Eleven years ago, Joyce Haley sold her construction company “way before retirement age,” as she described it, and started looking for what she wanted to do next. She spoke about it with her doctor, who was also a good friend, and he asked if she knew what a standardized patient was. She didn’t.

“He told me to go watch the Seinfeld episode about standardized patients, and then realize it's nothing like that,” she said. “So, I watched it and laughed, then I called him and said, okay, what is it really like?”

After the call, Haley trained as a standardized patient, or SP, someone who is paid to take on patient personas in a medical setting to help train medical students, and sometimes other medical professionals such as residents or nurses, in certain skills. She is one of many SPs who work with Tufts University School of Medicine students on the Boston and Maine campuses. Haley also is a Gynecologic Teaching Associate (GTA). At Tufts, GTAs instruct medical students to perform breast and pelvic exams correctly. 

“Students at the School of Medicine work with standardized patients throughout the curriculum, but particularly in the first three years,” said Laura Baecher-Lind, dean of education affairs and professor of obstetrics and gynecology at the School of Medicine. “Standardized patients are most helpful with three domains of learning objectives: history taking, physical exam, and interpersonal skills. We get really rich feedback on those three areas from our standardized patients.”

Standardized patient events at the School of Medicine in Boston take place in the Camilla Bessey Thompson and Paul D. Thompson, M.D., Clinical Skills and Simulation Center (CSSC). For Maine Track students, they take place at Maine Medical Center in the Hannaford Center for Safety, Innovation & Simulation. 

“In both Boston and Maine, we have dedicated exam rooms that look just like exam rooms that you would encounter in a medical office. Typically, there is a standardized patient in each exam room, and students go from room to room to engage in those encounters,” said Baecher-Lind. “There are simulation rooms adjacent to the exam rooms, and sometimes we will have students do, for instance, an eye and ear exam in a simulation room following a standardized patient encounter.”

Getting Familiar with Standardized Patients

Students’ first encounter with SPs takes place just one month into their medical school education, during which students practice interviewing SPs in a medical interviewing course before going through the process with actual patients. In another course on clinical reasoning, Baecher-Lind and other faculty assess students after encounters with SPs by asking questions like, what do you think is the most likely diagnosis for this patient, and what tests do you want to order and why?

Standardized patients are also involved in medical students’ core clerkship year, when they participate in objective structured clinical exams, also known as OSCEs. These assessments are fact-based and involve taking a patient history and performing physical exams. 

Some of the SP encounters are formative, which means they are for student learning only and do not count toward a student’s grade. Other encounters are summative, which means students are evaluated on their performance as part of their grade, and SPs contribute to those evaluations. Typically, Baecher-Lind said, it takes a year to develop new SP cases and then another year to pilot them. But such efforts are critical to make sure the cases are sound, that there's no ambiguity, and that the standardized patients can assess the students consistently. 

“When students are in their clerkship, their encounters with actual patients will vary,” said Baecher-Lind. “As faculty, we need a way for students to have an objective and standardized patient encounter, so we know we're evaluating them for competency and proficiency. That’s where SPs come in.” 

A team of Tufts educators in Maine and Boston will present the work they’ve done with standardized patients and OSCEs in the clerkships at the international Association of Standardized Patient Educators (ASPE) conference in June in Vancouver, British Columbia.