By Joseph Daly, BS, CLI, EMT
Top takeaways:
- Cultural competency emphasis: Modern EMS standards highlight the importance of cultural diversity in patient care, but traditional lecture-based training falls short of fostering practical cultural competence.
- Standardized patients (SPs): SPs are trained actors simulating patient encounters to develop learners’ clinical, interpersonal and cultural skills, offering a hands-on approach to EMS education.
- Versatility in training: SPs can portray culturally specific scenarios, helping EMS providers adapt assessments and treatments to respect diverse cultural norms and practices.
- Feedback and professional development: SPs provide detailed feedback on learners’ performance, helping improve clinical and cultural competencies.
- Community relevance: SP scenarios can be tailored to reflect the cultural demographics of specific service areas, enhancing the relevance and impact of the training.
| More: Engaging the senses in EMS training
Modern shifts in prehospital care standards have rightfully placed a greater emphasis on the cultural competency of EMS providers. To meet these standards, it is imperative that educational approaches emphasize the role of cultural diversity in patient care. EMS providers are often presented with cultural challenges that can affect their ability to deliver patient care.
While training for EMS providers often covers cultural diversity and respect, these lecture-based discussions are far from a hands-on approach that fosters cultural relevatism. Incorporating standardized patients (SPs) into EMS education can train providers to appropriately treat patients from culturally diverse populations. The use of SPs in EMS education can foster cultural competency and strengthen public trust.
History of standardized patients
Pioneered by Dr. Howard Barrows, standardized patients are highly trained individuals who simulate patients within a standardized setting. The creation of SPs stemmed from a desire to better educate medical students on assessment competencies. Before implementing SPs, students were trained to perform clinical assessments by repeatedly assessing a live patient. Dr. Barrows noted that many of these patients became annoyed after participating in repeated assessments [1].
To create a more standardized learning tool, Dr. Barrows developed the first SP case, named “Patty Dugger.” The Dugger case was modeled after a real patient who had been evaluated and treated for paraplegia and multiple sclerosis [1]. To portray this case, Dr. Barrows contracted theatre students to act out the patient’s condition and present medical students with simulated clinical findings [1]. From this first case, the era of SP education was born.
SPs are versatile educational assets, as they can be trained to portray specific cases designed to mimic real-life patient encounters. SPs are highly skilled patient actors who can accurately portray clinical findings so learners may assess them and develop clinical impressions and treatment plans. SPs are also responsible for scoring learners on their ability to accurately perform examinations, assessments and treatments; interact with patients; and many more important aspects of clinical care.
In addition to portraying and assessing clinical scenarios, SPs are also involved in training learners to develop professional relationships with patients. As SPs are human actors, they can connect with learners and simulate patient emotions, behaviors and more. These non-clinical aspects of medicine are crucial for learners so that they can develop professional interpersonal skills and learn to connect with patients from all backgrounds.
Following learning or assessment scenarios, SPs are trained to provide comprehensive feedback to learners. SPs will discuss with learners the aspects of the encounter that went well and aspects that need to be improved on. SPs often have detailed debriefs with learners where they can provide methods to perform better in future scenarios. This feedback is essential for learners to develop clinical and professional competencies.
Potential roles for standardized patients in EMS
During patient assessment scenarios, EMS providers and students are tasked with appropriately assessing and treating a patient based on case presentation. The patient in these scenarios is often portrayed by a peer or instructor. In these scenarios, little emphasis is placed on specialty considerations, such as cultural diversity. While these scenarios are useful in training initial assessment and treatment competencies, they do not accurately reflect patient encounters in the real world. Thus, one can argue that these simulated encounters do not adequately prepare providers for field patient encounters. A more thoughtful alternative would be to replace the portrayed patient with a highly trained SP.
Because of their versatility, SPs can be trained to portray scenarios that encourage the development of cultural competence. SP encounters and case design can target a learning objective involving a particular characteristic (e.g., performing a physical examination on a patient from a culture where physical touch must be limited) [2]. Countless other scenarios can be developed and tailored to meet the educational institution’s needs. These scenarios can be developed based on a cultural census of the populations the institution serves.
