Standardized patients continue helping ECU health sciences students learn despite COVID

For 15 years, Ann Flake has helped students across the East Carolina University Division of Health Sciences practice their clinical skills—and the COVID-19 pandemic hasn’t changed that.

Flake serves as a standardized patient (SP), part of a program in the division’s Office of Clinical Skills Assessment and Education (OCSAE). Standardized patients provide students opportunities to learn without risk to actual patients through in-person simulations and interactions—some of which have gone virtual in the past three months as education has shifted to a web-based format to support social distancing.

Nearly 60 standardized patients have been involved in the program since the shift from normal operations, working to relearn teaching methods to meet course needs differently.

“I’m thankful to ECU for giving me the opportunity to participate in the SP program,” said Flake, who moved to Greenville in 1963 for her first job as a radiologic technologist at then-Pitt County Memorial Hospital. “It’s very gratifying to contribute to the learning experience and give students an opportunity to practice their clinical, problem-solving and decision-making skills.”

Standardized patients allow students to learn critical skills through interactions with specially trained community members, through both in-person and online simulations. (Photo by Rhett Butler)

During a typical simulation, a student interviews a standardized patient while one faculty member and a small group of other students observe. The SP then offers feedback that helps students become caring clinicians. SPs are asked to assess the clinical and interpersonal skills of students and practitioners.

Jessica McCombs, a graduate student in the College of Nursing, plans to teach in a clinical or classroom setting. She said working with standardized patients as helped her grow into that realm.

“I love helping others grow and do what they love,” she said. “That is why I am so grateful for the SPs and hope to be a compassionate and bold teacher.”

It also helped McCombs build her confidence interacting with patients in a nurturing setting.

“The SPs worked one on one and allowed you to feel comfortable and practice until you felt like you had mastered the skill,” she said. “They were patient and provided a wonderful learning experience. The SPs I had calmed me down when I was so nervous to perform skills I am not used to.”

If a particular skill calls for a patient that Flake can represent realistically, she will memorize a script for the session that may include opportunities for students to practice taking patient histories, physical exams, diagnostic reasoning, effective communication and teamwork.

Since methods for completing the exercises have changed, Flake adjusted to using technology to deliver her part of the education sessions. She learned to use WebEx and got used to other minor changes in the regular routine.

“Pre-pandemic events were usually one-to-one in person and timed,” she said. “At the end of the event, the student is evaluated with a checklist and/or constructive feedback. Now, those same things still happen, but SPs and students are at home on our computers. We use our laptop, tablet or phone to interact with the student.”

Dr. Gina Firnhaber, assistant clinical professor in the College of Nursing’s nurse anesthesia program, said faculty and program directors made immediate changes once the pandemic prevented on-campus interactions.

“We quickly cobbled together instruction using existing OCSAE videos then, thanks to the ingenuity of the OCSAE staff, resumed in-person training and assessment via Webex,” she said. “Though going virtual has removed the hands-on experiences and doesn’t adequately address all facets of physical examination, one-on-one and small group experiences through Webex have allowed us to continue our instruction schedule with quality learning opportunities for students.”

Firnhaber said that while students have remained flexible during the changes in education delivery, the standardized patients themselves have adjusted in phenomenal ways.

“Our standardized patients adapted amazingly to delivering training online,” she said. “Despite a few areas of difficulty, like performing internal eye exams, instruction via virtual format has been effective while allowing us to keep students safe. Even after return to classroom settings is allowed, I can envision a hybrid of virtual and hands-on delivery for this content.”

Molly Cashion, standardized patient trainer in the OCSAE, added that the standardized patients and physical training assistants, who are carefully trained to oversee the details of physical examinations, have stepped up during an uncertain time.

“We have had a remarkable response from our employees during all of this uncertainty,” she said. “They each had a different learning curve to be able to deliver instruction and feedback online, and they have shown their amazing ability to adapt and deliver.”

The office has trained employees in WebEx and Cisco AnyConnect for virtual interactions, in addition to other technical supplements and resources in response to the disruption to normal education regimens.

“We are running other technical items behind the scenes so learners can focus solely on interviewing a standardized patient or discussing physical exam items with one of our physical training associates,” said Patrick Merricks, OCSAE associate director and standardized patient trainer.”

Merricks added that the current situation has inspired creativity, teamwork and resilience.

“Probably the most creative moment during this transition was offered up by John Darrow, clinical skills PTA trainer,” he said. “Clinical Skills was tasked with assessing nursing students on performing the entire physical exam virtually. Mr. Darrow suggested that since some students might not have someone in their residence to help demonstrate their physical exam skills, that students instead could review a physical exam video then complete a checklist, thus demonstrating their knowledge of the physical exam.”

That kind of expertise has made the transition to online training virtually seamless, he added, showcasing the knowledge and relationships that are vital to making many moving parts work in tandem.

“It is their expertise that helps shape the written cases into becoming living, breathing patient experiences,” Merricks said. “The roots of these relationships are well established so the transition to the virtual world seemed flawless.”

The OCSAE serves the entire Division of Health Sciences—something Flake has done as well in her work as a standardized patient contributing to the education of allied health, dental, medical and nursing students.

“It is my hope,” she said, “that students come away with an increased level of confidence in their skills and ability to cope competently with real-life situations.”