Standardized Patient Program
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Welcome to the Standardized Patient Program (SPP) at the Stanford University School of Medicine. The program provides clinical skills training for medical students throughout the four-year curriculum. The SPP supports the commitment of Stanford University School of Medicine to produce graduates who apply clinical skills in the care of patients and promote health care that appropriately responds to social, cultural, and health system contexts within which care is delivered.
"The Simulated/Standardized Patient (SP) is a person who has been carefully coached to simulate an actual patient so accurately that the simulation cannot be detected by a skilled clinician. In performing the simulation, the SP presents the gestalt of the patient being simulated; not just the history, but the body language, the physical findings, and the emotional and personality characteristics as well.”
– Howard Barrows, M.D.
Given that the best way to replicate a human being is with a human being, many aspects of the real clinical world can be evoked using specially trained actors to portray patients with particular health conditions or concerns. Because of their special training they are referred to as “Standardized Patients” (SP). They are able to give a consistent and pre-defined account of their condition and to answer the full spectrum of questions about themselves.
WHAT WE DO
Current Use of Standardized Patients in the Stanford School of Medicine Curriculum
The Stanford Standardized Patient Program develops and administers clinical encounter-based exams throughout the medical school curriculum. We are heavily integrated throughout the Practice of Medicine (POM) curriculum for the pre-clerkship students, with both formative exercises emphasizing history and physical examination skills, as well as examinations at the end of the first (Micro CPX) and second (Mini CPX) years of medical training. A number of core clerkships also hold SP exercises during the clinical years.
The SPP coordinates the Clinical Performance Exam (CPX), a statewide examination administered to all Stanford medical students towards the end of medical training. Successful completion of the CPX is a requirement for graduation.
The Stanford SPP is also developing new and exciting programs for housestaff in coordination with the Office of Graduate Medical Education.
History of the Stanford SP Program
The Stanford Standardized Patient Program started in 1994 with two exercises: one in the Internal Medicine clerkship and one in the Family Medicine clerkship. A clinical skills center did not exist, nor did A/V capacity. Real clinic space in the Blake Wilbur Building at Stanford was used on weekends and evenings. In 1998, the program moved to the modular trailers at 1215 Welch Road; four VHS camcorders on tripods to record exercises and portable massage tables for physical exams were utilized. By 2000, Stanford’s SP Program was one of ten sites working with the National Board of Medical Examiners (NBME) on the development of the Clinical Skills portion of the United States Medical Licensing Examination (USMLE). By that time, ten rooms with exam tables as well as audio/visual capability had been secured. Analog cameras were converted to allow for digital recording in 2006.
In August 2010 the program moved into the Immersive Learning Center (ILC), located on the ground floor of the Li Ka Shing Center for Learning and Knowledge. The ILC is one of the largest and most comprehensive facilities of its kind. Among other facilities, the ILC has 12 fully equipped clinic rooms outfitted with two cameras and three microphones each – ideal for standardized patient activities.
Stanford is an active member of the California Consortium for the Assessment of Clinical Competence (CCACC), a multidisciplinary collaboration of physicians and other medical educators from all eight medical schools in the state of California.
History of Standardized Patients in Medical Education
Dr. Howard Barrows trained the first standardized patient in 1963 at the University of Southern California. This SP simulated the history and examination findings of a patient who had multiple sclerosis and was paraplegic. Dr. Barrows also developed a checklist that the SP used to evaluate the performance of the trainee. Although the adoption of standardized patient simulations was relatively slow in many schools, by the early 1980s more and more medical schools were utilizing SP examinations in their curricula, as were a number of residency programs particularly in the northeastern United States. By the early 1990s, the value of standardized patients in medical education was firmly established, both nationally and internationally. The Medical Council of Canada was the first to use SPs in a licensure examination in 1993. The Educational Commission for Foreign Medical Graduates (ECFMG) introduced the Clinical Skills Assessment exam in 1998 to test the clinical skills of foreign medical graduates. Lastly, in 2005, the ECFMG and the National Board of Medical Examiners (NMBE) joined forces and created the USMLE Step 2 Clinical Skills exam. This exam is mandatory for American and foreign medical students to obtain medical licensure in the United States.