The incorporation of SPs into assessment scenarios can encourage providers and students to think critically and adapt their care to be culturally appropriate. SPs can aid providers in developing core cultural competencies (e.g., respect for diversity and understanding of cultural differences). These real-world scenarios can be hyperrealistic and force providers to consider other aspects of prehospital care besides the basic assessment and treatment competencies.
SPs trained in cultural competency can facilitate debriefing sessions with providers regarding their ability to respect the patient’s culture. Following an assessment scenario, the provider or student can discuss aspects of the encounter with the SP. The SP can provide feedback to the participant on their ability to respect and understand the patient’s culture or other program-desired competencies. The participant and SP can also discuss strategies to improve cultural competence in future scenarios or real-world patient encounters. This feedback can be tailored to specific cultural populations the SP has been tasked with portraying.
Benefits of cultural competency education
The implementation of SPs in cultural competency education can provide participants with a deeper knowledge of cultural competencies. By practicing scenarios involving cultural considerations, participants will be better suited to handle these scenarios in a real-world setting. The versatility of SPs can allow for scenarios to be portrayed based on almost any aspect of culture and the associated prehospital care plans.
SPs can foster critical thought amongst participants. Scenarios involving cultural competency may require participants to appropriately adjust assessments and treatment plans with respect to the patient’s culture. These life-like scenarios can encourage participants to think critically and apply knowledge learned throughout their education.
SP-based education may also foster interpersonal collaboration with culturally competent professionals (e.g., social workers and community health advocates. Through this collaboration, providers can address social concerns for health in the community they serve. Employing SPs and cultural competency-based scenarios can develop a culturally competent EMS system that can connect with and treat patients from diverse backgrounds. This implementation can increase public trust, as culturally diverse groups can feel respected and cared for by EMS providers who serve their communities.
Limitations of standardized patients
The use of SPs in cultural competency-based training for EMS providers is a practical strategy for enhancing education in cultural competence. While this application has the potential to foster cultural relevatism and strengthen public trust, there is limited research into its practical application. Further research studies are required to explore the role of the implementation of SPs for cultural competence training in EMS education. These studies should focus on the role of SPs in EMS education, as well as outcomes and data concerning cultural competence.
Additionally, EMS educational governing bodies often cite specific ratios of certified instructor staff that must be present at course meetings. It is likely that SPs will not be certified at the EMS instructor level; this will require the institution to schedule a higher proportion of certified staff for the course. Future explorations of this facet are required to ensure compliance with governing bodies’ policies. A potential solution to this issue would be proposed alterations in policies that permit SPs to participate in course sessions solely to enhance cultural competence rather than provide EMS-specific education.
Finally, hiring and maintaining a team of SPs can come at a significant fiscal responsibility to an educational institution. Employing SPs will require a designated percentage of payroll for the time and training of SPs.
REFERENCES
- Jones F, Eduardo Passos-Neto C, & Freitas Melro Braghiroli O. (2015, September 16). Simulation in Medical Education: Brief history and methodology. Principles and Practice of Clinical Research. https://journal.ppcr.org/index.php/ppcrjournal/article/view/12
- Uzelli Yilmaz D, Azim A, & Sibbald M. (2021). The Role of Equity, Diversity, and Inclusivity in Standardized Patient Programs. Academic Medicine, Publish Ahead of Print. https://doi.org/10.1097/acm.0000000000004447
ABOUT THE AUTHOR
Joseph Daly holds a Bachelor of Science in Biology and is currently pursuing a Master of Science in Medical/Healthcare Simulation. He is a New York State Certified Lab Instructor (CLI) and works for a high-volume EMS agency in New York City, responding to over 100,000 calls annually. His professional interests include EMS education, simulation-based training and advancing cultural competency in pre-hospital care.
EMS1 is using generative AI to create some content that is edited and fact-checked by our editors.