The cognitive demands of standardized patients: understanding limitations in attention and working memory with the decoding of nonverbal behavior during improvisations.

INTRODUCTION: This study was designed to look at the challenges of standardized patients while in role and to use the findings to enhance training methods. The study investigated the effect of improvisations and multiple-task performance on the ability of standardized patients to observe and evaluate another's communication behaviors and its associated mental workload.
METHOD: Twenty standardized patients participated in a 2 types of interview (with and without improvisations)-by-2 types of observation (passive and active) within-groups design.
RESULTS: The results indicated that both active observations and improvisations had a negative effect on the standardized patients' ability to observe the learner, missing more than 75% of nonverbal behaviors during active improvisational encounters. Moreover, standardized patients experienced the highest mental demand during active improvisational encounters.
CONCLUSIONS: The findings suggest that the need to simultaneously portray a character and assess a learner may negatively affect the ability of standardized patients to provide accurate evaluations of a learner, particularly when they are required to improvise responses, underscoring the need for specific and targeted training.