A Standardized Patient is someone who has been trained to portray, in a consistent, standardized manner, a patient in a medical situation. Standardized Patients, or SPs, are used by the University of Pittsburgh School of Medicine (UPSOM) and by other institutions to teach and evaluate students. SPs learn a case based on a real patient other than themselves and are interviewed and examined by students as though they were that person in the doctor’s office or clinic, giving that patient’s history and simulating his or her physical symptoms such as pain or difficulty walking.
Students are to examine and interact with each patient exactly as they would with a real patient if they were the only doctor available (with no preceptor to whom to report). We believe that the simulations are authentic and the situations realistic. As students examine these patients, they need to remember to do what they feel is indicated in order to evaluate a patient with this problem. It will be up to the student to decide what needs to be examined.
A typical encounter with a SP may involve interviewing, counseling, or examining the patient in the same manner as would occur during a regular clinic encounter. For certain sessions, the SP is trained to provide constructive feedback to the learner from the patient’s point of view. In certain sessions, SPs are trained to score learner performances on a specific checklist built for this type of evaluation.
Students have the opportunity to practice interviewing a patient and efficiently gather information needed to help diagnose the problem while practicing effective interpersonal skills that will help them later to connect with real patients. They also can practice techniques and approaches for physical examination and to counsel patients on a variety of issues, some very challenging such as breaking bad news.
Before encountering students, prospective Standardized Patients audition, interview, and participate in more than 16 training hours. Depending on the case, which is written by clinicians, SPs practice a variety of encounters. They learn how to provide feedback and score student performance. Once the SPs are trained, they are required to successfully present or demonstrate their character before an encounter with a student.
During some work with Standardized Patients, students may use sessions of time-in and time-out to distinguish active interaction time with the patient from discussion time. During time-out periods, the Standardized Patient will remain in time-out mode until the student calls time-in and continues the interaction. Time-outs are always called by the student or facilitator to increase the safety of the encounter.
The Clinical Skills Assessment (CSA) is an objective assessment of clinical skills.
The CCA (Clinical Competency Assessment) is designed to ensure that the graduating UPSOM students can gather and interpret clinical patient data and communicate in an effective manner and to help students identify areas they may wish to improve. The CCA also will be a preparation exercise for the USMLE Step 2CS. The CCA is designed to be similar to the USMLE Step 2CS exam, but it will not be identical. In addition, the CCA is used to assess certain areas of the UPSOM curriculum. The CCA is used to assess your ability to consider reasonable diagnostic possibilities by presenting a set of common clinical scenarios. In addition, you must demonstrate an acceptable level of professionalism and rapport as well as written communication skills.
Cases are written by faculty members and are based on real patient scenarios.
Feedback usually comes from two sources: verbal and written. Depending on the objectives of the course or session, you might receive one or both forms of feedback. Checklists—written feedback—usually are developed for Standardized Patients to score a student's performance in various categories. Other times, the facilitator will want the student to specifically ask an SP for information about their performance, from the patient's point of view providing not what you did right or wrong but how the encounter made the patient feel.
Follow the link to the course page in the Web site to view the various courses that utilize Standardized Patients.
A Standardized Patient is a person who has been carefully trained to portray an actual patient. Research has found that these types of encounters have certain advantages that cannot be duplicated by the use of paper problems, role playing, questionnaires, or even real patients. The advantages include: You are working in a controlled, reproducible clinical situation; the clinical problem is present at any time or any place; it provides a unique opportunity to practice the various skills; and, most importantly, the standardized patient can provide you with objective and unbiased feedback.
Sessions with Standardized Patients usually are held in classrooms and lecture halls in Scaife Hall at the University of Pittsburgh. Some sessions will take place in the Clinical Skills Suite on the Mezzanine level of Scaife Hall. The CCA and CSA (and other Objective Structured Clinical Examination type sessions) will take place at the Peter M. Winter Institute for Simulation Education Research (WISER) at 230 McKee Place, Suite 300, third Floor.
Feedback will depend on the type of encounter in which you are interacting with Standardized Patients. If it is a teaching session, most facilitators will encourage feedback, but, if it is an assessment session, time will not permit the student to ask the SP about performance. During assessment sessions, SPs will fill out checklists to rate the performance.