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Assessment of Clinical Skills of Residents Utilizing Standardized Patients: A Follow-up Study and Recommendations for Application

Paula Stillman, MD; David Swanson, PhD; Mary Beth Regan, EdD; Mary M. Philbin; Virginia Nelson; Thomas Ebert, MD; Bryson Ley, MD; Thomas Parrino, MD; Jeannette Shorey, MD; Alfred Stillman, MD; Elaine Alpert, MD; Joel Caslowitz, MD; David Clive, MD; James Florek, MD; Milton Hamolsky, MD; Charles Hatem, MD; Janice Kizirian, MD; Richard Kopelman, MD; David Levenson, MD; Gilbert Levinson, MD; Jack McCue, MD; Henry Pohl, MD; Fred Schiffman, MD; Joel Schwartz, MD; Michael Thane, MD; and Marshall Wolf, MD
[+] Article, Author, and Disclosure Information

The following institutions cooperated in this project: Beth Israel Hospital, Boston, Massachusetts; Boston City Hospital, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts; Baystate Medical Center, Springfield, Massachusetts; Hartford Hospital, Hartford, Connecticut; Memorial Hospital, Pawtucket, Rhode Island; Memorial Hospital, Worcester, Massachusetts; Mount Auburn Hospital, Cambridge, Massachusetts; New England Medical Center, Boston, Massachusetts; Rhode Island Hospital, Providence, Rhode Island; St. Vincent Hospital, Worcester, Massachusetts; University Hospital, Boston, Massachusetts; University of Massachusetts Medical Center, Worcester, Massachusetts; Worcester City Hospital, Worcester, Massachusetts; and Veterans Affairs Medical Center, Boston, Massachusetts.

Grant Support: By the American Board of Internal Medicine, the Fund for the Improvement of Post-Secondary Education, and the National Board of Medical Examiners. The content of the article does not necessarily reflect the policies or opinions of the funding agencies.

Requests for Reprints: Paula L. Stillman, MD, Curriculum Dean, University of Massachusetts Medical Center, 55 Lake Avenue North, Worcester, MA 01655.

Current Author Addresses: Drs. Stillman and Regan and Ms. Philbin and Ms. Nelson: University of Massachusetts Medical School—Curriculum Dean's Office, 55 Lake Avenue North, Worcester, MA 01655.

Dr. Swanson: National Board of Medical Examiners, 3930 Chestnut Street, Philadelphia, PA 19104.

Dr. Ebert: Internal Medicine, The Medical Center of Central Massachusetts, 119 Belmont Street, Worcester, MA 01605.

Dr. Ley: Internal Medicine, The Memorial Hospital, 89 Pond Street, Pawtucket, RI 02860.

Dr. Parrino: Department of General Medicine, Providence Veterans Affairs Medical Center, Providence, RI 02908.

Dr. Shorey: Health Care Associates, Beth Israel Hospital, 330 Brookline Avenue, Boston, MA 02215.

Dr. A. Stillman: Medical Arts Building, 100 South Street, Southbridge, MA 01550.

Dr. Alpert: Boston University School of Medicine, Suite 1108, 720 Harrison Avenue, Boston, MA 02118.

Dr. Caslowitz: Internal Medicine, Veterans Affairs Medical Center, 150 South Huntington Avenue, Boston, MA 02130.

Dr. Clive: Internal Medicine, University of Massachusetts Medical Center, 55 Lake Avenue North, Worcester, MA 01655.

Dr. Florek: Fallon Clinic, 425 North Lake Avenue, Worcester, MA 01605.

Dr. Hamolsky: Cannon Building, Room 205, Three Capitol Hill, Providence, RI 02908.

Dr. Hatem: Internal Medicine, Mount Auburn Hospital, 330 Mount Auburn Street, Cambridge, MA 02138.

Dr. Kizirian: Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02902.

Dr. Kopelman: Internal Medicine, New England Medical Center, 171 Harrison Avenue, Boston, MA 02111.

Dr. Levenson: Renal Endocrine Association, Mellon Pavillion, 4815 Liberty Avenue, Pittsburgh, PA 15224.

Dr. Levinson: Internal Medicine, St. Vincent Hospital, 25 Winthrop Street, Worcester, MA 01604.

Dr. McCue: Internal Medicine, Baystate Medical Center, Springfield, MA 01199.

Dr. Pohl: Albany Medical College, ADM 312, Albany, NY 12208.

Dr. Schiffman: Internal Medicine, Miriam Hospital, 164 Summit Avenue, Providence, RI 02906.

Dr. Schwartz: Internal Medicine, Salem Hospital, 81 Highland Avenue, Salem, MA 01970-2714.

Dr. Thane: Internal Medicine, Boston City Hospital, Room 3E-19, 818 Harrison Avenue, Boston, MA 02118.

Dr. Wolf: Internal Medicine, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115.

© 1991 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1991;114(5):393-401. doi:10.7326/0003-4819-114-5-393
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Objective: To determine the reliability and validity of "standardized patients" to assess clinical performance of internal medicine residents.

Design: Each resident spent 2 half-days interacting with 19 standardized patients (nonphysicians taught to portray patients in a reproducible fashion). Each resident was asked to obtain focused histories, perform relevant physical examinations, and provide patient education or counseling. At the end of each 10- to 15 minute encounter, the resident was asked to identify positive findings on physical examination and to prioritize a differential diagnosis. Other, more traditional indicators of clinical skills were also obtained.

Participants: Three hundred ten residents from nineteen internal medicine training programs in the New England region of the United States.

Results: Reproducible estimates of data gathering and interviewing skills were achieved with 1 day of testing. Validity analyses were difficult to interpret because of the lack of an external "gold standard." However, faculty judgments of performance from reviewing videotapes corresponded with standardized-patient-based scores. Differences in group performance were also demonstrated across years of training and between U.S. or Canadian and foreign medical graduates.

Conclusions: Systematic and effective procedures for developing standardized-patient-based test materials and for training standardized patients have been developed. This technique is best used for measuring data gathering and interviewing skills. Correlations with commonly used evaluation methods were generally low; this may be because standardized patients measure different skills. Local use of this technique by residency programs and the development of regional consortia sharing resources, costs, and expertise are advocated.





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