- Pitt's School of Medicine Standardized/Simulation Patient Program
- What is a Standardized/Simulated Patient/Participant?
- The History of Standardized/Simulated Patients
- What is Standardized/Simulated Patient Methodology?
- Is including Standardized/Simulated Patients in education effective?
Since its inception in 2001, the University of Pittsburgh School of Medicine's Standardized/Simulated Patient (SP) Program has grown annually to support over 50 teaching and testing sessions that run reiteratively throughout each academic year at the School of Medicine .
The SP Program also provides the services of our SPs to other University of Pittsburgh entities such as the Schools of Pharmacy, Nursing, Dental Medicine, Health and Rehabilitation Sciences, Social Work, Education, and Law. We serve many local universities, residency programs, and other educational partners including UPMC's Peter M. Winter Institute for Simulation Education and Research (WISER) and Vetran Affairs Pittsburgh Healthcare System (VAPHS).
Over 170 SPs are guided by a staff of six who see to it that all are thoroughly trained and ready to work in this unique, educational modality.
A SP is an individual from the community who has been trained to portray, in a consistently reproducible manner, a patient/person in a medical and/or communication based situation. SPs receive extensive training regarding clinical communication skills, educational expectations, and components of helpful verbal feedback and other logistics of the environment. They study materials about the objectives and goals of the program in addition to a detailed story or "case" to portray, that is reflective of a real patient history or situation. SPs engage with learners in carefully designed "role play" events as though they were a person seeking care in some way.
Because SPs are involved in both teaching and testing of a variety of professional learners, training allows SPs to approach the work organically and adjust in order to meet the goals of different tasks.
Standardization is most relevant to formal testing of learners and refers to the management process of SP training, event design, and materials development. We train SPs to display an appropriate range of behaviors and use of personal judgement in order to ensure genuine and unique response to individual student skills.
SPs are co-educators rather than “actors” and are able to:
- Provide individualized feedback – a proxy for patient’s perspective
- Provide continuity, reproducibility, and realism
- Respond to learner skill – reinforcing human connection
- Evaluate skills by checklist completion
- Provide objectivity and diversity
The Agency for Healthcare Research and Quality created a Healthcare Simulation Dictionary that "features a collection of definitions showing how various terms---and their meanings--- are being used in the profession today."
The idea of SPs began in 1964, when Howard S. Barrows MD, neurologist and medical educator at the University of Southern California, introduced the idea of a programed patient. Medical Educators realized that test scores of knowledge did not provide all that was needed in teaching and assessing essential clinical skills. These patients, which later became known as standardized patients, carefully were coached to simulate an actual patient so accurately that the simulation could not be detected by a skilled clinician.
The " programmed patient " , later labelled a "standardized patient" was trained to present not just the history of a patient but also the body language, emotions, personality, and physical findings. In the early 2000s the United States National Board of Medical Examiners, Medical Licensing Exam (USMLE) implemented SP exams for all graduating medical students. That exam has since been discontinued, but the legacy of tracking learner skill with trained SPs continues in the medical and health science schools .
SP Methodology grew from established adult learning theory that promotes the value of experiential learning.
It refers to theories and practices surrounding:
- SP Case writing: objectives, case materials, and checklist development
- Activity Design: planning, metrics, data collection, HR, policies and procedures, logistics, quality assurance…
- Recruitment and selection of SPs
- Training (SPs and Faculty)
- Case Portrayal
- Verbal and written feedback
- Checklist completion
- SP professional development
Literature supports the fact that simulation helps to synthesize knowledge.
Skills practice improves performance. Exposure to real situations portrayed by carefully trained SPs help prepare students for what they may see as professionals and equip them with the communication tools they need to effectively and compassionately address their patients' issues. Instead of having to learn effective communication with a patient that is in potential crisis, students learn to use affirming, sympathetic communication with our SPs, giving them a realistic yet safe environment in which to practice.
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