Assessing Clinical Skills of Residents with Standardized Patients

Abstract

Current techniques do not provide a reproducible, reliable, or valid basis for assessing clinical skills. The need for large-scale direct observation and standardized assessment procedures has precluded development of better techniques. A project using standardized patients presenting with common clinical problems evaluated the skills of 336 internal medicine residents at 14 New England residency programs in 1289 standardized patient and resident encounters. Results indicated that reproducible assessment of the clinical skills could be achieved in approximately 1 day of testing time using standardized patients. Resident performance improved with years of training, and senior residents and those from programs with stronger reputations performed better and were more homogeneous in ability. Low correlations between standardized-patient-based measures of clinical skills and other evaluation techniques suggested that standardized patients provided unique information. Reactions of residents and faculty to standardized-patient-based evaluations were favorable.

SPECIAL ARTICLE: Cognitive, Social and Environmental Sources of Bias in Clinical Performance Ratings

“…Research on clinical problem solving, 8 clinical performance assessment (primarily using standardized patient technology), [9][10][11][12] and clinical practice has shown consistently that clinical performance is case specific. Practitioners who excel at diagnosing and managing one clinical problem are not necessarily skillful at diagnosing even closely related clinical situations.…”

“…This will require planning and record keeping to fulfill the desired systematic sampling. Standardized patient encounters [9][10][11] and high-fidelity simulations [44][45][46] can be used to compensate for deficits in the naturally occurring patient mix. 104 Educators also need to increase the absolute amount of observation that is done in support of clinical performance evaluation.…”

The effectiveness of the human patient simulator in teaching anesthesia pharmacology to first year nurse anesthesia students

“…Operational definition-A written clinical examination developed to provide a standardized, objective measurement of pharmacology knowledge presented during course Human Patient Simulators 7 instruction (Hardin & Gleeson, 1975;Stillman & Swanson, 1986;Scwartz, Witzke, & Donnelly, 1998).…”

Psychometric characteristics of simulation‐based assessment in anaesthesia and accuracy of self‐assessed scores*

“…A large number of cases is required because performance varies between cases, and performance in one case is not a good predictor of performance in another [8]. This applies to written patient management problems, computer-based simulations, standardised patients and real patients [12][13][14]. The specific knowledge and experience that students bring to a case seem to be more important than general problem solving skills.…”