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

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

Topics of Discussion n Background and terms n Standardized patients in teaching n Standardized patients in evaluation n Developing scenarios and checklists n Resources

Background n Nothing new under the sun ( ) n Standardized patients and OSCE used since the 1970s in teaching and evaluation n Incorporated into the USMLE in 2005 Step 2CS Exam

Definitions n Standardized Patients (SPs): actors trained to simulate a patient in a clinical presentation and to give trainees feedback on performance

Definitions (contd) n Virtual patients: online cases paper cases n Simulators: models manikins

Definitions (contd) n 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

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

Definitions (contd) n OSTE Objective Structured Teaching Exam

Advantages of SPs n Validity n Availability n Reliability n Controllability n Adaptability n Minimal risk n Feedback n Extension of faculty

Uses of SPs Education : n Teach specific skills (interview, history & physical, diagnosis, management, procedures, professional behaviors) n Provide exposure to clinical problems n Teach how to deal with important issues (cross-cultural issues, ethics, delivering bad news)

Uses of SPs (contd) n Provide opportunities to meet educational objectives regarding variety and type of clinical problems n Provide cases trainees should, but might not see without planning n Give trainees feedback n Evaluate teaching methods

Uses of SPs (contd) Evaluation of trainees n Informal assessment and feedback (ungraded, low-stakes, pass/fail) n Formative or final assessment for grade (with or without feedback) n Assessment to determine progression to next level or licensure (high-stakes)

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

Human Resources Issues n Hospitality receiving, registration, information giving, telephone etiquette n Confidentiality n Team interaction n Professionalism

Things SPs Can Do n Act out scenarios (history, physical, need for counseling or information) n Simulate physical findings n Use checklists developed by faculty to evaluate trainees objectively n Give trainees feedback

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

Prior Development of UMC SP Program n Recruiting, screening, training patients to act out scenarios n Training patients to give feedback n Maintaining the standardized patient pool n Working out remuneration n Use of facilities

Development of UMC Standardized Patient Program (contd) Creating scenarios and checklists n Accessing those already available n Scripting from patient/employee encounters youve had n Scripting case for objectives

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

Developing Cases and Checklists (contd) What skill(s)? n Adapt for level of trainee n Adapt for time frame n Put in context of curriculum map or institutional goals

Next, create the case (scenario) n Access those already available n Script from patient/employee encounters youve had Developing Cases and Checklists (contd)

n Identify minimal competencies/ behaviors/questions n List in appropriate sequence n Be specific n Use language that an SP will understand

Examples n Patient asks for directions/clinical information from employee who doesnt know the answer n Employee encounters angry patient n Procedures (venipuncture checklist) n Model/mannequin cases (Sim center)

Examples n Admitting medical error n Obtaining informed consent n Delivering bad news n Telephone triage n Patient safety

Summary Using Standardized Patients can n increase learning opportunities through structured cases n Using standardized cases can provide another perspective of trainee performance n provide an objective rather than subjective, measure of skills

Resources n Bibliography n Web sites n Organizations n Clinical Procedures and Simulation Center n Clinical Skills Center

Resources ASPE (Association of Standardized Patient Educators) n Individual or institutional membership fee n Casebank Society for Simulation in Health Care n Multiple membership, individual, active, retired, student, resident fee n Free without journal