Simulated patient
Encyclopedia
A simulated patient, standardized patient or sample patient (SP) (also known as a patient instructor), in health care
, is an individual who is trained to act as a real patient
in order to simulate a set of symptoms or problems. Simulated patients have been successfully used in medical education
, nursing education, evaluation, and research.
trained the first standardized patient in 1963 in University of Southern California
. This SP simulated the history and examination findings of a paraplegic multiple sclerosis
patient. Dr Barrows also developed a checklist that the SP could use to evaluate the performance of the trainee. Dr. Paula Stillman trained another set of standardized patients in 1970 at the University of Arizona
. Her pilot program had local actors portray the "mothers" of imaginary children. The actors would describe the illness the unseen child was suffering from, requiring the medical students taking the history to develop differential diagnoses based on the mother's testimony. In 1984, a number of residency programs in the northeastern U.S.
gave their residents the same examination using SPs. Medical Council of Canada
was the first to use SPs in a licensure examination in 1993. The Educational Commission for Foreign Medical Graduates
introduced the Clinical Skills Assessment exam in 1998 to test the clinical skills of foreign medical graduates. This exam is now the USMLE Step 2 Clinical Skills exam and is mandatory for obtaining medical licensure
in the United States, for both foreign medical graduates and American medical students.
. Typically, the SP will use a checklist to record the details of the encounter.
Standardized patients have also been sent unannounced in physician practices to evaluate standards of care. They are also employed in health informatics
research.
al states and even certain examination findings (neurological examination
, for example), they may not be able to simulate certain other signs
such as heart murmurs or lung sounds
. Recruitment of SPs may also be difficult, time consuming and more expensive than using 'real' patients.
may also agree to take up these roles, especially if the position is paid. SPs need to draw on their own personal experiences with physicians, conversations with healthcare professionals, talking to specific patient populations etc. They also need to be trained to accurately and reliably simulate particular clinical scenarios. Frequent quality assessment may be needed to ensure consistency in the portrayal of the patient role, especially since SPs may absorb quite a significant amount of clinical knowledge during their interactions with healthcare professionals.
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
, is an individual who is trained to act as a real patient
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
in order to simulate a set of symptoms or problems. Simulated patients have been successfully used in medical education
Medical education
Medical education is education related to the practice of being a medical practitioner, either the initial training to become a doctor or additional training thereafter ....
, nursing education, evaluation, and research.
History
Dr. Howard BarrowsHoward Barrows
Howard S. Barrows, M.D. was a Professor Emeritus at the Southern Illinois University School of Medicine where he had previously served as Associate Dean for Educational Affairs and Chair of Medical Education...
trained the first standardized patient in 1963 in University of Southern California
University of Southern California
The University of Southern California is a private, not-for-profit, nonsectarian, research university located in Los Angeles, California, United States. USC was founded in 1880, making it California's oldest private research university...
. This SP simulated the history and examination findings of a paraplegic multiple sclerosis
Multiple sclerosis
Multiple sclerosis is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms...
patient. Dr Barrows also developed a checklist that the SP could use to evaluate the performance of the trainee. Dr. Paula Stillman trained another set of standardized patients in 1970 at the University of Arizona
University of Arizona
The University of Arizona is a land-grant and space-grant public institution of higher education and research located in Tucson, Arizona, United States. The University of Arizona was the first university in the state of Arizona, founded in 1885...
. Her pilot program had local actors portray the "mothers" of imaginary children. The actors would describe the illness the unseen child was suffering from, requiring the medical students taking the history to develop differential diagnoses based on the mother's testimony. In 1984, a number of residency programs in the northeastern U.S.
