Standardized Patients in Training and Evaluation

1. Standardized Patients in Training and Evaluation Judith G. Gearhart, MD

2. Our Objectives • Define simulations • Discuss applications • Observe examples • Examine opportunities for standardized cases to enhance employee performance • Create a case framework • Collaborate

3. Topics of Discussion • Background and terms • Standardized patients in teaching • Standardized patients in evaluation • Developing scenarios and checklists • Resources

4. 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

5. Definitions • Standardized Patients (SPs): “actors” trained to simulate a patient in a clinical presentation and to give trainees feedback on performance

6. Definitions (cont’d) • Virtual patients: online cases paper cases • Simulators: models manikins

7. 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

8. Also known as: • CPX (Clinical Performance Exam, Clinical Practice Exam) • PBA (Performance-Based Assessment) • CSA (Clinical Skills Assessment)

9. Definitions (cont’d) • OSTE Objective Structured Teaching Exam

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

11. Uses of SPs Education : • 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)

12. 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

13. 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”)

14. Other uses • Admissions of med trainees or residents • OSTE (Objective Structured Teacher Examination) • Human Resources • Practicing Physicians

15. Human ResourcesIssues • Hospitality receiving, registration, information giving, telephone etiquette • Confidentiality • Team interaction • Professionalism

16. 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

17. Abdominal tenderness Asterixis Carotid bruits Confusion Dilated pupil Gait abnormalities Hyper/hypotension Jaundice Sensory losses Sputum production Wheezing, asymmetrical BS Physical Findings that Can Be Simulated

18. 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

19. 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

20. Developing Cases and Checklists First, determine objective for case • teaching, evaluation, or combination • teaching/evaluating what skill?

21. 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

22. Developing Cases and Checklists (cont’d) Next, create the case (scenario) • Access those already available • Script from patient/employee encounters you’ve had

23. Developing Cases and Checklists (cont’d) • Identify minimal competencies/ behaviors/questions • List in appropriate sequence • Be specific • Use language that an SP will understand

24. 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)

25. Examples • Admitting medical error • Obtaining informed consent • Delivering bad news • Telephone triage • Patient safety

26. Summary Using 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

27. Resources • Bibliography • Web sites • Organizations • Clinical Procedures and Simulation Center • Clinical Skills Center

28. Resources