From the April 2018 ACP Internist
Standardized patients are used during medical school to ensure physicians develop competencies in communication and physical examination skills.
By Leah Lawrence
The role of the “standardized patient,” which turns 55 this year, has grown and adapted to medicine's changing landscape since its inception.
In 1963, neurologist and medical educator Howard S. Barrows, MD, recruited a woman at the University of Southern California (USC) to play “Patty Dugger,” a paraplegic patient with multiple sclerosis who was based on a real patient seen at Los Angeles County Hospital. Thought of as too “Hollywood” by many in neurology and medicine, Dr. Barrows' new educational tool eventually caught on and spread throughout the country.
“These methods were not always well received, but eventually people started to experiment and realized that standardized patients can give students feedback on clinical skills and on communication skills, all from a patient perspective,” said Karen Lewis, PhD, director of administration of the Standardized Patient Program and the Clinical Learning and Simulation Skills (CLASS) Center at the George Washington University School of Medicine and Health Sciences in Washington, D.C.
Today, standardized patients are used in the United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills exam to test medical students and graduates on their ability to take medical histories, perform physical examinations, and communicate their findings.
Valuable Lessons
The USMLE testing requirement greatly influenced many medical schools to establish their own standardized patient training programs, according to Daisy Smith, MD, FACP, ACP's Vice President of Clinical Programs.
“Many of these programs have evolved to make standardized patient programs a more useful tool for formative assessments that are valuable learning experiences,” Dr. Smith said. “They provide feedback in a low-stake setting where you don't have a sick patient or worried family hanging in the balance.”
Although initially programs had a checklist or “laundry list” of questions that the students had to ask the patient, many of them have evolved so that the checklist is shorter and students have to proceed in a more logical and patient-centered manner, according to Andrew R. Hoellein, MD, MS, FACP, associate dean for student affairs at the University of Kentucky in Lexington.
At the University of Kentucky, standardized patients are used to ensure other competencies as well, such as counseling of parents in the case of a pediatric patient or a psychiatric case, Dr. Hoellein said.
“We also want to make sure that students can take what they get from a history and a physical and apply it,” he said. “These interactions help them to start to work on medical decision making.”
As students advance in their training, they are faced with more challenging interactions, Dr. Lewis agreed.
“They have to learn to take a sexual history, or to take a history with a child and a parent,” Dr. Lewis said. “They have to learn how to break bad news to a patient, or tell someone that they have made a mistake.”
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