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
gave their residents the same examination using SPs. Medical Council of Canada
Medical Council of Canada
Medical Council of Canada ' is an organization that is charged with assessing medical candidates, evaluation of physicians through exams and granting a qualification called Licentiate of the Medical Council of Canada to those who wish to practice medicine in Canada.MCC is governed by a 51-member...
was the first to use SPs in a licensure examination in 1993. The Educational Commission for Foreign Medical Graduates
Educational Commission for Foreign Medical Graduates
Through its program of certification, the Educational Commission for Foreign Medical Graduates assesses the readiness of international medical graduates to enter residency or fellowship programs in the United States that are accredited by the Accreditation Council for Graduate Medical Education...
introduced the Clinical Skills Assessment exam in 1998 to test the clinical skills of foreign medical graduates. This exam is now the USMLE Step 2 Clinical Skills exam and is mandatory for obtaining medical licensure
Medical license
In most countries, only persons with a medical license bestowed either by a specified government-approved professional association or a government agency are authorized to practice medicine. Licenses are not granted automatically to all people with medical degrees...
in the United States, for both foreign medical graduates and American medical students.
Uses
Simulated patients are extensively used in medical and nursing education to allow students to practice and improve their clinical and conversational skills for an actual patient encounter. SPs commonly provide feedback after such encounters. They are also useful to train students to learn professional conduct in potentially embarrassing situations such as pelvic or breast exams. SPs are also used extensively in testing of clinical skills of students, usually as a part of an Objective Structured Clinical ExaminationObjective Structured Clinical Examination
An Objective Structured Clinical Examination is a modern type of examination often used in health sciences...
. Typically, the SP will use a checklist to record the details of the encounter.
Standardized patients have also been sent unannounced in physician practices to evaluate standards of care. They are also employed in health informatics
Health informatics
.Health informatics is a discipline at the intersection of information science, computer science, and health care...
research.
Advantages
The use of simulated patients has several advantages.- Convenience: SPs are able to provide cases that are needed at the time they are needed. They are likely to be more reliable, and may tolerate more students than real patients.
- Standardization: The use of standardized clinical scenarios allows direct comparison of the students' clinical skills, locally as well as nationally and internationally.
- Compression/expansion of time: SPs can provide a longitudinal experience and enable students to follow through patients over time, even in a compressed time frame of examination. One technique employed in SP encounters is the use of information cards. When the trainee or examinee articulates the need for an examination or a laboratory test, the SP hands him/her a small card with the results of that exam/test, and the encounter can continue.
- Safety: SP encounters allow students to learn about situations they may not be able to manage alone in a real clinical setting, or where the use of a real patient may be inappropriate. For example, counseling a cancer patient.
- Efficiency: The monitoring of students by SPs reduces the need for supervision of medical students by physician faculty during clinical encounters.
Limitations
At the same time, SPs are case specific and are able to assess clinical competency in a limited area only. Multiple encounters may be needed for broad ranged training or testing. Also, while SPs are quite proficient in simulating the symptoms, emotionEmotion
Emotion is a complex psychophysiological experience of an individual's state of mind as interacting with biochemical and environmental influences. In humans, emotion fundamentally involves "physiological arousal, expressive behaviors, and conscious experience." Emotion is associated with mood,...
al states and even certain examination findings (neurological examination
Neurological examination
A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired...
, for example), they may not be able to simulate certain other signs
Medical sign
A medical sign is an objective indication of some medical fact or characteristic that may be detected by a physician during a physical examination of a patient....
such as heart murmurs or lung sounds
Breath sounds
Respiratory sounds refer to the specific sounds identified through auscultation of the respiratory system with a stethoscope....
. Recruitment of SPs may also be difficult, time consuming and more expensive than using 'real' patients.
Recruitment
Simulated patients are often recruited from among local amateur or professional actors, through advertisements in local newspapers, or by word of mouth. Graduate students in nearby universitiesUniversity
A university is an institution of higher education and research, which grants academic degrees in a variety of subjects. A university is an organisation that provides both undergraduate education and postgraduate education...
may also agree to take up these roles, especially if the position is paid. SPs need to draw on their own personal experiences with physicians, conversations with healthcare professionals, talking to specific patient populations etc. They also need to be trained to accurately and reliably simulate particular clinical scenarios. Frequent quality assessment may be needed to ensure consistency in the portrayal of the patient role, especially since SPs may absorb quite a significant amount of clinical knowledge during their interactions with healthcare professionals.