Standardized Patient Program

The University of North Carolina School of Medicine's Standardized Patient (SP) Program serves students across all four years of medical school in addition to students from ten other health professional schools on campus. A member institution of the Association of Standardized Patient Educators (ASPE), the SP program is administered through the Office of Educational Development, which is responsible for student assessment; course design; curriculum evaluation & development; faculty development; educational research & program evaluation; and special programs for the recruitment, preparation, and retention of minority and disadvantaged students.

Since the late 1980's, standardized patients have been an integral part of the school's educational program. Students encounter SP's as both a learning resource and an assessment strategy in the areas of interviewing, physical examination skills, counseling and taking a history. In addition, the SP Program participates in research projects that focus on student and/or resident performance, knowledge and attitudes.

What is a Standardized Patient?

A Standardized Patient (SP) is sometimes referred to as a 'simulated patient' or a 'patient actor' who plays the role of someone visiting a health professional.  A SP portrays what is called a 'case', or a character. The character is a certain age, and has an unique background, life circumstances, and health issues.

The purpose of using SPs is to give our students the opportunity to practice the communication, diagnostic and examination skills that they need before they begin their professional careers.

SPs are used to both teach and evaluate students' skills. In some situations students conduct an interview or take a history, much like a doctor would on an initial visit. In other situations students may perform a physical examination. No physical exams are 'invasive', but some may require wearing a hospital gown for a heart, lung or abdominal exam. Usually these encounters with students are done on a one-to-one basis, and are usually videotaped so that faculty can also evaluate students' skills.

CSC staff work closely with SPs to prepare for each session with students.

For more information about becoming a standardized patient, please go to "Potential SPs” Page.

How Are Standardized Patients Used in Teaching?

UNC students work with Standardized Patients (SPs) for two purposes- to learn and practice professional behaviors and clinical skills, and to demonstrate their competence in these same areas.

SP's allow students to practice interviewing, counseling, and clinical examination skills with persons who are trained to portray scenarios derived from real clinical situations and challenges. Cases or scenarios are designed to provide an opportunity to develop and refine important skills and to, subsequently, demonstrate competence in those same skills and professional behaviors.

How SPs are used as a learning resource

SPs are used in two required medical courses and an interdisciplinary activity:

  • Introduction to Clinical Medicine Courses (ICM) 1&2. During the first year ICM 1 course students learn & practice specific skills, such as interviewing, taking a history, or doing a physical exam. In ICM 2, students practice and improve their clinical skills. An external group of instructors also teach students more specific skills, such as performing the breast exam. Details of these encounters can be found in the syllabi for the ICM 1 and ICM 2 courses (for intranet users only).

How SPs are used to assess performance

The two most common types of evaluations used by health professional schools to observe and assess students' clinical skills at key points in their education are the Objective Structured Clinical Exam (OSCE) and the Clinical Performance Exam (CPX). Both exams use SPs and have similar formats.

  • The Objective Structured Clinical Examination (OSCE) allows faculty, SPs and/or other health professionals to observe and evaluate how well students perform specific clinical skills and behaviors. The exam usually consists of several stations (or examination rooms) where SPs present a variety of patient problems. Students rotate through these timed stations. At each station, a student is asked to perform a specific, measurable task such as taking a patient history or performing a focused physical exam (e.g., heart exam, knee exam, eye exam). At each station an observer is asked to score the student's performance on a particular skill. The examiner may be in the room with the student or observing on a monitor. SP's and/or faculty observers complete checklists for each observed skill/station.

Standardized patients are currently used for OSCE's in the medical school's ICM 1 course (syllabus available only to intranet users), and the PharmD program at the School of Pharmacy.

  • The Clinical Performance Examination (CPX) is similar to the OSCE, with a few exceptions. While the overall format of the exam is the same, the CPX is a comprehensive examination that requires students to demonstrate a number of clinical skills and behaviors across 12 different patient encounters. The CPX is conducted in the Ambulatory Care Facility and SP's undergo 10-20 hours of training to ensure that these encounters are authentic. At UNC, the CPX is a 'high-stakes' exam, that determines whether students advance to the next level or graduate.

For more information about the School of Medicine exam, check the CPX web site.