Simulated patients were first used in the 1960s in undergraduate medical training in the United States of America. Since that time, most medical schools throughout the world have established Simulated Patient Programs, to enhance teaching and assessment. Simulated Patients are also used for undergraduate and postgraduate teaching; research; and for projects that evaluate educational interventions.
“Simulated Patients” and “Standardised Patients” are terms that are often used interchangeably, but are not strictly the same thing. Simulated Patients are trained to simulate realistic patient-clinician scenarios, and are defined by Burrows1 as “a normal person who has been carefully coached to present the symptoms and signs of an actual patient”. Standardised Patients, in contrast, are those who have been trained to portray the medical scenario consistently – from patient to patient, and for student to student. This is of prime importance for assessment tasks, to ensure that all students face an equivalent test situation.
The Simulated Patient Program provides Simulated Patients who are carefully trained to portray patients in a standardised way, particularly for assessment. The training for Objective Structured Clinical Examinations (OSCEs) is particularly intensive and is compulsory for all Simulated Patients to ensure a high level of standardisation.
Benefits of using Simulated Patients
In all sessions, whether for the purposes of learning or assessment, using Simulated Patients allows specific scenarios and conditions to be presented realistically.
Clinical scenarios can be written and portrayed to suit the educational purpose. A scenario can, for example be tailored specifically to the level expected of the student, with more complex cases later in the course. Similarly, scenarios can be scripted to focus on specific skills, or with specific conditions in mind.
Using Simulated Patients also provides a transition for students between theory and real-life patient encounters. For students, knowing that how they perform in the clinical encounter will not adversely affect a real patient, minimises their anxiety and provides a safe environment to practice their skills without jeopardising patient safety.
Some issues are rarely dealt with by students with real patients because of their sensitive or challenging nature or because the majority of real patients who agree to medical students are compliant and cooperative. Simulated Patients are an excellent way of giving students experience in dealing with such issues, in an environment that is safe for both student and patient.
In teaching settings, Simulated Patients can assess the student’s performance from a patient perspective and are trained to provide feedback to students to enhance their learning.
In examination settings, Simulated Patients are trained to respond more consistently in the examination than a real patient. They are able to duplicate their role in multiple examinations and can be allocated more student examinations than a real patient. Particularly important for examinations held in multiple locations, Simulated Patients can provide a standardised experience for all students, regardless of where the assessment takes place.