Table 2.

Summary of the written qualitative feedback of family medicine residents and standardized patient instructors collected immediately after training sessions

Stage	Resident comments n = 8	SPI comments n = 2
Overall	Wonderful experience Felt like I advanced more than any other teaching Reviewing anatomy, having didactic, then performing Learning directly from the patient, instead of books, videos, and observing senior physicians Teaching systematic, better than during clinical care	Went extremely well Enjoyed teaching, learned from experience with non-English speakers Met expectations for being polite, gracious Pleasantly surprised by curiosity, desire to clarify and ask questions Discovered resident learning experiences in Japan mostly had been passive, observational Some learners initially tentative Agreed to being photographed after the teaching session
Pre-SPI encounter	Observing examinations in the clinic prior to SPI experience made it more effective Helpful to review online written materials & videos on anatomy, and how to perform examinations	NA: SPI were not asked to provide
Pre-SPI lecture/coaching	Learning how to examine using manikin models Learning the procedures for interacting with an SPI	NA: Provided by faculty member
SPI session	SPI comfortable with teaching SPI demonstrating how to do exam, then doing it SPI knew own physical findings, and showed them Understanding the patient’s perspective (e.g., anxiety, discomfort, modesty) Individualized teaching in detail, in person Learner repeating over and over until got it right (e.g., finding cervix with speculum) Pacing the teaching to the learner’s ability Appreciation of teaching from the patient’s perspective about modesty, protecting it Learning different patterns of examination Feeling a real lump	Focused on “reading, watching, doing” Defined scope of session: e.g., procedures, role of SPI Encouraged questions “Cheat sheet”—SPI prepared, helped learner Inquiring about learners’ previous examination experiences Taught examination techniques, communication skills, sequence of the examination, putting the patient at ease, when to use chaperone, accommodating family members, positioning (e.g., common patient preferences, and accommodating co-morbidities) Teaching how to protect patient modesty, how to incorporate genitourinary exam routinely or focused into overall examination SPIs excited when learner palpated actual findings Enthusiasm of learners made session longer than SPI expected
Using interpreter	Having an interpreter present helpful to understand (pre-session) Very helpful for understanding and clarification (during SPI session)	Using an interpreter was novel Reading in advance about how to use interpreter Took nearly twice as long using interpreter Interpreter used first person Tried speaking initially in phrases, but interpreter preferred full sentences Positioned interpreter facing away, toward wall during examination, or caudad to exposed genitalia (male SPI on female interpreter) After getting used to interpreter, became easier, flowed better When learner practiced combining examination skills and communication to patient, opted to NOT use interpreter to facilitate the learner naturally integrating examination and communication skills (rather than disrupting flow by using interpreter)
Improvements	United States speculum different from Japan; not used to it Feel he/she needs to train many times after the session by oneself Video recording of the teaching session for reference for self-study would be helpful Want to confirm if performing examinations could be done by oneself Need manikin models with abnormal findings

SPI standardized patient instructor