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Simulated Patient (SP) methodology for communication training in any discipline

Val Fulmer


Introduction: The University of Pittsburgh School of Medicine Standardized Patient (SP) Program has assisted with communication skills training in medical and other health science departments since 2002. We will explore how the realism of training interpersonal communication skills with Simulated/Standardized Patient (SP) “role play” can enhance the quality and versatility of any communication-based evaluation or training in health and a variety of other environments.

Description: Since the early 1960s, collaborations with the dramatic arts have been leveraged in “educational acting” within medical schools around the world. Formal programs that employ SPs to teach and test interpersonal skills using educational “role play” techniques are now common. An SP is defined as “a person trained to consistently portray a patient or other individual in a scripted scenario for the purposes of instruction, practice, or evaluation”. SP methodology is a powerful tool to utilize when training objectives relate to the understanding of individual perspectives, cultural, technical and professional behaviors.

Program Results: Initially formed to support the School of Medicine, the desire for collaborative and interprofessional learning has expanded our program’s scope to include seven other health sciences within the University. As interpersonal communication skills have been shown to improve patient-centric care and customer satisfaction, this training provides experiential practice and measurable outcomes of these foundational skills.

Implications: As all disciplines move more towards improving the experience of the “consumer”, an increased concern with end user satisfaction is essential. The transferability of SP methodology is applicable across many fields, including Law, Business and Social Work among other programs. Continued collaboration has significant potential for training professionals in all disciplines.


Communication training, interpersonal skill, patient, patient experience, person-centered healthcare, role play simulated/standardized patient, small group learning

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NBOME Clinical Skills Evaluation Collaboration. Available at:

Barzansky, B. & Etzel, S.I. (2013). Medical schools in the United States, 2012-2013. Journal of the American Medical Association 310 (21) 2319-2327.

Howley, L., Szauter, K., Perkowski, L., Clifton, M. & McNaughton, N. (2008). Quality of standardised patient research reports in the medical education literature: review and recommendations. Medical Education 42 (4) 350-358.

Cleland, J.A., Abe, K. & Rethans, J.J. (2009). The use of simulated patients in medical education: AMEE Guide No 42. Medical Teacher 31 (6) 477-486.

Barrows, H.S. (1993). An overview of the uses of standardized patients for teaching and evaluating clinical skills. AAMC. Academic Medicine 68 (6) 443-451.

Wallace, P. (1997). Following the threads of an innovation: the history of standardized patients in medical education. Caduceus 13 (2) 5.

Hodges, B., Regehr, G., Hanson, M. & McNaughton, N. (1997). An objective structured clinical examination for evaluating psychiatric clinical clerks. Academic Medicine 72 (8) 715-721.

Solomon, P. & Salfi, J. (2011). Evaluation of an interprofessional education communication skills initiative. Education for Health 24 (2) 616.

Kilminster, S., Hale, C., Lascelles, M., Morris, P., Roberts, T., Stark, P., Sowter, J. & Thistlethwaite, J. (2004). Learning for real life: Patient-focused interprofessional workshops offer added value. Medical Education 38 (7) 717-726.

Association of Standardized Patient Educators, Standards of Best Practice: Advances in Simulation. Available at: AcxeY3lSX6wLo4-LTvEKRnlzJ_-Hocy- ycQMOh1kKLZwAYSVGw0Eb0b5XzRXSJ7XQJ1tgfy80lopDg2nnLIGPNgcd-r5w%3D%3D

International Nursing Association for Clinical Simulation and Learning, Standards of Best Practice. available at:

Wamsley, M., Staves, J., Kroon, L., Topp, K., Hossaini, M., Newlin, B., Lindsay, C. & O’Brien, B. (2012). The impact of an interprofessional standardized patient exercise on attitudes toward working in interprofessional teams. Journal of Interprofessional Care 26 (1) 28-35.

Sanko, J.S., Shekhter, I., Kyle Jr, R.R., Di Benedetto, S. & Birnbach, D.J. (2013). Establishing a convention for acting in healthcare simulation: merging art and science. Simulation in Healthcare 8 (4) 215-220.

Nestel, D. & Tierney, T. (2007). Role-play for medical students learning about communication: guidelines for maximising benefits. BMC Medical Education 7 (1) 3.

Society for Simulation in Health Care. HealthCare Simulation Dictionary. Abailable at:

Nestel, D., Tabak, D., Tierney, T., Layat-Burn, C., Robb, A., Clark, S., Morrison, T., Jones, N., Ellis, R., Smith, C., McNaughton, N., Knickle, K., Higham, J. & Kneebone, R. (2011). Key challenges in simulated patient programs: An international comparative case study. BMC Medical Education 11 (1) 69.

Berenson, L.D., Goodill, S.W. & Wenger, S. (2012). Standardized Patient Feedback: Making It Work Across Disciplines. Journal of Allied Health 41 (1) 27E-31E.

Nestel, D., Clark, S., Tabak, D., Ashwell, V., Muir, E., Paraskevas, P. & Higham, J. (2010). Defining responsibilities of simulated patients in medical education. Simulation in Healthcare 5 (3) 161-168.

