University of Pittsburgh

Standardized Patients in Medical Education

Standardized Patients in the Curriculum

Background

As a fundamental part of becoming a doctor, medical students must learn basic history taking and physical exam skills. Once these skills are learned, however, opportunities to assess the skills and ensure that students are at least minimally competent must exist. The Standardized Patient program was implemented as a method for safe, structured learning, feedback, and formative and summative assessment.

Goal

The goal of using Standardized Patients in medical education is to provide a highly realistic learning resource for students that helps them to develop skills in interviewing and examination techniques. Standardized patients participate in skill demonstration and instruction, practice and experience, and evaluation and assessment.

ImplementationLink to SPE Education

Standardized Patients (SPs) are used in a variety of ways. SPs are trained to portray specific cases that address the learning objectives of a particular course. In addition, they are trained to give specific, behaviorally based feedback to learners about their performance. SPs are used for both learning activities (e.g. Medical Interviewing) and summative assessment (e.g. a 10-station Observed Structured Clinical Exam [OSCE] at the end of third year).

Each student spends approximately 63 hours in standardized patient instruction and assessment across the four-year curriculum. This year, students will participate in approximately 14,000 SP encounters.

 

Courses

  • Medical Interviewing: 7 four-hour sessions on learning the basics of interviewing patients; students receive individualized feedback regarding interpersonal skills
  • Advanced Medical Interviewing: 4 three-hour sessions learning more advanced interviewing techniques
  • Normal Physical Exam: Opportunity to practice physical exam techniques on patients of the opposite gender before his or her normal physical examination skills assessment
  • Gynecological and Genitourinary Exams: Guided opportunities to learn correct technique using mannequins followed by examining actual standardized patients
  • Tobacco Cessation Workshop: 1 two-hour session learning and practicing to counsel patients on smoking cessation
  • Geriatric Teaching session: 1 focused three-hour session on taking a history and assessing elderly patients for cognitive impairment, falls, health screening
  • Psychiatry Teaching: 1 four-hour session teaching students to interview patients with specific psychiatric disorders
  • Family Medicine Alcohol Workshop: 1 one-hour session where students assess patients for alcohol use (SBIRT) and counsel them to quit drinking
  • Clinical Skills Tutorial: 4 four-hour tutorial faculty-guided sessions for students scoring in the bottom 10% of the Clinical Competency Assessment.  Students perform one to two focused history and physical exams each session, and are given immediate feedback by faculty and SP in order to better prepare for the Step 2 CS
  • MD/PhD Review: Following completion of their PhD, returning MSTP students are given the opportunity to refresh their clinical skills with an expert faculty guide before beginning clinical rotations. Students practice performing a full history and a focused physical exam on patients with chest pain, syncope, and abdominal pain

Assessments

  • Normal Physical Exam: First year assessment of basic physical examination skills
  • Clinical Skills Assessment: Second year observed examination of student taking a complete history and physical
  • Advanced Physical Exam OSCE: Second year 4-station structured exam provides opportunities for students to perform focused histories and physicals
  • Combined Ambulatory Medicine and Pediatrics Clerkship OSCE: 10-station end-of-clerkship exam on common adult and pediatric medical problems with note writing
  • Family Medicine OSCE: End-of-clerkship OSCE on patient assessment of common conditions, case presentation and development of differential diagnosis and plan
  • Adult Inpatient Medicine: At mid-clerkship, this 3-station OSCE on problem-focused history and physical exams is centered on thoracic conditions, and is used for formative feedback, where each student returns to their clinical team with an educational prescription to facilitate individualized instruction
  • Obstetrics and Gynecology OSCE: During mid-clerkship, this 2-station OSCE focuses on assessment and counseling of domestic violence and contraception issues facing female patients. A learning prescription is created for each student

  • Surgery OSCE: 3-station, mid-clerkship learning event on the focused history and physical exam of abdominal conditions, where each student's performance assessment leads to an individualized learning prescription
  • Neurology Clerkship OSCE: Students perform an observed complete neurologic exam and receive feedback on their technique
  • Clinical Competency Assessment: Early 4th year, 10-station exam with integration of interstation exercises

Impact

Standardized Patients are an important and flexible learning resource for teaching and evaluating history taking and physical examination skills across the curriculum. Because a particular patient problem or scenario is readily available, and can be adjusted to meet the needs of the learner, educators can create an optimal learning environment, based on the learner’s experience and the objectives of the session. Students can learn and practice interviewing and physical exam skills in a safe setting without risking the comfort or safety of a real patient. Students also have the opportunity to work in emotionally charged situations, such as domestic violence, angry patients, or bad-news cases without risk.

Testing learner’s patient care skills using Standardized Patients ensures a more predictable, reliable, and fair assessment. And because the Standardized Patient is trained to provide feedback on the learner’s professional manner, attitude, and interpersonal skills, feedback can be immediate and from the patient’s point of view. Standardized Patients supplement instruction and assessment in a multitude of ways and provide an invaluable resource for the clinical curriculum.

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