Faculty, students, and actors as standardized patients: expanding opportunities for performance assessment.

BACKGROUND: In an effort to expand preclinical formative assessments, our medical school has implemented additional simulated encounters using faculty members and students in addition to actors to portray standardized patients (SP). This report focuses on the implementation of this strategy. In addition, a preliminary evaluation of the fidelity of the simulated clinical encounters based on SP type is reported. DESCRIPTION: Three new performance-based assessments were added to the second-year curriculum; each was associated with specific content in the problem-based learning curriculum. The training of student and faculty SPs was modeled after an existing training program for another assessment event. EVALUATION: To determine the impact of SP type on students' experiences, 313 students completed a 9-item anonymous questionnaire after each performance assessment; items were rated on a 5-point scale. Faculty members and students who were SPs also completed a brief satisfaction questionnaire. Faculty SPs were most intimidating to students, but they provided students with the most helpful feedback. Students were less anxious when peers were SPs, but they rated the encounter as a less valuable simulation. There was no difference in students' ratings of confidence in their diagnosis or the extent to which SP type inhibited their performance.
CONCLUSIONS: Students and faculty benefited from their SP experience. A combination of SP types can provide a broad range of cost-effective preclinical learning experiences. Students, faculty, and actors as SPs each have specific strengths and weaknesses related to cost, training needs, feedback quality, and simulation fidelity. The goals of the encounter should guide the choice of SP type.