In
health care
Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profe ...
, a simulated patient (SP), also known as a standardized patient, sample patient, or patient instructor, is an individual trained to act as a real
patient
A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health c ...
in order to simulate a set of symptoms or problems. Simulated patients have been successfully utilized for
education
Education is a purposeful activity directed at achieving certain aims, such as transmitting knowledge or fostering skills and character traits. These aims may include the development of understanding, rationality, kindness, and honesty. Va ...
, evaluation of health care professionals, as well as
basic
BASIC (Beginners' All-purpose Symbolic Instruction Code) is a family of general-purpose, high-level programming languages designed for ease of use. The original version was created by John G. Kemeny and Thomas E. Kurtz at Dartmouth College ...
,
applied, and
translational
Translation is the communication of the meaning of a source-language text by means of an equivalent target-language text. The English language draws a terminological distinction (which does not exist in every language) between ''transla ...
medical research
Medical research (or biomedical research), also known as experimental medicine, encompasses a wide array of research, extending from "basic research" (also called ''bench science'' or ''bench research''), – involving fundamental scientif ...
.
The SP can also contribute to the development and improvement of healthcare protocols; especially in cases where input from the SP are based on extensive, first-hand experience and observations as a clinical
patient
A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health c ...
undergoing care.
History
Dr.
Howard Barrows
Howard S. Barrows (March 28, 1928 – March 25, 2011) was an American physician and medical educator who was Professor Emeritus at the Southern Illinois University School of Medicine where he had previously served as Associate Dean for Educationa ...
trained the first standardized patient in 1963 in
University of Southern California
The University of Southern California (USC, SC, or Southern Cal) is a Private university, private research university in Los Angeles, California, United States. Founded in 1880 by Robert M. Widney, it is the oldest private research university in C ...
. This SP simulated the history and examination findings of a
paraplegic
Paraplegia, or paraparesis, is an impairment in motor or sensory function of the lower extremities. The word comes from Ionic Greek ()
"half-stricken". It is usually caused by spinal cord injury or a congenital condition that affects the neural ...
multiple sclerosis
Multiple (cerebral) sclerosis (MS), also known as encephalomyelitis disseminata or disseminated sclerosis, is the most common demyelinating disease, in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This d ...
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
The University of Arizona (Arizona, U of A, UArizona, or UA) is a public land-grant research university in Tucson, Arizona. Founded in 1885 by the 13th Arizona Territorial Legislature, it was the first university in the Arizona Territory.
T ...
. 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.
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country Continental United States, primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., ...
, gave their residents the same examination using SPs. The
Medical Council of Canada was the first to use SPs in a licensure examination in 1993.
[Standardized/Simulated Patients in Medical Education]
The
Educational Commission for Foreign Medical Graduates According to the US Department of Education, the Educational Commission for Foreign Medical Graduates is "the authorized credential evaluation and guidance agency for non-U.S. physicians and graduates of non-U.S. medical schools who seek to practice ...
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
Step 2 Clinical Skills (Step 2 CS) of the United States Medical Licensing Examination (USMLE) was an exam administered to medical students/graduates who wish to become licensed physicians in the U.S. It is similar to the COMLEX-USA Level 2-PE ex ...
exam and is mandatory for obtaining
medical licensure
A medical license is an occupational license that permits a person to legally practice medicine. In most countries, a person must have a medical license bestowed either by a specified government-approved professional association or a governme ...
in the United States, for both foreign medical graduates and American medical students. Since 2004 SPs have been used to assess the clinical competencies of osteopathic medical school candidates in the COMLEX USA Level 2-Performance Evaluation.
Uses
![Anesthesia Resident Simulation](https://upload.wikimedia.org/wikipedia/commons/4/4f/Anesthesia_Resident_Simulation.jpg)
Simulated patients (SP) 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 who perform such training are given titles such as Gynecological Teaching Associate (GTA) or Urological Teaching Associate (UTA), as covered in more detail below. SPs are also used extensively in testing of clinical skills of students, usually as a part of an
objective structured clinical examination. Typically, the SP will use a checklist to record the details of the encounter.
SPs have also been sent unannounced into a physician practices to evaluate the standards of care. They are also employed as
field researchers on
health informatics
Health informatics is the field of science and engineering that aims at developing methods and technologies for the acquisition, processing, and study of patient data, which can come from different sources and modalities, such as electronic hea ...
projects. They can also assist in the development of seminars and lectures in an academic setting, under the supervision of full or associate professors.
SPs can also serve as a "confederate" in a simulation to perform the roles of other clinicians within the care team.
SPs used for ''
in situ'' simulation activities may require special training.
For teaching future healthcare professionals how to perform intimate examinations, a specially trained simulated patient may be used. Intimate examinations include breast and pelvic examination on females and urogenital, prostate and rectal examination on males. Such roles are known by various names. One form of instruction is where a medical professional, a preceptor, teaches the medical student how to perform the examination using a simulated patient as the model.
News article posted by Association of Standardized Patient Educators
December 2013.
Advantages
The use of simulated patients has several advantages.
''Effectiveness'': a SP with extensive clinical out-patient experience, would have first-hand knowledge and experience with the clinical out-patient environment, which should have an advantage over a professional actor who has to learn how to "play the part" of a clinical patient.
''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
The largest limitation of simulated patients use can be their cost.
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
Signs and symptoms are the observed or detectable signs, and experienced symptoms of an disease, illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormali ...
, emotion
Emotions are mental states brought on by neurophysiological changes, variously associated with thoughts, feelings, behavioral responses, and a degree of pleasure or displeasure. There is currently no scientific consensus on a definition. ...
al states and even certain examination findings (neurological examination
A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. This typically includes a physical examination and a review of the patient's medical hist ...
, for example), they may not be able to simulate certain other signs such as heart murmurs
Heart murmurs are unique heart sounds produced when blood flows across a heart valve or blood vessel. This occurs when turbulent blood flow creates a sound loud enough to hear with a stethoscope. Turbulent blood flow is not smooth. The sound dif ...
or lung sounds. Recruitment of SPs may also be difficult, time-consuming and more expensive than using 'real' patients.[
]
Recruitment
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 a significant amount of clinical knowledge from their interactions with healthcare professionals.[
]
See also
* Virtual patient
The term virtual patient is used to describe interactive computer simulations used in health care education to train students on clinical processes such as making diagnoses and therapeutic decisions. Virtual patients attempt to combine modern tech ...
References
Further reading
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*
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* {{Citation , last = Kulze , first = Elizabeth , title = These Medical Models Teach With Their Own Bodies , url=http://www.vocativ.com/culture/health-culture/live-model-medical-training , access-date = 7 March 2017 , date = 2015-02-19
Medical simulation
Nursing education