Szauter, K., Fulmer, V. & Glueck, D. (2013). Adequate representation of socio-cultural issues in our standardized patient scenarios? Simulation in Healthcare 8 (3) 193-196.

Holland, L. & Ousey, K.. (2011). Inclusion or exclusion–recruiting Black and Minority ethnic community individuals as simulated patients. Ethnicity and Inequalities in Health and Social Care 4 (2) 81-90.

Howley, L.D., Gliva-McConvey, G., Thornton, J. & Association of Standardized Patient Educators (ASPE). (2009). Standardized patient practices: initial report on the survey of US and Canadian medical schools. Medical Education Online 14 (1) 4513.

Stillman, P., Swanson, D., Regan, M. B., Philbin, M.M., Nelson, V., Ebert, T., Ley, B., Parrino, T., Shorey, J., Stillman, A., Alpert, E. et al. (1991). Assessment of Clinical Skills of Residents Utilizing Standardized Patients; A Follow-up Study and Recommendations for Application. Annals of Internal Medicine 114 (5) 393-401.

Bokken, L., Rethans, J.J., Scherpbier, A.J. & van der Vleuten, C.P. (2008). Strengths and weaknesses of simulated and real patients in the teaching of skills to medical students: a review. Simulation in Healthcare 3 (3) 161-169.

Harden, R.M. & Gleeson, F.A. (1979). Assessment of clinical competence using an objective structured clinical examination (OSCE). Medical Education 13 (1), 39-54.

Johnson, J., Salisbury, H., Deaver, S., Johansson, M. & Calisch, A. (2013). Standardized patients in art therapy education: A phenomenological study. Art Therapy 30 (2) 79-85.

Feng, B., Srinivasan, M., Hoffman, J.R., Rainwater, J.A., Griffin, E., Dragojevic, M., Day, F.C. & Wilkes, M.S. (2013). Physician communication regarding prostate cancer screening: analysis of unannounced standardized patient visits. Annals of Family Medicine 11 (4) 315-323.

Clayton, J.M., Butow, P.N., Waters, A., Laidsaar-Powell, R.C., O’Brien, A., Boyle, F., Back, A.L., Arnold, R.M., Tulsky, J.A. & Tattersall, M.H. (2013). Evaluation of a novel individualised communication-skills training intervention to improve doctors’ confidence and skills in end-of-life communication. Palliative Medicine 27 (3) 236-243.

Hatchett, P., Haun, C. & Goldenhar, L. (2004). Training standardized patients to give feedback to medical trainees: The state of the art. ASPE Project Awards. available at:

Bokken, L., Linssen, T., Scherpbier, A., van der Vieuten, C. & Rethans, J.J. (2009). Feedback by simulated patients in undergraduate medical education: a systematic review of the literature. Medical Education 43 (3) 202-210.

Kneebone, R., Nestel, D., Wetzel, C., Black, S., Jacklin, R., Aggarwal, R., Yadollahi, F., Wolfe, J., Vincent, C. & Darzi, A. (2006). The human face of simulation: patient-focused simulation training. Academic Medicine 81 (10) 919-924.

Maguire, P. & Pitceathly, C. (2002). Key communication skills and how to acquire them. British Medical Journal 325 (7366) 697-700.

Ware, J.E., Snyder, M.K., Wright, W.R. & Davies, A.R. (1983). Defining and measuring patient satisfaction with medical care. Evaluation and Program Planning 6 (3-4) 247-263.

Institute for Healthcare Communication. (2011). Impact of communication in healthcare. Available at: (Last accessed 26 July 2017).

McNaughton, N., Tiberius, R. & Hodges, B. (1999). Effects of portraying psychologically and emotionally complex standardized patient roles. Teaching and Learning in Medicine 11 (3) 135-141.

Woodward, C.A. & Gliva-McConvey, G. (1995). The effect of simulating on standardized patients. Academic Medicine 70 (5) 418-420.

Gerzina, H.A. (2014). An Analysis of the Relationship Between Job Stress and Resilience Among US Members of the Association of Standardized Patient Educators. (Doctoral dissertation, Kent State University).

Anderson, M.B., Stillman, P.L. & Wang, Y. (1994). Growing use of standardized patients in teaching and evaluation in medical education. Teaching and Learning in Medicine 6 (1) 15-22.

Curtis, J.R., Back, A.L., Ford, D.W., Downey, L., Shannon, S.E., Doorenbos, A. Z., Kross, E.K., Reinke, L.F., Feemster, L.C., Edlund, B., Arnold, R.W., O’Connor, K. & Engelberg, R.A. (2013). Effect of communication skills training for residents and nurse practitioners on quality of communication with patients with serious illness: a randomized trial. Journal of the American Medical Association 310 (21) 2271-2281.

Gude, T., Vaglum, P., Anvik, T., Baerheim, A. & Grimstad, H. (2013). A few more minutes make a difference? The relationship between content and length of GP consultations. Scandinavian Journal of Primary Health Care 31 (1) 31-35.

Furman, G. (2015). Available at:

Turan, S., Elcin, M., Uner, S., Odabasi, O., Sayek, I. & Senemoglu, N. (2009). The impact of clinical visits on communication skills training. Patient Education and Counseling 77 (1) 42-47.

