Evaluating interns' performance using simulated patients in a casualty department.

An observational study examined the care that was provided by 61 interns for three simulated (standardized) patients in a casualty department within a large teaching hospital. The consultations were recorded on videotape and were scored by reference to explicit criteria that were set by an expert panel. The criteria described standards of clinical competence, communication skills and preventive care for each of the three cases. An additional list of the general opportunities for preventive advice that were suggested by the patients' case histories also was compared with the interns' actual behaviour. Clinical competence was not demonstrated uniformly across the three cases. The problem of urinary-tract infection was managed best; 19% of the interns complied with all criteria, and 93% of the interns complied with 75% of the criteria. For tension headache, only 3% of the interns complied with all the criteria but 67% of interns complied with 75% of the criteria. In the case of bronchitis, only 3% of interns complied with all the criteria but 58% of interns met 75% of the criteria. The quality of preventive care also varied from case to case, being best for the patient with bronchitis and worst for the patient with tension headache. Over all, only three of the 13 criteria were met by more than half the interns. The communication-skills criteria identified three behaviours which the interns were most likely to omit: the interns summarized the patients' problems in only 73 of the 173 consultations; they explained the aetiology of the problems in only 127 of the 173 consultations; and they ensured that the patients understood their plan of management in only 21 of the 173 consultations.