Standardized Patients in Training and Evaluation

Judith G. Gearhart, MD

Our Objectives Define simulations Discuss applications Observe examples Examine opportunities for

standardized cases to enhance employee performance

Create a case framework Collaborate

Topics of Discussion Background and terms Standardized patients in teaching Standardized patients in evaluation Developing scenarios and

checklists Resources

Background

“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

Standardized Patients (SPs):

“actors” trained to simulate a patient in a clinical presentation

and to give trainees feedback on performance

Definitions (cont’d)

Virtual patients:

online cases

paper cases Simulators:

models

manikins

Definitions (cont’d)

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:

CPX (Clinical Performance Exam, Clinical Practice Exam)

PBA (Performance-Based Assessment)

CSA (Clinical Skills Assessment)

Definitions (cont’d)

OSTE

Objective Structured Teaching Exam

Advantages of SPs Validity Availability Reliability Controllability Adaptability Minimal risk Feedback Extension of faculty

Uses of SPsEducation : 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) 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

Admissions of med trainees or residents

OSTE (Objective Structured Teacher Examination)

Human Resources Practicing Physicians

Human ResourcesIssues Hospitality

receiving, registration,

information giving,

telephone etiquette Confidentiality Team interaction Professionalism

Things SPs Can Do

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

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

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

Next, create the case (scenario) Access those already available Script from patient/employee

encounters you’ve had

Developing Cases and Checklists (cont’d)

Developing Cases and Checklists (cont’d) Identify minimal competencies/

behaviors/questions List in appropriate sequence Be specific Use language that an SP will

understand

Examples 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

Admitting medical error Obtaining informed consent Delivering bad news Telephone triage Patient safety

SummaryUsing Standardized Patients can increase learning opportunities

through structured cases Using standardized cases can

provide another perspective

of trainee performance provide an objective rather than

subjective, measure of skills

Resources

Bibliography Web sites Organizations Clinical Procedures and Simulation

Center Clinical Skills Center

ResourcesASPE(Association of Standardized Patient Educators)

www.aspeducators.orgIndividual or institutional membership feeCasebank

Society for Simulation in Health Care

www.ssih.orgMultiple membership, individual, active, retired, student, resident feeFree without journal