1. Holtschneider, Mary Edel MEd, MPA, BSN, RN-BC, NREMT-P, CPLP

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In the previous Simulation column, I began a series dedicated to the use of standardized patients (SPs) to help increase the level of fidelity in simulation scenarios. I interviewed an SP who provided insight into the role and made some suggestions for nursing professional development (NPD) specialists to maximize their use of SPs in the practice environment. For this column, I interviewed Carol Kridler, MSN, RN, A-CCRN, retired NPD specialist, from Summa Health in Akron, Ohio, who has returned to work as a research nurse for a grant-funded program that uses simulation.


MEH: Carol, tell me about the project that you are working on and how you are using simulation.


CK: It is a Health Resources and Service Administration (HRSA) grant-funded project out of our Center for Senior Services entitled "Geriatric Workforce Enhancement Program (GWEP)." The 2-year grant has four main goals including (1) educating students and faculty regarding geriatrics, (2) educating practicing professionals about geriatrics, (3) educating community members, and (4) establishing a functioning interprofessional team to whom practitioners and the public can turn for geriatric advice. Sue Hazlett, RN, MS, is the principal investigator.


MEH: This sounds like an extensive project as it involves both students and clinicians. Please describe how you provide interprofessional education.


CK: We are currently in the second year of our grant, and our first steps involved educating students to become part of interprofessional teams that develop a comprehensive plan of care for a fictional patient. Some of the students involved include medical students from the Northeast Ohio College of Medicine (NEOMED); pharmacy students from NEOMED; nursing students from the University of Akron, Cleveland State University, and Walsh University; and other students from physical therapy, exercise physiology, social work, emergency medical services, dietary, and pastoral care. So far, we have had 8 days of classes for students with two groups each day.


In addition, our area agency on aging, which is locally called Direction Home, also participates. We schedule an education day with the students and provide the case online. Each program lasts about 4 hours. We gather the students and lead a brief group description of the program. They then view posters describing the risks and concerns of the older adult. From there, the students go to profession-specific huddles where the facilitator encourages discussion of topics that their individual profession needs to be cognizant of to care for this "patient."


The patient case involves a 74-year-old man who broke his arm in a motor vehicle accident. On the surface, it sounds fairly straightforward, but the patient is a recent widower and is suffering from depression. His one grounding force is his dog, which brings him great joy. The interprofessional group meets for a preassigned round-table discussion to determine a comprehensive plan of care, yet they do not get all of the patient's detailed information. The facilitator elicits information from each profession, encouraging the sharing of information especially on the first topic. After the first topic, participants are instructed to participate on their own with little or no input from the facilitator. It is emphasized that the interprofessional team can meet at the request of anyone on the team and that anyone can be the team leader.


MEH: This obviously takes a lot of coordination with various schools, facilitators, and student groups. How do you introduce the SP to the students?


CK: Rather than having our SP portray the patient, we have our SP portray the son/daughter who provides information from their vantage point. The SP that we bring in is the son/daughter of the patient, so the students never interview the patient directly. Participants find this family member to be very informative on matters that they had no idea existed.


MEH: This is a creative use of an SP and probably a bit of a surprise for the students as they likely expect to see the actual patient! How do you train the SP?


CK: I do not train the SPs directly as they are trained by the academic SP program. However, from my experience, they are very well prepared. I observe that they get into the role so well that it is not until the final debriefing that participants are aware that this is not really a family member but an SP! The SPs stay for the final debriefing and provide their input along with the facilitators (Walker, Armstrong, & Jarriel, 2011).


MEH: What differences have you noticed when you have done this with practicing clinicians?


CK: We have had 2 days (four classes) for licensed professionals and have used the same format. We host the practicing clinicians at a conference so that they are away from the workplace. We have not noticed many differences with regard to the use of SPs between the students and those who are licensed.


MEH: How have you evaluated the program?


CK: We have done Level 1 reaction evaluations thus far and are looking at ways to get higher level evaluations.


MEH: What lessons can you share regarding your experience with SPs?


CK: SPs are great to work with as are the SP trainers! As I mentioned, I have not directly trained the SPs as we have gotten them from an active university SP program. I really like how the SPs provide their feedback to the learners during the debriefing session along with the facilitators ( The learners are all very complimentary and appreciative of their insights, which is great. In my discussions with the SP trainers, they report that the SPs have commented about how much they have even learned through the simulations and how valued they were made to feel.


Since I have not worked with SPs in the past, this has been a great learning experience for me. One thing that we have not done is consider different ways for the SP to provide feedback. For example, the SPs currently do not stay in their role during the debriefing session. It might be interesting to try having them stay in their role until the entire educational session is finished.


Another important aspect that I have learned from this process is that it is essential to prepare the facilitators adequately. Many of our facilitators are highly experienced teachers yet do not have expertise on how to facilitate a simulation session with interprofessional learners and an SP. We have determined that we need to give the facilitators more guidance to ensure their success.


MEH: What other plans do you have for the future of this project?


CK: We would like to focus more on Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS(R)) as the NEOMED students have had an optional TeamSTEPPS(R) day in the past ( It is going to be a mandatory part of their curriculum beginning this fall. It is also being incorporated into the nursing curriculum at the University of Akron. I see us continuing to use SPs and integrating them into our educational endeavors.


MEH: Beyond the simulation education that you provide, what other community education do you offer?


CK: We have held a Community Education Day that included the interprofessional team along with an attorney to provide general assistance with Advance Care Planning, an accountant to provide advice on financial planning, and a clinical psychologist who presented a program on gardening with many options for the older adult who may have some mobility and flexibility issues. This was very well received in the rural setting. We plan to present this again in an inner city setting later this summer or in the fall.


I find several key takeaways from Carol's experience that NPD specialists can focus on when incorporating SPs into their practice. First, it is important to guide facilitators on how to lead simulations and interact with SPs as they might not have expertise in this area. Many have experience with teaching, but not in facilitating. Second, SPs can play roles beyond the patient, and using an SP as a son/daughter can add a different dimension to the learning experience. Third, since SPs can provide excellent feedback and input for learners, it is important to analyze the optimal ways for them to carry out this aspect of their role.


In future columns, we will continue to explore various uses of SPs and how they add fidelity to educational programs. Do you have a project that involves SPs that you would like to share? Please e-mail me at




Walker S., Armstrong K., Jarriel A. (2011). Standardized patients, part 4: Training. International Journal of Athletic Therapy and Training, 16(5), 21-23. [Context Link]