Simulated patient

A simulated patient or standardized patient (SP) (also known as a patient instructor), in health care, is an individual who is trained to act as a real patient in order to simulate a set of symptoms or problems. Simulated patients have been successfully used in medical education, evaluation, and research.

History
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 paraplegic multiple sclerosis patient. Dr Barrows also developed a checklist that the SP could use to evaluate the performance of the trainee. In 1984, a number of residency programs in the northeastern U.S. gave their residents the same examination using SPs. Medical Council of Canada was the first to use SPs in a licensure examination in 1993. The Educational Commission for Foreign Medical Graduates introduced the Clinical Skills Assessment exam in 1998 to test the clinical skills of foreign medical graduates. This exam is now the USMLE Step 2 Clinical Skills exam and is mandatory for obtaining medical licensure in the United States.

Uses
Simulated patients are extensively used in medical education to allow medical students to practice and improve their clinical and conversational skills for an actual patient encounter. SPs commonly provide feedback after such encounters. They are also useful to train medical students to learn professional conduct in potentially embarrassing situations such as pelvic or breast exams. SPs are also used extensively in testing of clinical skills of medical students, usually as a part of an Objective Structured Clinical Examination. Typically, the SP will use a checklist to record the details of the encounter.

Standardized patients have also been sent unannounced in physician practices to evaluate standards of care. They are also employed in medical informatics research.

Advantages
The use of simulated patients has several advantages.
 * Convenience: SPs are able to provide cases that are needed at the time they are needed.
 * Direct comparisons of competence: The clinical skills of students can be directly compared.
 * Compression/expansion of time: SPs can provide a longitudinal experience and enable students to follow through patients over time, even in a compressed time frame of examination. One technique employed in SP encounters is the use of information cards. When the trainee or examinee articulates the need for an examination or a laboratory test, the SP hands him/her a small card with the results of that exam/test, and the encounter can continue.
 * Safety: SP encounters allow students to learn about situations they may not be able to manage alone in a real clinical setting.
 * Efficiency: The monitoring of students by SPs reduces the need for supervision of medical students by physician faculty during clinical encounters.

Limitations
At the same time, SPs are case specific and are able to assess clinical competency in a limited area only. Multiple encounters may be needed for broad ranged training or testing. Also, while SPs are quite proficient in simulating the symptoms, emotional states and even certain examination findings (neurological examination, for example), they may not be able to simulate certain other signs such as heart murmurs or lung sounds.