Simulated or Standardized Patients (SP) are human role players who interact with learners in a wide range of experiential learning and assessment contexts. SPs are highly trained to realistically and accurately reproduce a history, physical and/or emotional scenario just like an actual patient would present in a healthcare setting.  SPs are specifically trained to not only represent the context of a situation or problem, but to also consistently recreate that same situation or problem each time they portray the role with a different learner. SPs are trained to present not just the health history but also the body language, emotions, personality, and physical findings of the role.  SPs are interviewed and examined by Learners, just as one would by one’s own healthcare provider. However, instead of disclosing personal medical, family and social history, an SP will answer questions based on the facts provided in the specific case scenario or script that they have learned to portray. SPs can also provide feedback on learner performance from the perspective of the person they portray, which is unique to working with SPs.

The terms standardized patient and simulated patient (SP) are often used interchangeably and refer to a person trained to portray a patient in realistic and repeatable ways. Both are part of an educational team, focused on fulfilling the learning objectives of a simulation activity in service to our learners.

The context in which SPs are working determines the degree of repeatability or standardization of their behavior. This behavior can be seen as part of a continuum. On one end of the continuum, in high stakes assessment, SPs are trained to behave in a highly repeatable or standardized manner in order to give each learner a fair and equal chance and are often referred to as standardized patients. Multiple SPs can be trained to do the same case scenario and no matter which SP interacts with the Learner, the Learners would all receive the same information and responses. This allows us to accurately assess Learners according to one standard case.

In formative settings, where the experience is the focus and standardization may not be as important in the design, carefully trained SPs are able to respond with more authenticity and flexibility to the needs of individual learners and are referred to as simulated patients.

As the name implies, Standardized Patients offer a standardized, controlled experience for learners. Standardized Patients are specifically trained to not only represent the context of a situation or problem, but to also consistently recreate that same situation or problem each time they portray the role with a different learner. Working with Standardized Patients provides measurable and reproducible results, unlike peer role-play or working with someone who has not received professional SP training. Standardized Patients receive rigorous training to maintain a consistent, highly realistic portrayal. SP are also prepared extensively to give feedback to learners on communication and interpersonal skills by completing a scoring rubric checklist. SP methodology is acknowledged by the Liaison Committee on Medical Education (LCME) and the Accreditation Council for Graduate Medical Education (ACGME) as a valid, reliable tool for training and evaluation in the undergraduate and graduate medical education settings.

A Simulated Patient is a person who is trained to realistically reproduce a history, physical and/or emotional scenario just like an actual patient would present.  Simulated Patients are trained to present not just the health history but also the body language, emotions, personality, and physical findings of the role. They are also prepared extensively to give feedback to learners on communication and interpersonal skills. Working with SPs facilitates practice in critical thinking, patient safety, crisis management, team interaction, decision making and communication skills in addition to acquisition of competence in clinical techniques and procedures. Independent studies have validated that SPs provide a high level of skill acquisition and retention.

The role of the SP is to provide an opportunity for the learner to develop, practice and enhance techniques and skills in a safe and supportive environment. SPs can expect to portray a variety of different case scenarios. Most cases deal with complaints that healthcare providers would most often see in their practice. SPs may play the role of the patient or of a family member. Many roles are fairly straightforward to portray; however, there will be times the SP is required to portray a range of emotions or a variety of different characters that have mental health, boundary issues, etc. SP encounters often involve: History-taking and interviewing skills, Physical examination skills, Patient education skills, Communication skills - verbal and nonverbal.

Our Standardized/Simulated Patients come from all walks of life and are between 21-90 years of age. Many have backgrounds in education, business, theater, film, social work or other professions. All SPs must possess excellent communication skills, a flexible schedule, reliable transportation, and punctuality. While SPs are paid for training and working with learners, most SPs find that their motivation comes from a desire to assist in the training of excellent healthcare providers.

Learners, depending on the context, are variously described as students, trainees, participants, examinees, or candidates.

Learners may be:

• College of Medicine
• Physician Assistant Program
• College of Nursing
• College of Pharmacy
• College of Dentistry
• College of Health Professions (OT/ PT)

Licensed community healthcare providers from local hospitals, clinics, and pharmacies.

No. We teach SPs what they need to know for each role. Most SPs do not have medical training because the patient roles they would portray are typically not medical professionals. Most SPs find that they learn from the work but must act like they know less than they really do, in order to keep the simulations realistic.

SPs are trained to portray a patient/family member case scenario that we assign. All the details are provided, the SP will never provide their own health information. Through our training process, SPs learn to speak and react just as the person in the case scenario would. We create the case scenario with the complete history for SPs to learn, including the reason for the healthcare visit, the past medical history, and social details such as the job, family, and activities. We describe the emotional and physical state. We show the SP how to move like the patient, and how to react to the physical examination. For example, if they were portraying someone with back pain, we would show them where it would hurt and what they could or could not do because of their symptoms.

Many of our SPs are professional or very experienced actors, but we also look for those who have a public speaking or an educational background. There are similarities to what SPs and actors do, but there are differences, too. This work has nothing to do with finding dramatic moments or playing to an audience. It has everything to do with disciplining oneself physically and sometimes emotionally to comply with the demands of the case and the exam. Simulations can be repetitive, because the same experience must be provided for every Learner in a consistent way. SPs are trained to assess the Learner communication skills, and give written and verbal feedback, so the learner receives constructive feedback. The SP is a key member if our educational team.

