Presentation of a real patient as part of a medical instruction
History of Standardized Patients
The use of lay patients to simulate the presentation of a real patient as part of a medical instruction or evaluation began in the early 1970s. Howard S. Barrows published the first book on this topic in 1971, Simulated Patients (Programmed Patients); The Development and Use of a New Technique in Medical Education . Use of simulated/standardized patients was initially slow to develop, but began to take off in the early 1980s.
At East Tennessee State University, in 1987, when Forrest Lang, MD became course director of the Introduction to Clinical Medicine Course (designed to serve as a clinical interface for M-2 students at Quillen College of Medicine), he introduced standardized patients (SPs) into the course. The initial group of standardized patients was recruited from the Road Company, a professional group of actors and playwrights. They served as standardized patients in the classroom as well as patients/doctors in a series of video-clips used to provide interactive instruction in doctor-patient communication.
In 1991, with the beginning of the Kellogg-funded, Rural Primary Care Track, standardized patients were also recruited from Mountain City and Rogersville to teach in a new inter-professional communication course. Standardized Patients were also used for practice in physical diagnosis for the rural track students.
In 2000, the Schools of Medicine and Nursing, with involvement from Public Health, developed a required inter-professional communication course that relies heavily on the use of Standardized Patients to this day.
The role of SPs at ETSU expanded when Martin Eason, MD arrived in 2003 from Louisville, KY with experience using Standardized Patients to provide primary instruction in physical diagnosis. Standardized Patients learn how to perform the physical examination and are tested. Those scoring over 90% on a physical examination checklist of several hundred maneuvers, teach M-1 students how to perform the physical examination. SPs also participate in teaching the Pharmacy and Medical Students exam skills and the assessment of those skills.
ETSU also has a group of specialized SPs in the GTA/MUTA program. These Gynecologic Teaching Associates and Male Urogenital Teaching Associates are women and men who are specially trained to aid students and provide feedback on their technique in gynecological and urogenital exams. This program was started more than 25 years ago and has been recently reorganized to keep up with current practices. Jane Jones was the first to recruit GTAs for ETSU.
Currently, there are over 55 SPs trained in communication skills with over 30 trained in specialized physical areas.
(The above information contained in the historical section is based on contributions by: Forrest Lang, M.D.; Martin Eason, M.D.; and Christine Murdock, a long-time SP in the Standardized Patient program.)
Barrows, Howard S.; Simulated Patients (Programmed Patients); The Development and Use of a New Technique in Medical Education ; Springfield, Ill., Thomas; 1971.