Standardized (Simulated) Patients and the Medical Interview

Abstract

A simulated patient is one who has been coached to generate a “live and interactive simulation of a patient problem” (Vu, Steward, and Marcy, 1987). In 1964 Barrows first reported the use of programmed patients to assess student performance in clinical neurology (Barrows and Abraham-son, 1964). Since that time, patient surrogates have served a variety of purposes: to teach techniques of physical examination (Anderson and Meyer, 1978; Stillman, Ruggill, and Sabers, 1978; Stillman et al., 1980; Stillman and Swanson, 1987), reproductive medicine (Kerr, Templeton, and Parboosingh, 1977), clinical nutrition (Carroll, Hain, and Howell, 1983), telephone medicine (Dunn, Norton, and Dunn, 1987), and clinical problem solving (Norman, Tugwell, and Feightner, 1982; Woodward, 1983); to evaluate professional performance at the student, resident, and practicing physician levels (Lamont and Hennen, 1972; Mumford et al., 1984; Stillman and Sabers, 1978; Ramsey et al., 1987); to evaluate various teaching methods (DaRosa, Mazur, and Folse, 1984; Mumford et al., 1987; Stillman et al., 1987; Terasaki, Morgan, and Elias, 1984); to determine needs in continuing medical education (Davis et al., 1985); and as a research tool to learn more about the practice of medicine and about physician/patient communication (Burri, McCaughan, and Barrows, 1976; Hoppe, et al., 1990; Owen and Winkler, 1974; Roter and Hall, 1987; Roter, Hall, and Katz, 1987). The use of simulated patients to teach interviewing skills began in the early 1970s (Jason et al, 1971; Stillman, Sabers, and Redfield, 1976; Werner and Schneider, 1974) and continues on a large scale today (Barrows, 1987; Carroll, Schwartz, and Ludwig, 1981; Hoppe et al., 1988; Kahn, Cohen, and Jason, 1979; Leven-kron, Greenland, and Bowley, 1987).