Guidelines for developing scenarios using standardized patients
Standardized Patients (SPs) are people who have been trained to accurately and consistently recreate the parameters set-up in a scenario of an actual patient at a specific point in time. In order for the SPs to portray the patient as accurately as possible, a clear, specific scenario is required. Following are some guidelines to assist you in the development of detailed scenarios.
Teaching and learning goals
- Identify clear goals and objectives for each scenario
- Learning outcomes for the student should be clear and specific.
- If the objectives are not clear, the student may focus on making a diagnosis when the objective is taking a patient history. This would be problematic for the SP in trying to keep to the expected role. This may also diminish the students learning experience.
- Ensure the scenario encompasses relevant information for the level of the student (differential diagnosis they are familiar with)
- Use scenarios developed from real patient problems that have occurred in settings appropriate to the goals and objectives
Physical/ mental characteristics of the patient
- Each scenario must address the patient profile (e.g. age, gender, language, etc..)
- reason(s) for the patient's visit
- pertinent past medical history
- history of the present illness
- allergies the patient has
- patient's personal history and/or family history.
Props required in the room and/or on the patient
- What items should be in the room in addition to what is usually found in a hospital room?
- What should the patient be wearing (e.g. gown, own clothes, pajamas)?
- Does the patient require any scars or bandages?
- Are there any limitations of mobility? If so, provide details.
What type of examination will the patient undergo?
- Based on the scenario, you will have identified the type of patient encounter (e.g. patient history taking, physical assessment, etc…).
- If physical assessment is part of the scenario:
- Will the patient need to disrobe?
- Will there be palpating and if so, in what area?
- Where can the SP be expected to be touched?
Will the Standardized Patient be expected to provide feedback to the student?
If you would like the SP to provide feedback to the student on specific items this must be stated within the scenario. Many of the SPs have received formal training in providing feedback. In order for the feedback to be a valuable and constructive learning experience for the student.
Additional Considerations for Standardized Patient Parameters
- Will you need an accompanying family member; a wife, a child, particular ethnic background?
- If required, state the exact response standardized patients should respond with
- For open-ended questions such as "what can you tell me about that?" include responses for standardized patients.
- If you want the standardized patient to promt the student, the time and suggested wording must be indicated
- Include any questions the standardized patient MUST ask and MAY ask
- Write from the standardized patients point of view and in laymen terms; instead of 'patient felt constriction in chest' write 'I felt a tightness in my chest'
- Remember to include information on the patients alcohol, smoking, recreational and prescriptions drug use, if they are relevant to the case. Provide details such as 'I smoke about 15 cigarettes a day' or 'I drink one or two beer every night'
- Indicate the props, costumes and or make up required by the standardized patient
Once you have completed your scenario, please submit it to simcentre [dot] med [at] mcgill [dot] ca (Stephanie Tassé-Smith) at least 4 weeks prior to your scheduled session. This will allow ample time to cast the standardized patients and go through a 'dry run' a minimum of 1 week before.
Guidelines for a dry run with standardized patients
When developing and playing out scenarios, it is important that the Standardized Patients (SPs) understand the objectives of each scenario and how they relate to your course/OSCE. All Standardized Patients will be given their scenarios a minimum of 1 week prior to the Dry Run. This gives the SPs time to memorize the details and prepare for the role. Most of the SPs are professionally trained actors. Some are retired teachers, retired Nurses, etc. All have been chosen for their role playing abilities, sensibility and communication skills. They are there to assist you in meeting your scenario objectives.
What is a Dry Run?
A Dry Run is a rehearsal where you will have the opportunity to meet with the Standardized Patient assigned to your station and run through the scenario.
When should a Dry Run take place?
A Dry Run should take place at least 1 week prior to the scheduled course/OSCE date.
Where should a Dry Run take place?
The Dry Run should occur in the clinical exam room where the scenario will be played out. This allows for you and the SP to determine if there are any special requirements for the room, such as how the room should be arranged; or specific equipment etc…
Why is a Dry Run Necessary?
A Dry Run allows for the opportunity to address questions surrounding the details of the scenario. Specifics about how the scenario will be played out will be decided between you and the Standardized Patient. This provides the opportunity to standardize the station allowing the scenario to be played out consistently and fairly for all students.
How long will the Dry Run take?
This depends on the requirements of each scenario. We suggest a minimum of 20 minutes for each scenario.
Changes to Scenarios
During the Dry Run notes are taken on any changes to be made to the scenario. These are handed to the SP Coordinator/Trainer immediately following the Dry Run. Scenarios will then be updated and sent back to you for approval. Changes to scenarios WILL NOT be made on the actual course/OSCE day.
Deadlines for Submitting Scenarios
Out of fairness to the SP and to ensure that your objectives are met, we ask that Scenarios be forwarded at least 4 weeks prior to simcentre [dot] med [at] mcgill [dot] ca
Dry Run. This allows enough time to review the scenarios and cast SPs appropriately.
Examples of Possible Questions asked by SPs
- How much information do you want me to volunteer?
- What are the primary issues of the scenario?
- What information must I reveal during the interview (prompts)?
- What information must I hold back from giving, unless asked?
- If the student strays from the topic, would you like me to steer them back in the right direction?
- How do you want this patient to be played out? Aggressive? Friendly? Hysterical? Shy?
- Does my problem manifest itself physically?