Standardized
Patients in
Training and
Evaluation
Judith G. Gearhart, MD
Our Objectives
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Define simulations
Discuss applications
Observe examples
Examine opportunities for
standardized cases to enhance
employee performance
Create a case framework
Collaborate
Topics of Discussion
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Background and terms
Standardized patients in teaching
Standardized patients in evaluation
Developing scenarios and
checklists
Resources
Background
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“Nothing new under the sun”
(1916-1963)
Standardized patients and OSCE
used since the 1970s in teaching
and evaluation
Incorporated into the USMLE in
2005 Step 2CS Exam
Definitions
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Standardized Patients (SPs):
“actors” trained to simulate a
patient in a clinical presentation
and to give trainees feedback on
performance
Definitions (cont’d)
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Virtual patients:
online cases
paper cases
Simulators:
models
manikins
Definitions (cont’d)
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OSCE (Objective Structured
Clinical Exam):
An examination assessing trainee
performance in a simulated clinical
setting using standardized patients
and cases
Uses objective checklists to
determine whether trainee
performs desired competencies
Also known as:
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CPX (Clinical Performance Exam,
Clinical Practice Exam)
PBA (Performance-Based
Assessment)
CSA (Clinical Skills Assessment)
Definitions (cont’d)
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OSTE
Objective Structured Teaching
Exam
Advantages of SPs
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Validity
Availability
Reliability
Controllability
Adaptability
Minimal risk
Feedback
Extension of faculty
Uses of SPs
Education :
 Teach specific skills (interview,
history & physical, diagnosis,
management, procedures,
professional behaviors)
 Provide exposure to clinical
problems
 Teach how to deal with important
issues (cross-cultural issues, ethics,
delivering bad news)
Uses of SPs (cont’d)
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Provide opportunities to meet
educational objectives regarding
variety and type of clinical
problems
Provide cases trainees should, but
might not see without planning
Give trainees feedback
Evaluate teaching methods
Uses of SPs (cont’d)
Evaluation of trainees
 Informal assessment and feedback
(ungraded, “low-stakes”, pass/fail)
 Formative or final assessment for
grade (with or without feedback)
 Assessment to determine
progression to next level or
licensure (“high-stakes”)
Other uses
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Admissions of med trainees or
residents
OSTE (Objective Structured
Teacher Examination)
Human Resources
Practicing Physicians
Human Resources
Issues
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Hospitality
receiving, registration,
information giving,
telephone etiquette
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Confidentiality
Team interaction
Professionalism
Things SPs Can Do
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Act out scenarios (history,
physical, need for counseling or
information)
Simulate physical findings
Use checklists developed by
faculty to evaluate trainees
objectively
Give trainees feedback
Physical Findings that Can
Be Simulated
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Abdominal tenderness
Asterixis
Carotid bruits
Confusion
Dilated pupil
Gait abnormalities
Hyper/hypotension
Jaundice
Sensory losses
Sputum production
Wheezing, asymmetrical BS
Prior Development of UMC
SP Program
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Recruiting, screening, training
patients to act out scenarios
Training patients to give feedback
Maintaining the standardized
patient pool
Working out remuneration
Use of facilities
Development of UMC
Standardized Patient
Program (cont’d)
Creating scenarios and checklists
 Accessing those already available
 Scripting from patient/employee
encounters you’ve had
 Scripting case for objectives
Developing Cases and
Checklists
First, determine objective for case
 teaching, evaluation, or
combination
 teaching/evaluating what skill?
Developing Cases and
Checklists (cont’d)
What skill(s)?
 Adapt for level of trainee
 Adapt for time frame
 Put in context of curriculum map
or institutional goals
Developing Cases and
Checklists (cont’d)
Next, create the case (scenario)
 Access those already available
 Script from patient/employee
encounters you’ve had
Developing Cases and
Checklists (cont’d)
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Identify minimal competencies/
behaviors/questions
List in appropriate sequence
Be specific
Use language that an SP will
understand
Examples
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Patient asks for directions/clinical
information from employee who doesn’t
know the answer
Employee encounters angry patient
Procedures (venipuncture checklist)
Model/mannequin cases (Sim center)
Examples
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Admitting medical error
Obtaining informed consent
Delivering bad news
Telephone triage
Patient safety
Summary
Using Standardized Patients can
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increase learning opportunities
through structured cases
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Using standardized cases can
provide another perspective
of trainee performance
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provide an objective rather than
subjective, measure of skills
Resources
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Bibliography
Web sites
Organizations
Clinical Procedures and Simulation
Center
Clinical Skills Center
Resources
ASPE
(Association of
Standardized Patient
Educators)
www.aspeducators.org
Individual or institutional
membership fee
Casebank
Society for Simulation
in Health Care
www.ssih.org
Multiple membership,
individual, active, retired,
student, resident fee
Free without journal