Hanyang Med Rev.  2012 Feb;32(1):35-44. 10.7599/hmr.2012.32.1.35.

Medical Education Using Standardized Patients

• Park HK

• KMID: 2053757
• DOI: http://doi.org/10.7599/hmr.2012.32.1.35

Abstract

This article is intended to review up to date knowledge about standardized patients (SPs) and SP-based objective structured clinical examinations (OSCE) in medical education. SPs have become almost indispensable in the education and training of health care professionals. The utilization of SPs provides an invaluable contribution to the creation of a safe, yet realistic, learner-centered environment. While SPs provide a realistic experience of patient interaction that can be evaluated by a third party observer, they can also be trained to assess the student's performance and provide feedback to the student with consistency. Standardization of the performance, recording student behaviors by well-developed checklists, and/or receiving feedback from the SPs are important parameters of the educational experience and provide a meaningful evaluation of student performance. In assessment, SPs are used most commonly in the context of formal examinations, often referred to as OSCEs. An OSCE should be prepared step by step according to principles of appropriate logistics. The validity of the OSCE assessment is increased by matching educational content with the balanced blue print matrix for comprehensive performance examination. The thorough training of all physician/SP raters involved during the whole observation time in which students interact with SPs is critical to the reliable OSCE. SP-based OSCE has its own limitations, so it is to be judged as one among many evaluation methods for competency and/or performance.

Keyword

Patient Simulation; Medical Education; Undergraduate; Competency-Based Education

MeSH Terms

Checklist
Competency-Based Education
Delivery of Health Care
Education, Medical
Humans
Organization and Administration
Patient Simulation

Reference

1. Barrows HS. An overview of the uses of standardized patients for teaching and evaluating clinical skills. AAMC. Acad Med. 1993. 68:443–451.

2. Harden RM, Stevenson M, Downie WW, Wilson GM. Assessment of clinical competence using objective structured examination. Br Med J. 1975. 1:447–451.

3. Lane C, Rollnick S. The use of simulated patients and role-play in communication skills training: a review of the literature to August 2005. Patient Educ Couns. 2007. 67:13–20.

4. Beshgetoor D, Wade D. Use of actors as simulated patients in nutritional counseling. J Nutr Educ Behav. 2007. 39:101–102.

5. Watson MC, Skelton JR, Bond CM, Croft P, Wiskin CM, Grimshaw JM, et al. Simulated patients in the community pharmacy setting. Using simulated patients to measure practice in the community pharmacy setting. Pharm World Sci. 2004. 26:32–37.

6. Brazeau C, Boyd L, Crosson J. Changing an existing OSCE to a teaching tool: the making of a teaching OSCE. Acad Med. 2002. 77:932.

7. Norman GR, Tugwell P, Feightner JW. A comparison of resident performance on real and simulated patients. J Med Educ. 1982. 57:708–715.

8. Adamo G. Simulated and standardized patients in OSCEs: achievements and challenges 1992-2003. Med Teach. 2003. 25:262–270.

9. Cleland JA, Abe K, Rethans JJ. The use of simulated patients in medical education: AMEE Guide No 42. Med Teach. 2009. 31:477–486.

10. Robertson K, Hegarty K, O'Connor V, Gunn J. Women teaching women's health: issues in the establishment of a clinical teaching associate program for the well woman check. Women Health. 2003. 37:49–65.

11. Fairbank C. Men's health: it is imperative to teach scrotal and rectal examination. Clin Teach. 2011. 8:101–104.

12. Ker JS, Dowie A, Dowell J, Dewar G, Dent JA, Ramsay J, et al. Twelve tips for developing and maintaining a simulated patient bank. Med Teach. 2005. 27:4–9.

13. Bokken L, Rethans JJ, van Heurn L, Duvivier R, Scherpbier A, van der Vleuten C. Students' views on the use of real patients and simulated patients in undergraduate medical education. Acad Med. 2009. 84:958–963.

14. Rethans JJ, Gorter S, Bokken L, Morrison L. Unannounced standardised patients in real practice: a systematic literature review. Med Educ. 2007. 41:537–549.

15. Halbach JL, Sullivan LL. Teaching medical students about medical errors and patient safety: evaluation of a required curriculum. Acad Med. 2005. 80:600–606.

16. Haist SA, Griffith IC, Hoellein AR, Talente G, Montgomery T, Wilson JF. Improving student's sexual history inquiry and HIV counseling with an interactive workshop using standardized patients. J Gen Intern Med. 2004. 19:549–553.

17. Haist SA, Wilson JF, Pursley HG, Jessup ML, Gibson JS, Kwolek DG, et al. Domestic violence: increasing knowledge and improving skills with a four-hour workshop using standardized patients. Acad Med. 2003. 78:S24–S26.

18. Eagles JM, Calder SA, Nicoll KS, Walker LG. A comparison of real patients, simulated patients and videotaped interview in teaching medical students about alcohol misuse. Med Teach. 2001. 23:490–493.

19. Bokken L, Rethans JJ, Jobsis Q, Duvivier R, Scherpbier A, van der Vleuten C. Instructiveness of real patients and simulated patients in undergraduate medical education: a randomized experiment. Acad Med. 2010. 85:148–154.

20. Barrows HS. Training standardized patients to have physical findings. 1999. Illinois: Southern Illinois University School of Medicine;1–32.

