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What's an SP?

A standardized patient (SP) is an individual who is scripted and trained to exhibit certain signs and symptoms of medical conditions. SPs may be able-bodied individuals who simulate a patient's illness in a standardized way or actual patients with stable findings who are trained to present his or her own illness in a standardized way. SPs are chosen because of their intelligence and attention to detail. While some SPs are actors, many are retirees and people who simply enjoy altruistic work.

Teaching Associate Professionals (TAPs) are SPs who have been trained to teach physical examination maneuvers on his or her body.

An SP will not vary from student to student. In performing the simulation, the SP presents not just the medical history, but the body language, the physical findings, and the emotional and personality characteristics as well. Each SP is so carefully coached that the simulation cannot be detected by a skilled clinician.

The idea of using SPs was developed in 1963 by Dr. Howard S. Barrows, a neurologist. Now, all medical schools in the United States are using SPs for teaching and/or testing. SPs do not replace real patients in the curriculum. They do provide a realistic learning resource for students who are developing their interviewing and examination skills in preparation for interactions with real patients and are particularly useful for beginning students.

Advantages of Using SPs

SPs are comparable to real patients (valid).
SP roles are standardized and repeatable (reliable).
SPs are available any time, any place (convenient).
Faculty can control the setting and level of difficulty of the clinical encounter.
Use of SPs avoids inconvenience, discomfort or harm to real patients.
SP encounters minimize student anxiety.
SPs can provide immediate and constructive feedback.

The UAMS Standardized Patient program was established in 1993 by Dr. I. Dodd Wilson, then Dean of the College of Medicine, who recognized the need for practical teaching and assessment of medical students. Jeanne Heard, M.D., Ph.D., medical director, Mary Cantrell director, developed the SP program and, with support from Chancellor Harry Ward, created the UAMS Clinical Skills Center.

The Clinical Skills Center is a "mock" clinic with 10 examination rooms and a central observation room. The examination rooms are fully equipped with examination tables, diagnostic instruments, sinks, soap, latex gloves, and paper towels. The clinic rooms also include cameras with sound and feedback capabilities. The observation room includes 10 viewing stations equipped with color monitors, headsets, videotape recorders, and microphones. All colleges at UAMS use the center for teaching and testing. Located on the lower level of the JBSU building, next door to the campus bookstore, it opened in December 1997.

The key to interacting with SPs is to relate to them exactly as a "real" patient with similar problems. SPs will not interrupt a student during an encounter, nor will they volunteer any information. Students should not attempt to communicate with an SP out of role or other than as a physician to a patient. This is unprofessional and will embarrass both the SP and the student.

Time-in/Time out Guidelines

When SPs are used in small group teaching sessions, the "time-in/time-out" format is used. The guidelines are very simple.

Imagine that the SP is sitting in a clinic room, waiting to be seen. The SP will not acknowledge the group until addressed as a real patient.

One student begins the interview by introducing him or herself and eliciting the reason for the visit (or the chief complaint).

If the student in the encounter becomes uncomfortable or does not know what to say, he/she can signal by saying "time-out." The SP will go into suspended animation and act as if waiting for the doctor. When the student is ready to resume, he/she will call "time-in."

The student can ask for help in "time-out," but this is not the time for a lecture or lengthy discussion.

If a preceptor needs to correct a student or to emphasize something the student has done, he/she may also call "time-out".

Only the facilitator or student in the encounter can call "time-out."

Once all the students who wish to interview the patient have done so, the preceptor will ask the SP to step out of role and give feedback to each student who participated in the encounter.