SP Scripts and Training 26

Scripts for the five encounters (Appendices 2-6) completed by participants were written by the medical director of the Standardized Patient Center (a pediatric psychiatrist), the SP Program Coordinator (an actress with a degree in theater arts), and a pediatric audiologist (the author). Each script included the same diagnosis and case history for the infant that was being diagnosed, with only the emotional response of the parent changing between scripts. A bilateral

Figure 1. Audiogram results for infant in encounter. ABR revealed a bilateral mild sloping to profound sensorineural hearing loss.

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mild to profound sensorineural hearing loss was chosen because responses to auditory input may be evident to parents, the infant would benefit from hearing aids and early intervention, and a cochlear implant would not be an option at the time of diagnosis. The infant was described as a six-week old boy with no risk factors for hearing loss, born after a healthy pregnancy, and weighed 7 pounds, 8 ounces at birth. He failed his newborn hearing screening at the hospital resulting in a referral for further testing, and the parent is returning on the day of the encounter for the full diagnostic testing recommended by the hospital. Results of the auditory brainstem response testing (ABR; Figure 1) and otoacoustic emission testing (OAE; Figure 2) were included with information given to SPs and participants. The ABR and OAE are

electrophysiologic tests typically performed as part of a diagnostic hearing evaluation on children under the age of six months before behavioral testing can be completed (Cunningham, Cox, Committee on Practice and Ambulatory Medicine, & Section on Otolaryngology and Bronchoesophagology, 2003).

Scripts differed in the emotional response from the parent to whom the student had to respond as she delivered the news of the diagnosis. The responses included a “tearful mother,” a “contesting father,” a “guilty mother,” an “overwhelmed mother,” and a “tearful father.” These responses were chosen because they are common responses of parents to the initial diagnosis (Yoshinaga-Itano & Abdala de Uzcategui, 2001) and because students are often concerned with how to respond to these reactions (English & Zoladkiewicz, 2005). Questions asked by the parents were taken from the “Concern List” developed by English et al. (2007). Scripts for each of the encounters included a different occupation and education level for the parent as well as different names for the parent and the infant to increase realism of the encounters as separate

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patients. Table 2 summarizes the five sessions and details the amount of time spent with SPs. Encounters included 20 to 25 minutes to complete the counseling session. The first three sessions included a 10 minute face-to-face feedback session with the SP.

Table 2. Encounter details

Session Number

SP

Gender SP Reaction SP Behavior

Maximum Time in Encounter Maximum Time in Feedback with SP 1 Female Tearful Mother cries in

response to diagnosis 25 minutes 10 minutes

2 Male Contesting

Father does not believe hearing test

results

25 minutes 10 minutes

3 Female Guilty Mother blames herself

for hearing loss 25 minutes 10 minutes 4 Female Overwhelmed Mother shuts down in

response to diagnosis 20 minutes None 5 Male Tearful Father cries in

response to diagnosis 20 minutes None

A three-hour training session for the SPs took place a week before the encounters. Scripts were provided to the actors before the training session took place. This was the first time for all of the actors to take part in SP encounters involving an audiologic case. During the training session, the pediatric audiologist reviewed what the parent of an infant referred on a newborn hearing screening would have experienced before the audiologist delivered the results of the diagnostic testing. This review included a video of the newborn hearing screening process done in the hospital room as well as a video of the sleep deprived diagnostic ABR testing which they would have completed just before the audiologist came in to give the results. SPs were apprised

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of instructions they would have received following the referral on the hearing screening in the hospital, as well as instructions on how to “sleep deprive” their baby in preparation for the diagnostic ABR. Feelings of the parents of an infant who referred on a hearing screening were discussed. These included concern and anxiety in the weeks following the screening up to the diagnostic testing, as well as overall anxiety. The anxiety may be because this is their first child

Table 3. Details on SPs used in encounters

Standardized

Patient Age Gender

Years of Experience as SP Session(s) Actor Participated In January 2014 June 2014 SP1 32 F 5 X X SP2 31 M 5 X X SP3 28 F 3 X X SP4 41 F 5+ X SP5 37 M 5 X X SP6 23 M 1 X X SP7 33 F 5 X X SP8 23 M 5 X SP9 25 F 3 X SP10 29 F 1 X SP11 36 F 3 X SP12 28 F 1 X SP13 56 M 2 X SP14 44 M 5 X SP15 47 F 7 X

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and they are most likely not getting a lot of sleep and spent the previous night sleep depriving their infant. During the training session, all five scripts were reviewed and reactions for each session were discussed including questions they needed to ask, behaviors that would be common for the parent within the encounter, and what to avoid. Results of the testing including explaining the audiogram and OAE results were not reviewed purposely to make the information as “new” to the actors as possible when the students first presented it. Role playing and demonstrations of the reactions were completed during training. When training the SPs for the second session of data collection in June, video recordings of the sessions in January were used to give examples of how the parent should react. Table 3 shows details of SPs trained for this project which included 14 actors (8 women and 6 men) ages 23-56 years with one to more than five years of experience as SPs. SP4 had experience at another institution before coming to Washington University, and her total amount of experience was unknown. A fifteenth actor was trained and reviewed encounters as a monitor, but never portrayed the parent during an encounter.