Integration of Standardized Patients into Simulation

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Standardized participants (SPs) can greatly enhance high-fidelity simulation. The educational experience becomes more realistic than by simply using a simulator. There is very limited literature about the use of SPs with high-fidelity simulation. This article provides an overview of SP methodology and offers suggestions for integrating SPs into medical simulation scenarios.

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Fundamentals of standardized patient methodology

The SP was introduced in 1963 by Barrows [4], a neurologist and junior faculty member at the University of Southern California. Working with Stephen Abrahamson, who was newly recruited to establish one of the first departments of medical education in the United States, Dr. Barrows sought to improve the evaluation of medical students at the conclusion of the neurology clerkship. He challenged himself to develop a case for which he knew every sign and symptom that could be reproduced exactly for

Advantages and limitations of standardized patients

Multiple applications of SP methodology have been developed in parallel with quality standards for reliability and validity. Advantages of using SPs are shown in Box 1.

SP methodology is limited in that multiple patient encounters may be needed for broad-ranged training or testing. The number of cases a learner sees during an objective structured clinical examination (OSCE), for example, typically ranges from 8 to 12. Another constraint is that SPs may not be able to simulate every physical sign

Integration of standardized patients into simulation

Simulation is a training and feedback method in which learners practice tasks and processes in lifelike circumstances using models or virtual reality. Feedback from observers, peers, or video cameras has been used to assist skills improvement. High-fidelity medical simulation provides a new set of tools for clinical skills development that is similar to professional training where there is no zero tolerance for error (aviation, defense, maritime, and nuclear energy).

Adding an SP to the

Feedback and debriefing

After an encounter, SPs can provide immediate and constructive feedback to learners based on their objective reports (checklists) or subjective ratings of interpersonal skills. The debriefing process helps people learn from their experience by reflecting, analyzing, and talking about the experience. It is recommended to debrief the participants immediately after a high-fidelity simulation, while the experience is fresh and it is easy to demonstrate a key point or repeat part of the simulation.

Recommended resources

For the medical educator interested in learning more about working with SPs, the following resources are recommended:

Summary

SPs can greatly enhance high-fidelity simulation. The educational experience becomes more realistic than by simply using a simulator. If an institution has an SP program, the SP trainer can hire and train SPs for simulation. Once the SPs are trained, the simulation can be replicated many times. The SP's ability to record what happens during the simulation and give feedback to the learner enriches the experience. Faculty are free to participate in the simulation in an observer role, taking notes

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