Evaluation of a Digital Standardized Patient Experience in Advanced Health Assessment

Historically, undergraduate nursing health assessment courses have focused on physical exam skills in acute care settings.  In graduate school, however, the focus shifts to advanced skills, patient-provider communication, synthesis of data, and clinical decision making regardless of setting.  In 2013, the use of a digital standardized patient (DSP) was added to advanced health assessment at the University of Michigan.  Use of in-depth simulated patient experiences allowed students to practice patient communication, advanced physical assessment, diagnostic reasoning, clinical decision making, and basic skills on a complicated patient. The purpose of this project was to develop the advanced health assessment skills of nurse practitioner students, examine student self-efficacy in competencies of advanced health assessment, and evaluate student comfort with progression to real world clinical experiences after the use of a DSP.  Students were surveyed pre- and post-experience to evaluate comfort with digital technology, communication and skill self-efficacy, and confidence in progressing to a live patient.  After the DSP experience, almost all (N=25, 92%) stated that they were confident in their ability to take a complete health history, preform physical exam tests (72%), and identify the difference between normal and abnormal findings (76%).  Almost two thirds (63%) felt better prepared to interview a live patient, but 16% stated that they were not at all confident in their ability to perform a complete physical exam on a patient.  Only 54% felt that the DSP helped to synthesize data and develop differential diagnoses.  Forty one percent of the students did not feel that the digital patient responses were authentic and 43% stated that the digital patient did not realistically simulate a live patient. Despite the benefits of using a DSP, there is still a need for exposure and experience with live patients outside of healthy peers.  Incorporating this data and student feedback, the next phase of this project will add an in-person standardized patient experience.  Students will complete both digital and in-person patient experiences to continue to enhance skills and comfort with clinical decision making to better prepare them for their first clinical course.