Medical training has traditionally depended on patient contact. However, changes in healthcare delivery coupled with concerns about lack of objectivity or standardization of clinical examinations lead to the introduction of the 'simulated patient' (SP). SPs are now used widely for teaching and assessment purposes. SPs are usually, but not necessarily, lay people who are trained to portray a patient with a specific condition in a realistic way, sometimes in a standardized way (where they give a consistent presentation which does not vary from student to student). SPs can be used for teaching and assessment of consultation and clinical/physical examination skills, in simulated teaching environments or in situ. All SPs play roles but SPs have also been used successfully to give feedback and evaluate student performance. Clearly, given this potential level of involvement in medical training, it is critical to recruit, train and use SPs appropriately. We have provided a detailed overview on how to do so, for both teaching and assessment purposes. The contents include: how to monitor and assess SP performance, both in terms of validity and reliability, and in terms of the impact on the SP; and an overview of the methods, staff costs and routine expenses required for recruiting, administrating and training an SP bank, and finally, we provide some intercultural comparisons, a 'snapshot' of the use of SPs in medical education across Europe and Asia, and briefly discuss some of the areas of SP use which require further research.
Objective-To study the Results-Mean (SD) total score across complaints for competence was 49% higher than in the performance test (81-8 (11) compared with (10-1), p<0-0001). The Pearson correlation across complaints between the competence total score and the performance total score of the participating physicians was -0-04 (not significant). When efficiency and consultation time of the consultations were taken into account, the correlation was 0-45 (p
Video assessment of GPs in daily practice according to the procedures described is a valid and reliable method, one which is useful for education and quality improvement. There is a trade-off between feasibility on one hand and validity, reliability and credibility on the other hand. Compared to investments in observation methods in standardized settings, the costs of video observation of GPs' actual performance are acceptable.
Standardized patients (SPs) are simulated patients or actual patients who have been carefully coached to present their illness in a standardized way. Much is known about the use of standardized patients in medical education. This article reviews advantages and disadvantages, reliability and validity of the use of standardized patients in general practice and primary care research. Performance in general practice can be measured with direct or indirect methods. With direct methods the physician-patient contact is directly observed or heard. Indirect methods are seldom complete and seldom accurate and therefore often invalid. Direct methods (observation, video, audiotapes, etc.) have face validity, but nevertheless have shortcomings. The SP method can mainly avoid the disadvantages of the other methods. The presentation of the case by the SP is accurate. The judgement of physician's behaviour during the consultation by the SP is accurate and reliable. SPs are generally believable. Less than one in five SPs is detected by the physicians, so the method has face validity. To obtain sufficient reliability and validity, a thorough selection and training of SPs is required, as is careful organization with an eye for detail. The SP method also has some important shortcomings. The method is time and work demanding, limiting the number of physicians that can be measured. In addition, measurement is usually limited to one consultation. In reality, however, diagnostic and therapeutic interventions are often spread over several consultations. This 'first-visit-bias' hampers conclusive answering of some research questions.
The review has highlighted important aspects of patient safety in clinical deterioration that could be further addressed by educational strategies targeting the role of ward nurses. These strategies include: utilizing clinical decision-making models to develop nurses' decision making skills; developing a standardized tool for systematic nursing assessment and management of clinical deterioration; incorporating training in clinical deterioration as a core competence of pre-registered nursing education; providing vital signs training to nursing assistants; and conducting more rigorous studies to evaluate the effectiveness of the educational programmes.
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