Table 4. Simulation Objectives, Critical Actions, and Report Learner Receives Prior to the Simulation.

Before the resident entered the simulation room, they were informed that the patient was a 15-year-old non-English speaking female adolescent coming alone for a well-child check and that she needed an interpreter, who were both already seated in the room. 

Simulation Case Template
PATIENT NAME: Maria Lopez, 15 years old; CHIEF COMPLAINT: Well Child Check; PHYSICAL SETTING: Outpatient Clinic
Brief narrative description of the case	A 15-year-old Mexican female is coming in alone, with permission from her mother, for a well-child check. An interpreter is needed for her visit. The resident is to conduct an adolescent interview, during which it is discovered that the patient is very uncomfortable discussing sensitive health information, especially sexual health, in the presence of a medical interpreter. The goal of this simulation case is for pediatric residents to practice conducting an adolescent interview (HEEADSSS exam) through the appropriate use of an interpreter, while also discussing the importance of upholding patient confidentiality.
Primary Learning Objectives	Describe the appropriate use of a medical interpreter for non-English speaking patients within the context of patient-centered care Demonstrate skills in adolescent interviewing Summarize the importance and expectations of upholding patient confidentiality Demonstrate social skills including self-awareness of cultural humility
Critical Actions	The goal is to have the resident conduct an adolescent interview (HEEADSSS exam) through appropriate use of an interpreter and also discuss the importance of upholding patient confidentiality. The resident should at some point in the adolescent interview ask questions regarding the sexual health of the standardized patient (SP), which should then prompt the SP to show discomfort and describe the “Back Story Concerns Regarding Confidentiality” (described below, a story about an adolescent in her community having her private health information become a topic of local gossip). The resident should engage the SP about confidentiality and work to understand her point of view. If done appropriately, the SP would be willing to discuss her sexual health in order to reduce risks of unplanned pregnancy, STIs, and other safety concerns.
Learner Preparation or Pre-work	Report learner receives prior to the simulation of a 15-year-old Mexican female adolescent coming alone for her well-child check today (The mother’s consent was provided for the patient to be seen alone today.) The patient speaks Spanish and said an interpreter was needed. Both the medical assistant and medical student confirm that an interpreter is needed. The trusted and thorough medical student saw the patient first. The patient has no significant medical history, no major surgeries, no hospitalizations, and no medications. The patient’s BMI is 22. A physical exam is completely unremarkable. She has stressors but screens negative for depression. She has never been tested for STIs. She has minimal exposure to drugs and violence.