Summary

In healthcare simulation, standardized patients (SPs) offer a powerful modality that goes beyond traditional manikin-based scenarios. An SP is an individual trained to portray an actual patient case consistently and realistically within the simulation context. In a SP-based simulation, the role of the patient is played by the SP and not by a manikin, like in standard high-fidelity simulations.

During the simulation, learners interact with the SP just as they would with an actual patient, including taking a history, performing physical examinations, and determining a diagnosis or treatment plan. By interacting with an SP, learners can practice critical skills like patient communication, history-taking and physical examination in a way that would be impossible using a manikin; SPs facilitate the development of vital communication competencies such as building patient rapport, active listening, clear communication, and emotional intelligence skills like empathy.

After the scenario, the SP transitions into providing valuable firsthand feedback about the learner’s performance, communication approach, and areas for improvement.

In SP-based simulations, a critical aspect is the training of the SP themselves. This training has two main purposes: portraying the patient’s role realistically and consistently, as well as providing constructive feedback and performance evaluation.

The Association of Standardized Patient Educators (ASPE) produces a standard of best practice providing clear and practical guidelines for educators who work with SPs. The standard covers five domains: safe work environment, case development, training, program management, and professional development. The underlying principles emphasize psychological safety, authentic case content, consistent role portrayal, structured feedback, quality management, and continuous improvement.

Designing an effective SP-based simulation requires careful preparation. The simulation faculty must develop comprehensive case materials, including the patient’s presenting complaint, medical history, symptoms, physical findings, and expected course of treatment, to allow the SP to portray the patient. Also, evaluation instruments need to be agreed for the SP to provide feedback on the learners. Careful planning of the training protocols for the SP are hence necessary.

While SPs enable highly realistic patient interactions, there are some limitations compared to manikin-based simulations. SPs cannot accurately simulate abnormal vital signs or physical findings of diseases; furthermore, for obvious reasons, SPs cannot undergo any invasive procedures. In such cases various technologies like simulated medical devices displaying programmed vitals may be required.

Standardized patients remain an invaluable simulation tool by bridging the gap between theoretical learning and authentic patient care experiences. When properly trained using established best practices, SPs provide a safe, standardized yet highly realistic method to cultivate essential clinical skills, communication competencies, and professional behaviors in healthcare learners before engaging with real patients.