Kahan, M., Gomes, T., Juurlink, D. N., Manno, M., Wilson, L., Mailis-Gagnon, A., Srivastava, A., Reardon, R., Dhalla, I.A. & Mamdani, M.M. (2013). Effect of a course-based intervention and effect of medical regulation on physicians’opioid prescribing. Canadian Family Physician 59 (5) e231-e239.

Aalbers, M.W., Hommes, J., Rethans, J.J., Imbos, T., Muijtjens, A.M. & Verwijnen, M.G. (2013). Why should I prepare? a mixed method study exploring the motives of medical undergraduate students to prepare for clinical skills training sessions. BMC Medical Education 13 (1) 27.

Downing, S.M., Tekian, A. & Yudkowsky, R. (2006). Research methodology: procedures for establishing defensible absolute passing scores on performance examinations in health professions education. Teaching and Learning in Medicine 18 (1) 50-57.

Anderson, L.W., Krathwohl D.R. & Bloom B.S. (2001). A taxonomy for learning, teaching, and assessing: a revision of bloom's taxonomy of educational objectives. Boston: Allyn & Bacon.

Zigmont, J.J., Kappus, L.J. & Sudikoff, S.N. (2011). Theoretical foundations of learning through simulation. Seminars in Perinatology 35 (2) 47-51.

Guraya, S.Y. & Almaramhy, H.H. (2012). Small group teaching improves students’ acquisition of knowledge and skills. Saudi Medical Journal 33 (12) 1304-1309.

Rudolph, J.W., Simon, R., Dufresne, R.L. & Raemer, D.B. (2007). Debriefing with good judgment: combining rigorous feedback with genuine inquiry. Anesthesiology Clinics 25 (2) 361-376.

Zigmont, J.J., Kappus, L.J. & Sudikoff, S.N. (2011). The 3D model of debriefing: defusing, discovering, and deepening. Seminars in Perinatology 35 (2) 52-58.

Rudolph, J.W., Simon, R., Raemer, D.B. & Eppich, W.J. (2008). Debriefing as formative assessment: closing performance gaps in medical education. Academic Emergency Medicine 15 (11) 1010-1016.

Nestel, D., Kelly, M., Jolly, B. & Watson. M. (2018). Healthcare Simulation Education: Evidence, theory and Practice. New Jersey: John Wiley & Sons Ltd.

Mahoney, J., Vitale, F., Eibling, D., Campbell, P. & Clifton, M. (2008). Standardized patient cases for teaching tobacco cessation. MedEdPORTAL Publications. Available at:

Scott, R.P., Stogsdill, M., Fulmer, V. & Day, H. (2012). Technology-based Approaches to Competencies in Women's Health in the VA System. Available at:

Gelman, A., Amin, P., Pletcher, J., Fulmer, V., Kukic, A. & Spagnoletti, C. (2014). A standardized patient case: a teen questioning his/her sexuality is bullied at school. MedEdPORTAL Publications. Available at:

Croft, C., Pletcher, J., Fulmer, V., Steele, R., Day, H. & Spagnoletti, C. (2013). A same-sex couple copes with end- of-life issues: a case materials guide. MedEdPORTAL Publications. Available at:

Day, H., Scott, R., Fulmer, V., et al. (2013). Women’s health issues in military veterans: standardized patient cases in motivational interviewing, a case materials guide. MedEdPORTAL Publications. Available at:

Cherry, M.G., Fletcher, I. & O’Sullivan, H. (2013). Exploring the relationships among attachment, emotional intelligence and communication. Medical Education 47 (3) 317-325.

Asnani, M.R. (2009). Patient-physician communication. West Indian Medical Journal 58 (4) 357-361.

Association of Standardized Patient Educator Newsletter. Available at: intelligence/medical-allied-healthcare

Association of Standardized Patient Educator Newsletter. “Standardized History, unusual life”. Available at:

Dieckmann, P., Gaba, D. & Rall, M. (2007). Deepening the theoretical foundations of patient simulation as social practice. Simulation in Healthcare 2 (3) 183-193.

Dieckmann, P., Molin Friis, S., Lippert, A. & Østergaard, D. (2009). The art and science of debriefing in simulation: Ideal and practice. Medical Teacher 31 (7) e287-e294.

Cassell, E.J. (1984). The Place of the Humanities in Medicine. New York: The Hastings Center.

Griffith, 3rd, C.H., Wilson, J.F., Langer, S. & Haist, S.A. (2003). House staff nonverbal communication skills and standardized patient satisfaction. Journal of General Internal Medicine 18 (3) 170-174.

May, W., Park, J.H. & Lee, J.P. (2009). A ten-year review of the literature on the use of standardized patients in teaching and learning: 1996-2005. Medical Teacher 31 (6) 487-492.

Cahill, H., Coffey, J. & Sanci, L. (2015). ‘I wouldn’t get that feedback from anywhere else’: learning partnerships and the use of high school students as simulated patients to enhance medical students’ communication skills. BMC Medical Education 15. (1) 35.

The doctor stitching together medicine and art. (2014). Available at:



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