Coaching Standardized Patients: For Use in the Assessment of Clinical Competence »

Peggy Wallace, PhD, is Associate Adjunct Professor of Medicine and Director of Curricular Resources and Clinical Evaluation at the University of California, San Diego School of Medicine, where she is responsible for the teaching, assessment, and remediation of clinical skills using standardized patients in the undergraduate medical school curricula. For the past 10 years she has been Director of the Professional Development Center at the UCSD School of Medicine, where the clinical skills of residents and practicing physicians are also being assessed.

Dr. Wallace held a faculty position at USC in the Department of Medical Education under Dr. Stephen Abrahamson from 1977 to 1995 and was responsble, along with Dr. Howard Barrows, for the reintroduction of standardized patients into the USC Medical School curriculum beginning in the mid-1980s. In the early 1990s, Dr. Wallace became one of the founding directors of what ultimately became the California Consortium for the Assessment of Clinical Competence (CCACC), a consortium of all eight medical schools in California. She is currently codirector of the CCACC, whose purpose is the design and yearly administration of a high-stakes Clinical Practice Examination given to all senior medical students in the state. She has initiated and participated in research within the CCACC to determine and improve standardized patient performance in case presentation and checklist accuracy, and has designed an effective remediation program for students who do not perform up to the expected standards on the communication skills component of clinical performance examinations at UCSD. She has served as consultant to the National Board of Medical Examiners on the Standardized Patient Project, which produced the USMLE Step 2 Clinical Skills Examination. Additionally, Dr. Wallace has conducted numerous workshops nationally, and for the World Health Organization internationally, on instructional technology, the use of video in medicine, procedures for training standardized patients, and SP case development. She has also published a history of the use of standardized patients in medical education entitled Following the Threads of an Innovation.

In today's medical education curriculum, it is necessary for students to learn the proper technique for taking medical histories, performing physical exams, and finding the appropriate way to educate and inform patients. The best way for a student to learn these skills is through hands-on training with a Standardized Patient (SP)--an actor who has been hired to portray a specific set of health problems and symptoms.

Tips to Help You

• Develop Coaching Skills and Be a Director to Your SPs


• Cast Standardized Patients


• Get the Best Performance from Your Actors


• Perfect Your SPs' Timing of Fact Delivery during Examinations


• Improve the SPs' Written Feedback to Students


• Streamline Training Regimens; Checklists Included

Working with SPs has become so important in medical education that it is now a component of the USMLE clinical skills assessment exam. To ensure best practice, the coaches who prepare SPs now need general guidelines.

This handbook is intended as that guide and as a support for those who are involved in training SPs, to encourage each coach to develop a system that will deliver the best results and, in the end, help train the most competent doctors.

Doody Review Services

Reviewer:Fiona Cherryman, MEd, BSc, MRTT(The Michener Institute for Applied Health Sciences)
Description:This guide for those contemplating coaching and working with standardized patients (SPs) provides a comprehensive review of the selection, direction, and utilization of SPs. It melds the creativity of the artistic portrayal of patients from the perspective of the actor with achieving the academic goals of the OSCE. The annotated examples bring this book alive and provide insight from the author's experiences.
Purpose:The author aims to provide a book that can be used both as a comprehensive "how to" and as a reference. The book certainly is highly structured in the chronology of events. The author provides a thorough and systematic approach for readers to easily follow. Although I would use the book as a reference, it works best read chronologically.
Audience:Those contemplating coaching standardized patients are the intended audience. It can be useful as a reference for those using standardized patients and others associated with OSCE examinations, but this is intended for the small group of SP coaches.
Features:The author uses examples from her own practice to highlight her commentary on the process of selecting, training, and directing standardized patients. The appendixes are stellar and include a full case study and the accompanying materials. These provide depth and detail to the text. The context they provide solidifies the descriptions of process in the rest of the book. The chapter summaries provide a review of the covered material and link well into the succeeding chapter.
Assessment:This book is easily accessible to all readers. The comprehensive index and table of contents make it easy to use as an on the fly reference. The author writes more from the artistic than the academic perspective, which is refreshing. This is a useful book for anyone working with standardized patients, either compiling cases or directing SPs.

List of Figures and Tables

Preface

Acknowledgements

Introduction

PART ONE: Required Skill Sets: Developing the Expertise Needed to Coach Standardized Patients

Chapter 1 - Overview: The Art and Practice of Coaching Standardized Patients

The Collaboration in Standardized Patient Work

The Uniqueness of Standardized Patient Work

Some Qualities of Effective Coaches

The Importance of Selecting the Right SPs

The Skills Needed to Be an SP

The Skills Needed to Be an SP Coach

Chapter Summary

Looking Ahead

Chapter 2 - Clinical Skills: Acquiring the Basic Doctoring Skills

Learning the Four Clinical Skill Sets

Portraying the Medical Student With the SPs

Chapter Summary

Looking Ahead

Chapter 3 - Acting: Understanding How the SPs Portray the Patient

Getting Into the Patient's Psyche

Familiarizing Ourselves With the Actor's Tools

The Interconnectedness of Acting, Directing, and SP Coaching

The Art of Acting: A Model for Enhancing Patient Portrayals

Chapter Summary

Looking Ahead

Chapter 4 - Directing: Coaching to Deepen the SPs' Performances

The Relationship of the Coach/Director With the SPs

Chapter Summary

Looking Ahead

PART TWO: Training Procudures: Casting and Training the Standardized Patients

Chapter 5 - Casting: Finding the Right Standardized Patients

Recruitment

Auditioning

Selection

Chapter Summary

Looking Ahead

Chapter 6 - Training theStandardized Patients: An Overview

General Guidelines for Training

Chapter Summary

Looking Ahead

Chapter 7 - Training Session One: Familiarization with the Case

Notes to the SP Coach About Training Session One

Chapter 8 - Training Session Two: Learning to Use the Checklist

Chapter 9 - Training Session Three: Putting It All Together (Performance, Checklist, Feedback)

Training the SPs to Give Effective Written Feedback

Chapter 10 - Training Session Four: First Dress Rehearsal (Clinician Verification of SPs' Authenticity)

Chapter 11 - Training Options: Variations on the Training Sessions

Chapter 12 - The Practice Exam: Final Dress Rehearsal

Afterword

References

Additional Readings on Acting and Directing

Appendix A: Maria Gomez Case Materials

Appendix B: Standardized Patient Administrative Forms

Index