Types of Exams Involving Standardized Patients

The SP program is critical to the internal evaluation of students and residents as well as preparing them for national standardized clinical exams.
Andrew R. Hoellein, MD, MS, FACP – UK College of Medicine

From basic communication skills to advanced physical examination and diagnosis, SPs provide a flexible and predictable context for students to learn, practice, and hone their skills in a safe, low-pressure environment.
Terry D. Stratton, PhD – UK College of Medicine

Practicing one-on-one with SPs in the learning lab lets students soak in feedback that they are given by the SP.  For the student, being able to practice communication skills before they are responsible for real patients with real problems, allows them to focus on listening to the patient.
Janice M. Kregor, MD – UK College of Medicine

The Standardized Patient program is utilized by several of the University of Kentucky’s health care colleges including the College of Medicine, College of Nursing, College of Dentistry, College of Pharmacy, Rehabilitation Therapy, and Social Work. Incorporating the use of Standardized Patients, we work together to develop curriculum to that will enable students and residents to learn how to handle emotionally charged and difficult scenarios in a competent and professional manner.

Interviewing/Counseling Sessions
Beginning in first-year and continuing throughout their education, the student's interviewing skills are assessed in graded exams. To more accurately simulate an actual clinic, only the student and SP are in the room. After each interview, the standardized patient evaluates the student following a set of criteria developed for the particular case. This evaluation form is then returned to the course director. Both the student's verbal and nonverbal skills are practiced and evaluated during these sessions.
 


First-year medical student interviewing an SP.


Nursing student interviewing an SP during an exam.

 

Breast/Gynecological/Pelvic/Hernia Exams
During the second year of medical school, students are instructed on proper techniques for performing breast/gynecological/pelvic/hernia exams. Standardized Patients (SPs) are utilized as both instructors and patients for these sessions. These sessions are structured for maximum comfort for both students and instructors with three to four students per SP in a room. The instructor is responsible for a brief lecture to students prior to the exam. The SP is required to allow the instructor to demonstrate and the students practice the exam on them.  The SP provides the student feedback from their perspective as both content expert and patient. These sessions always follow a thorough lecture given by a physician on the specific exam.

Clinical Performance Examination (CPX) 
Please visit the Student Assessment and Program Evaluation Web site for information about this exam.

Focused Physical Exam
The Focused Physical exam is designed to assess the student's communication and physical exam skills. During these encounters, students interview SPs; based on that information, perform the appropriate focused physical exam. The SP then grades the student based on the appropriateness of the information obtained and the correctness of the physical procedures performed.

 


Standardized Patient Program Coordinator, Joe Gatton, training SPs in preparation for a focused physical exam for UK's Physician's Assistant Program. 


Student from the Physician's Assistant Program examines an SP during a focused physical exam.



Full Physical Examination
Toward the end of their first year of medical school and continuing throughout their medical education, the students are required to perform a full physical examination on an SP who will then rate them on the accuracy of their technique and specific competencies. The medical director or a designated physician provides extensive training to the SP for these exams. At the end of approximately 16 to 20 hours of training, a physician will do reliability testing on the SP to insure accuracy and consistency.

Clinical Performance Examination (CPE)
The Clinical Performance Exam (CPE) is given at the end of the third year inpatient Internal Medicine Clerkship. The exam typically consists of twelve stations, eight of which use SPs. The other stations focus on X-ray, EKG and blood gas interpretation. Each station consists of a focused history and/or physical on common inpatient internal medicine conditions (chest pain, pneumonia, etc.). This exam is a critical component to the student’s evaluation and grade.

 

                   

Medical students examining SPs during a CPE.


Objective Structured Clinical Examination (OSCE)
The Objective Structured Clinical Examination (OSCE) is a well-documented assessment technique used to assess clinical skills of students.  Participants perform clinical tasks in a series of test stations while interacting with a trained a Standardized Patient (SP).  This Standardized Patient pretends to be a patient with a real illness.  Participants must ask appropriate questions about the illness and perform a relevant and focused examination in a given amount of time.  After the exam is completed, the SP assesses the performance using a checklist of clinical skills being tested.

 


Nursing student examines an SP during an OSCE.