Types of Standardized Patients and Recruitment in Medical Simulation

Issues of Concern

Training

Training SPs often occurs at a local level. However, the Association of Standardized Patient Educators (ASPE) has published a document that outlines best practices. ASPE has outlined key values to ensure the SPs' and learners' physical and psychological safety while providing the best possible learning: safe work environment, case development, program management, professional development, and feedback and assessment methods. A safe working environment, confidentiality, and respect for each other and the learners ensure that psychological and physical safety are maintained. When training SPs for their role, every opportunity should be made for the SP to interact with the faculty in a rehearsal setting so that nothing is left to interpretation when interacting with the learner(s).  This process allows the SP to ask questions about the case and demonstrate the necessary physical findings before the live performance to ensure accuracy.[2]

Some institutions request that SPs provide feedback to the learner, either written or verbal, and meetings should occur to review the associated instruments. The level of role portrayal requires weighing against the use of a feedback tool by an SP; when an SP is called upon to do too many things, the level of fidelity may suffer, causing the potential for a negative experience by the learner.[3] One recent study surmised that SPs might provide more accurate feedback on a validated tool as that individual is more attuned to the content of the scenario.[4]

Facilities should also provide opportunities for reflection on performances, ongoing professional development, and continuing education opportunities.[2] Script templates completed by the faculty that SPs can utilize are crucial, along with elements that discuss emotional states, must use phrases, critical actions, and information that should be held back until a learner inquires. This information assists with calibrating the performance of the SP and ensures that the utmost attention gets paid to maintain fidelity. While literature shows that SPs find value in providing training opportunities for learners of all levels, the satisfaction of providing their service is incumbent upon the proper training so that reacting and adjusting to learner skills, maintaining the appropriate level of emotion, and remembering all of the pertinent facts of a scenario are maintained.[5] Ensuring the accuracy and validity of an SPs performance is crucial.[6] When using SPs for summative and high-stakes assessments, performances must be standardized equally amongst all SPs recruited for a session(s) to remove any measure of subjectivity.

Clinical Significance

A growing body of literature shows SPs' positive impact on healthcare providers' education. Using simulation enhanced by incorporating an SP supports adult learning theory, especially the principle of self-efficacy of motivation.[7][8] Further, a recent meta-analysis demonstrated gains in 3 of Bloom’s taxonomy domains: affective, psychomotor, and cognitive.[7] Primary care providers were more likely to remember to incorporate various screening tools into a visit based on simulated patient encounter experience, even months beyond the training initiative.[9] When using SPs for scenarios rooted in clinical decision-making skills, learners rated the scenarios as more realistic, and they also scored higher in evaluations following participation when compared to scenarios using mannequins.[10]  

While many nursing and medical schools implement SPs in their curricular activities, associated training costs and management can sometimes be prohibitive. As a result, other methodologies are scrutinized; however, learner outcomes are enhanced when utilizing SPs.[1] By and large, learners appreciate the ability to interact with SPs for various crucial skills, from history and physical skills to communication skills dealing with delicate topics. Complex medical conditions, such as movement disorders, cerebrovascular accidents, and other nuanced neurologic conditions, can be accurately and believably portrayed by SPs with the right training and practice.[9][11][12][13]

SPs can be implemented in hybrid simulations. For example, an SP can play the family member of a mannequin, either adult or pediatric/neonatal. An SP can also use wearable technology to simulate abnormal findings, such as tabs that link SPs to software with abnormal ultrasound pathology or heart and lung sounds that can indicate murmurs, crackles, or dysrhythmias.[14]

Some SPs have the training to serve as models for procedures such as genitourinary exams and ultrasounds. These particular exams often pay more due to their invasive nature. Programs that utilize SPs for these psychomotor skills attribution should have policies and procedures in place should abnormal findings be discovered.  A faculty member should screen these SPs before a learner’s examination to ensure that a learner finds nothing abnormal incidentally. Any anatomical differences noted do not detract from learning.

The Future

There is the possibility that virtual SPs may become more prevalent over time; this is a trend that is continuing to receive coverage in the literature. Several studies have documented no significant difference between real and virtual SP encounters, especially those assessing communication skills.[13][15]

Pearls and Other Issues

Key facts to keep in mind about types of standardized patients and recruitment in medical simulation are as follows:

• Standardized patients can greatly enhance fidelity in simulation scenarios.
• Planning and communication between the facilitator and the standardized patient before the educational exercise improves performance.
• Learners are often more engaged when using standardized patients over manikins.

Enhancing Healthcare Team Outcomes

A recent systematic review of the current research indicates that more research is necessary regarding the utilization of SPs in interprofessional simulation activities.[6] Potential areas for future research could include communication, hand-offs, and a team-based response to pre-arrest scenarios.