title: Deliberate Practice with Standardized Patient Actors and the Development of Formative Feedback for Advance Care Planning Facilitators.
abstract: Multimodal curricular assessment after adding standardized patient (SP) actor-based simulation to an advance care planning (ACP) facilitator training course and development of a formative feedback tool.
  
  
  
  ACP represents a highly valued service requiring more and better trained facilitators.
  
  
  
  Participants were primarily nurses and social workers in a large multisite health system. The course included a precourse video demonstration of ACP, traditional lectures, and four 30-minute simulations with SPs. Knowledge was tested with a multiple choice question (MCQ) test. In addition to standard postcourse/postsimulation evaluations, learners were surveyed pre/post/30-90 days delayed for self-perceived confidence. A linear mixed-effects model was used to analyze changes over time. Trained faculty rated performance in simulations with an observational mini-clinical examination (mini-CEX)-type rating form with a checklist, global competency, and global communication rating. Inter-rater reliability (IRR) was calculated on randomly selected paired ratings.
  
  
  
  Sixty-seven individuals consented to participate. MCQ scores improved from 83% ± 10% to 92% ± 8% (p < 0.001). Paired learner surveys of self-confidence across six domains were available for 65 pre, 65 post, and 40 delayed with a mean positive change on a 0 to 10 point scale from pre-post (2.32 ± 1.65; p < 0.001) and predelayed (2.34 ± 1.96; p < 0.001) time frames. For the faculty observation ratings of simulation performance, the average raw agreement for critical actions was 82% and IRR was 0.71.
  
  
  
  Learner feedback and self-assessment suggest that actor-based simulation contributed to improved confidence in conducting ACP. The mini-CEX observation form is adequate for formative feedback, with further testing needed to make judgments of competence.
authors.affiliation: 1 OSF HealthCare , Peoria, Illinois.|2 Jump Simulation , Peoria, Illinois.|3 University of Illinois College of Medicine at Peoria , Peoria, Illinois.
authors.forename: William F
authors.initials: WF
authors.lastname: Bond
authors.affiliation: 3 University of Illinois College of Medicine at Peoria , Peoria, Illinois.
authors.forename: Hanna C
authors.initials: HC
authors.lastname: Gonzalez
authors.affiliation: 4 Illinois Wesleyan University , Bloomington, Illinois.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Funk
authors.affiliation: 1 OSF HealthCare , Peoria, Illinois.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Fehr
authors.affiliation: 1 OSF HealthCare , Peoria, Illinois.
authors.forename: Jeremy S
authors.initials: JS
authors.lastname: McGarvey
authors.affiliation: 1 OSF HealthCare , Peoria, Illinois.
authors.forename: Jessica D
authors.initials: JD
authors.lastname: Svendsen
authors.affiliation: 1 OSF HealthCare , Peoria, Illinois.
authors.forename: Robert
authors.initials: R
authors.lastname: Sawicki
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D004521:Educational Measurement / Q000379:methods; D005260:Female; D000068156:Formative Feedback; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation; D016544:Patient Simulation; D015203:Reproducibility of Results
keywords: advance care planning; deliberate practice; end of life; facilitation; simulation; standardized patient actor