NBOME mail

Day In the Life: Standardized Patient

February 27, 2019

The latest in our monthly “Day in the Life” series took us into the day-to-day of NBOME’s Standardized Patients (SPs). COMLEX-USA Level 2-PE candidates from all over the country travel to our facilities in Philadelphia and Chicago to meet with these folks as they simulate real patients in order to assess the candidates’ performance in examination rooms. SP Trainer Assistants Joanne Cunningham (Philadelphia) and Candace Dickerson (Chicago) took attendees through what it takes to be an SP.

The concept of a standardized patient was introduced in the 1960s by Howard S. Barrows, M.D., with the idea to simulate a real-life patient in a manner so realistic and consistent that encounters with them can provide a fair standard for assessment of aspiring doctors. SPs must respond consistently to each candidate. A candidate asking the same questions and performing the same maneuvers should learn the same information, regardless of whether he/she sees an SP in Chicago or Philadelphia. Keeping the simulation standardized allows every candidate an equal opportunity to demonstrate his or her skills in key clinical and interpersonal areas.

Where do SPs Come From?

Almost anyone can be an SP. In fact, that’s what we aim for. Doctors treat a diverse range of ages, ethnicities, and backgrounds, so the NBOME works to ensure a similar range in their SP pools. We look for reliability, recall skills, and the ability to follow directions and think and act within the context of a case, as well as fairness and confidentiality.

Basic Training

SPs are highly trained, so even a skilled clinician might be hard-pressed to distinguish the difference between a real patient and an SP. The extensive training process involves several days of training in both a particular case and in communication assessment, followed by another several days of “pretest” practice and quality assurance, and can take anywhere from a few weeks to a couple months. An SP’s performance and scoring is then reviewed by a team of physicians, psychometricians, and other experts who need to sign off before the SP can go “live” in the exam. Training continues even after this and lasts throughout an SP’s career at the NBOME, with physicians and trainers regularly monitoring SP performance, and SPs regularly monitoring their own performance as well as that of any counterparts on their case.

Day In The Life

The COMLEX-USA Level 2-PE is offered most mornings, along with several afternoons and some Saturdays each month. A minimum of 14 SPs are scheduled for each exam session, 12 to be part of the exam, seeing candidates, and 2 who are on “standby” in case of callouts or other changes. SPs arrive at 8AM for a morning exam and 2PM for an afternoon exam, and work until about 3:30 PM or 9:30 PM, respectively. They sign out their case, pick their lunch (notable perk of the SP lifestyle) and set up their examination room to its standard configuration. They review their case and report any physical findings (e.g., a bruise, a runny nose, or a cough) to the Trainer on Duty (TOD). Any findings SPs may have could, depending on the case, interfere with their portrayal and lead candidates to incorrect conclusions. Accordingly, SPs are required to report such findings to the TOD who, with a staff physician’s assistance when needed, will determine that the SP needs to be replaced with one of the “standby” SPs or, if the finding won’t add confusion, provide the SP with a response to use if asked about the finding. SPs then have time before the exam begins, time they may spend meeting with their trainers, undergoing a medical screening with a staff physician, watching encounter videos, or studying their case.

At 9AM/3PM, SPs meet for announcements from the TOD, receive blueprints for their day’s encounters, and sign in to the computers in their exam rooms. SPs report to their rooms by 9:20AM/3:20PM, and exams begin promptly at 9:30/3:30 (barring delays).

For each session, SPs see up to 12 Candidates for 12 encounters (consisting of 14 minutes each). Candidates take patient histories, perform physical examinations, and sometimes perform osteopathic manipulative treatment (OMT)*.  After an encounter is finished, candidates have 9 minutes to write a patient note, during which time the SPs score the encounter, reset their rooms, and prepare themselves for the next encounter. Everyone prepares differently—between encounters you’ll see SPs walking around, reading, playing games, doing jumping jacks, and even balancing their checkbooks—whatever it takes for them to put aside the last encounter and treat the next one like it’s their first. SPs who are on standby also experience 12 encounters in a day, but for them it’s on video: they watch and rescore all encounters from one of their past days in the exam or, if applicable, one of their counterpart’s days.

Students need to demonstrate competent clinical and communication skills before they can progress to residency, yet it’s impossible to assess these skills through traditional question and answer testing. That’s what makes COMLEX-USA Level 2-PE, and our SPs, so special. Through the work of our dedicated SPs, we’re able to test this critical component of medicine, protecting the public in the process.

If you or someone you know might be interested in working as an SP at the NBOME, please direct them to our website: https://www.nbome.org/who-we-are/employment/standardized-patients/.


*Candidates are not allowed to perform any invasive procedures.