, and was excluded from the faculty standard. In the remaining simulation there was good agreement, and all four faculty members were included in the standard. The mean pre-test inaccuracy score for the residents was 2.33±0.42, and the mean post-test score was 1.00±0.52. This difference was statistically significant (p=0.01) indicating that the residents judged cue importance more accurately after the standardized patient training than before. Upon the 6-item questionnaire, both faculty and residents strongly agreed that it was a worthwhile exercise (faculty mean 6.2 out of 7, resident mean 6.3). They also strongly agreed that the standardized patients were well prepared and believable (faculty 6.0, residents 6.3) and that standardized patients should have a permanent role in the plastic surgery curriculum (faculty 6.1, residents 6.0). The plastic surgery faculty member contributed 14 hours to develop and implement the program. The cost of the six standardized patients was $357.84.
CONCLUSIONS: Standardized patients can be used effectively in the training of plastic surgery residents to evaluate candidates for aesthetic surgery. The residents’ responses on paper cases more closely approximated the faculty’s answers after the experience, faculty and residents alike rated the experience highly, and the cost was nominal. The addition of a standardized patient experience to a plastic surgery curriculum can provide instruction in traditionally difficult-to-teach areas such as effective communication and patient selection.
Figure 1. Resident interviewing a standardized patient.
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