21. Kneebone R, Nestel D, Yadollahi F, Brown R, Nolan C, Durack J, et al. Assessing procedural skills in context: Exploring the feasibility of an Integrated Procedural Performance Instrument (IPPI). Med Educ. 2006. 40:1105–1114.

22. Kneebone R, Kidd J, Nestel D, Asvall S, Paraskeva P, Darzi A. An innovative model for teaching and learning clinical procedures. Med Educ. 2002. 36:628–634.

23. Kneebone R. Evaluating clinical simulations for learning procedural skills: a theory-based approach. Acad Med. 2005. 80:549–553.

24. Linssen T, Bokken L, Rethans JJ. Return visits by simulated patients. Med Educ. 2008. 42:536.

25. Bokken L, Linssen T, Scherpbier A, van der Vleuten C, Rethans JJ. The longitudinal simulated patient program: evaluations by teachers and students and feasibility. Med Teach. 2009. 31:613–620.

26. Small PA Jr, Stevens CB, Duerson MC. Issues in medical education: basic problems and potential solutions. Acad Med. 1993. 68:S89–S98.

27. Harden RM, Gleeson FA. Assessment of clinical competence using an objective structured clinical examination (OSCE). Med Educ. 1979. 13:41–54.

28. Barzansky B, Etzel SI. Educational programs in US medical schools, 2002-2003. JAMA. 2003. 290:1190–1196.

29. Reznick RK, Blackmore D, Cohen R, Baumber J, Rothman A, Smee S, et al. An objective structured clinical examination for the licentiate of the Medical Council of Canada: from research to reality. Acad Med. 1993. 68:S4–S6.

30. Newble D. Techniques for measuring clinical competence: objective structured clinical examinations. Med Educ. 2004. 38:199–203.

31. Williams RG, McLaughlin MA, Eulenberg B, Hurm M, Nendaz MR. The patient findings questionnaire: one solution to an important standardized patient examination problem. Acad Med. 1999. 74:1118–1124.

32. Smee S. Skill based assessment. BMJ. 2003. 326:703–706.

33. Tervo RC, Dimitrievich E, Trujillo AL, Whittle K, Redinius P, Wellman L. The Objective Structured Clinical Examination (OSCE) in the clinical clerkship: an overview. S D J Med. 1997. 50:153–156.

34. Wilkes M, Bligh J. Evaluating educational interventions. BMJ. 1999. 318:1269–1272.

35. Selby C, Osman L, Davis M, Lee M. Set up and run an objective structured clinical exam. BMJ. 1995. 310:1187–1190.

36. Park H, Lee J, Kim S, Kim K, Park H. The effect of using two duplicated examination sites to simulate the same cases on the OSCE reliability. Korean J Med Educ. 1999. 11:37–52.

37. Colliver JA, Williams RG. Technical issues: test application. AAMC. Acad Med. 1993. 68:454–460.

38. Valentino J, Donnelly MB, Sloan DA, Schwartz RW, Haydon RC 3rd. The reliability of six faculty members in identifying important OSCE items. Acad Med. 1998. 73:204–205.

39. Tombleson P, Fox RA, Dacre JA. Defining the content for the objective structured clinical examination component of the professional and linguistic assessments board examination: development of a blueprint. Med Educ. 2000. 34:566–572.

40. Vu NV, Barrows HS, Marcy ML, Verhulst SJ, Colliver JA, Travis T. Six years of comprehensive, clinical, performance-based assessment using standardized patients at the Southern Illinois University School of Medicine. Acad Med. 1992. 67:42–50.

41. Park H, Lee J, Hwang H, Lee J, Choi Y, Kim H, et al. The agreement of checklist recordings between faculties and standardized patients in an Objective Structured Clinical Examination (OSCE). Korean J Med Educ. 2003. 15:143–152.

42. Wass V, McGibbon D, Van der Vleuten C. Composite undergraduate clinical examinations: how should the components be combined to maximize reliability? Med Educ. 2001. 35:326–330.

43. Hodges B. Validity and the OSCE. Med Teach. 2003. 25:250–254.

44. Regehr G, Freeman R, Hodges B, Russell L. Assessing the generalizability of OSCE measures across content domains. Acad Med. 1999. 74:1320–1322.

45. Cusimano MD, Rothman A, Keystone J. Defining standards of competent performance on an OSCE. Acad Med. 1998. 73:S112–S113.

46. Kaufman DM, Mann KV, Muijtjens AM, van der Vleuten CP. A comparison of standard-setting procedures for an OSCE in undergraduate medical education. Acad Med. 2000. 75:267–271.

47. Humphrey-Murto S, MacFadyen JC. Standard setting: a comparison of case-author and modified borderline-group methods in a small-scale OSCE. Acad Med. 2002. 77:729–732.

48. Carraccio C, Englander R. The objective structured clinical examination: a step in the direction of competency-based evaluation. Arch Pediatr Adolesc Med. 2000. 154:736–741.

49. Blake KD, Gusella J, Greaven S, Wakefield S. The risks and benefits of being a young female adolescent standardised patient. Med Educ. 2006. 40:26–35.

50. Sloan DA, Donnelly MB, Schwartz RW, Strodel WE. The Objective Structured Clinical Examination. The new gold standard for evaluating postgraduate clinical performance. Ann Surg. 1995. 222:735–742.