BACKGROUND: Patients having cardiac symptoms often delay for hours before seeking treatment. Educational programs have had little impact on reducing this delay time. OBJECTIVES: To identify symptoms expected by a patient during a myocardial infarction and to examine whether a discrepancy between expectations and experience influenced delay in seeking treatment. METHODS: A retrospective, descriptive design was used. The setting was a large northeastern medical center. The convenience sample included 65 patients (mean age, 57; 74% men) after their first myocardial infarction. Data were collected with the Symptom Representation Questionnaire, a semi-structured interview guide that identified subjects' expectations about heart disease, actual symptom experience, and strategies used to manage the experience. RESULTS: The majority of subjects reported that they had expectations about the symptoms of heart disease that focused on location, intensity, associated symptoms, and quality. Expectations did not match the symptom experience of 74% of subjects. Subjects whose expectations did not match their experience delayed significantly longer before seeking treatment than subjects whose expectations did match their experience. CONCLUSIONS: Our results indicated that patients have expectations about symptoms of heart disease that may influence their behavior during a myocardial infarction.

The agreement between standardized patients' (SPs) and faculty in scoring student performance is an important component in determining the accuracy of SP assessment scores. For this study, checklist scores completed by SPs were compared to checklists completed by faculty. The SPs completed the checklists immediately following each SP‐student interaction. Faculty reviewed videotapes from randomly selected interactions and completed the same checklists as the SPs. Overall, agreement between SPs and faculty ranged between 81 percent and 92 percent, with a mean of 86 percent. The interpersonal skills agreement ranged from 78 percent to 97 percent and technical skills from 82 percent to 89 percent. Agreement between SPs and faculty was good especially in later cases. Discrepancies were most often due to SPs assigning credit when the faculty did not. This study supports the use of SPs as accurate, relatively inexpensive, and feasible recorders of student performance for selected skills.

To prepare freshmen dental students for clinical experiences, standardized patients (SPs) were used to teach basic skills in communication, examination, and record keeping. SPs allow students to practice and be assessed in a realistic, predetermined, and controlled setting. The SP cases integrated the clinical content from freshman “Preventive Periodontics” with the behavioral content taught in “Basic Patient Management.” Six SP cases were developed: two oral hygiene instruction cases, two medical and dental history cases, and two head and neck examination cases. One case of each type was used for instructing the students, and the others were used for assessing student competency at the end of the course. The SP methodology was evaluated by comparing the performance of freshmen, who had taken the course, with sophomores, who had only traditional clinical experiences. To make the comparison, sophomores participated in the same SP assessment as the freshmen. Scores for both groups were analyzed in three skill areas: interpersonal, technical, and record keeping. Freshmen scored higher in all three skill areas, with significant differences of 21% in technical skills and 31% in record keeping skills.

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