Module Components

• Overview
• Assignments

Topics

• Clinical Simulation
• Virtual Patients
• Standardized Patients
• Online/Hybrid Learning Environments

Nurs 791 - Instructional Strategies and Assessment

Module 6: Learner Moderated Strategies

Standardized Patients

Standardized Patients

The Association of Standardized Patient Educators defines Standardized Patients (SPs) as follows: SPs are lay people/actors who are employed, carefully trained to simulate a particular “case” or script, and in many cases, provide feedback to the learner on their performance. This definition clearly differentiates an encounter with an SP from role play or working with a peer. SPs can portray scenarios in single encounters in which learners practice various types of skills to learn or alternatively to be evaluated according to pre-determined competencies and criteria. SP encounters can also be part of an OSCE (Objective Structured Clinical Examination) in which the learner moves from SP station to SP station to perform specific skills in an evaluation focused encounter.

In the early 1960’s, Dr. Howard Barrows, a neurologist in Southern California, developed the concept of “standardized patients” (SP) for two main reasons. First, patients with various conditions were not always available when needed for medical student learning experiences. Also, he wanted his students to have consistent “patient” experiences, particularly during assessment of learning. In the 50 years since, learning with SP encounters has spread widely across various disciplines. SP encounters became a part of the licensing examination for physicians in 2004.

SP encounters typically take place in a laboratory or simulated setting, most often in an examining room type of setting. The laboratory structure allows for dedicated personnel to manage and operate the facility, hire and train SPs, and work with faculty in designing the cases appropriate for the learning and evaluation needs of the learners. The laboratory structure also allows for a facility capable of videotaping all encounters which provides an important record of encounters which can be used for multiple evaluation by the learner, the faculty member, as well as the SP who is also trained to provide specific feedback from the very important perspective of the “patient”. The laboratory structure further provides a controlled and safe environment for learning and evaluation of learners working with real people simulating patients before transitioning to the clinical arena with real patients.

The number of SP laboratories as it continues to expand. The use of SPs by other disciplines has slowly expanded. A 2003 survey of standardized patient laboratories reflected that only 17 in North America worked with nursing students; 15 of these were in the United States, including the one here at the University of Maryland Baltimore – the Clinical Education and Evaluation Laboratory (CEEL).

A collaborative venture of the University of Maryland Schools of Nursing and Medicine, the CEEL opened in 2000 and students from those schools are the primary target learners. In addition, learners from other departments at the UMB campus, faculty development projects, and special programs such as those offered for the State Department of the United States where health care providers from U.S. embassies around the world participate. The CEEL also offers encounters as part of faculty research initiatives. Each year several thousand SP encounters take place in this setting.

 

Mini-Lecture - Listen as Kathy Schiavone, MPA, the Manager of the Clinical Education and Evaluation Lab, explains standardized patients and discusses their role in health care teaching and evaluation.

The cases that are used in SP encounters are carefully planned with input from the faculty members for a particular course or program. The faculty member(s) begin the process several months in advance to allow for planning and scheduling; they do so using the SP Encounter Request Form. You will see on this form that there are many aspects that need to be determined to tailor the encounter to the specific conditions specified by the faculty. This form is reviewed and appropriate approvals for resources are obtained.

Encounter of Student and Standardized Patient

Video 1 - This is an encounter between a psychiatric NP student and a standardized patient. The encounter is a grief assessment. The SP (Debra) lost her partner (Susan) in a motor vehicle accident 9 months ago.

Video 2 - This is the feedback that followed the encounter.

Information for Students and Faculty on Standardized Patients

• Student Information
• Faculty Information

Are you ready to try you hand at case writing? Using the SP Case Template used in the CEEL, work through developing a case in your area of clinical expertise.

 

So what is an SP encounter at the CEEL really like? Nancy Budd, Coordinator of the CEEL, has prepared an overview of the process for you to review.

For obvious reasons, SP encounters typically involve learners working with non-invasive skills. For scenarios/cases with invasive aspects, the CEEL frequently blends simulation modes by adding Sim-ManR to the SP. For example, consider a scenario in which an SP portraying an asthmatic patient who presents to the health care provider following an increasing number of attacks. The SP can begin to portray an actual attack. By having the learner move to Sim-ManR , an assessment of symptoms, treatment of the attack, and monitoring of respiratory parameters can be achieved. Once stabilized, the patient can again become the SP and the learner can follow through with patient management and teaching as appropriate.

As you heard, evaluation can be a key feature of SP encounters with opportunities for the SP to provide the learner with structured feedback, from the perspective of a patient, on the learner’s performance. For example, the SP Evaluation Form for the OB/GYN Clerkship for medical students provides feedback on various aspects of the encounter using two different formats. The final question always asked, and indeed, one of the most important, is about patient satisfaction with the learner as a health care provider. SPs are carefully trained for encounters as to the type of feedback to be given and care is taken to assure the consistency of feedback across SPs so that students are assured of objectivity in the process.

It is also important that learners have an opportunity to evaluate the experience of the SP encounter. For all encounters, regardless of type of learner or type of case, a CEEL evaluation form. As you can see the learner’s perceptions of the value of the encounter, the extent to which it was realistic, a good measure of knowledge and skills, as well as the other factors on the evaluation form are important in assuring the high quality of standardized patient encounters for all learners. This is true whether the encounters are for learning/practicing skills or evaluation purposes.