Case training is paid time and is typically 2-3 hours long. SPs have access to the case scenario at least 2 weeks (or more) before the training session so they have time to study and can arrive ready to answer questions and role play during training. SPs are required to attend the training session for the case scenario, this is to ensure accurate understanding of the role and simulation validity. SPs should memorize all details noted in their script. Training may also include watching videos and learning how to give verbal or written feedback to Learners.

Yes, they do work with patients in supervised clinical experiences. They work with SPs because they can provide valuable feedback that learners don’t get anywhere else, and offer a safe, controlled learning environment essential to preparation for the future practice of medicine. Some things are better done working with the SPs first. For example, one SP can be seen by many different learners. With each learner, SPs can behave as though they are seeing a learner for the first time about the problem. This allows all learners the same chance to show their skills and provides a fair assessment.

Yes, they are aware that SPs are simulating the role. Learners are told to proceed just as they would with a patient in the real world.

Yes. Safety is a principal motivation behind simulation. In turn, simulation is conducted in a manner that minimizes risk. We ensure that all participants – SPs, learners, faculty, staff – have a safe psychological and physical learning environment. Our staff does their best to ensure safety by:

• Providing safe working conditions in the design of the activity (e.g., number of rotations and breaks, physical, cognitive, and psychological challenges in role portrayal).
• Anticipating and recognizing potential occupational hazards, including threats to SP safety in the environment (e.g., allergenic substances, exposure to sharps).
• Screening SPs to ensure they are appropriate for the role (e.g., no conflict of interest, no compromising of psychological or physical safety).
• Allowing SPs to opt out of any activity if they feel it is not appropriate for them to participate.
• Briefing SPs so they are clear about the guidelines and parameters of a simulation.
• Providing SPs with strategies to mitigate potential adverse effects of role portrayal and prevent physical injury or fatigue.
• Monitoring for and responding to SPs who have experienced adverse effects from participation in an activity.
• Supporting SPs who act in accordance with delineated program expectations if a complaint is made about them.
• Manage faculty expectations of the SPs possibilities and limitations through remediation techniques

No. SPs do not act as medical test subjects, take experimental medicines, or have blood or other samples taken. Typical simulations are meeting a patient or family member in a clinic, hospital or pharmacy, interviewing the patient about their medical problem, and completing a routine physical examination. Learners are evaluated on what they do during these simulated medical encounters

No. SPs do not act as medical test subjects, take experimental medicines, or have blood or other samples taken. Typical simulations are meeting a patient or family member in a clinic, hospital or pharmacy, interviewing the patient about their medical problem, and completing a routine physical examination. Learners are evaluated on what they do during these simulated medical encounters.

Usually, encounters will involve history taking, physical examination, and/or counseling (such as topics of smoking cessation, diet and exercise, medication management). Physical examinations may be brief to focus on a complaint or encompass a complete (noninvasive) exam. The physical examinations are basic examinations that most SPs have received from their physician during a routine check-up.

The Learner may examine an SP by:

• Listening to the heart and lungs
• Checking reflexes
• Pressing on the stomach
• Taking a blood pressure
• Looking at the eyes, ears, nose and throat

SPs do often need to wear a hospital gown; however, they also wear garments under the gown (such as sports bra, or tank top, and loose-fitting elastic/drawstring waistband shorts.) SPs always know beforehand if there will be a physical examination at an event. We provide the gown and a draping sheet that is used for covering the SP during the physical examination. For cases that do not require a gown, SPs wear their own clothes as the costume, based on what is appropriate for the role/character. For example, the SP may wear dress clothes if playing someone who works in business. We do not require SPs to purchase clothing for costumes.

Yes, SPs undergo basic non-invasive physical examinations commonly done in healthcare visits. It is routine for the learner to touch, palpate (press) and otherwise physically examine the SP, as well as, to expose the portions of the body being examined. For example, learners listen to the heart and lungs with a stethoscope; press on the abdomen; look into the eyes, ears, and throat; take blood pressure; assess muscle strength; check reflexes and pulses. When physical examinations are required, it is clearly outlined for SPs prior to their agreement to participate. SPs are provided with a drape sheet for modesty while the Learner conducts the physical examination.

It depends on the learning objectives of the simulation; physical exams can include focused exams such as an eye exam or a complete head-to-toe physical (excluding invasive examinations). Overall, all SPs must be comfortable with having a Learner examine them. They need to be comfortable wearing a patient gown and being videotaped for educational review purposes. Please note that SP/Learner encounters are simulated in a controlled environment with the supervision of the UTHSC staff/faculty.

No. It would not be fair for SPs to decide whether learners pass or fail. Our goal is to provide a consistent and fair assessment. SPs record the events of the encounter in a checklist specifically designed to evaluate communication skills. This assessment tool is called "The Master Interview Rating Scale" (MIRS). These scores are used along with other indicators of performance in determining the total final score. Remember, too, that the cases and details about work with Learners must remain confidential. SPs are not permitted to discuss Learners or to use case material in any public or private performance or to include the patient case name on their resume.

SPs are considered temporary employees of the University. This is an intermittent, as needed hourly position. The schedule depends on many variables and SPs will be scheduled according to the needs of the curriculum and the case demographics being portrayed. We match abilities as closely as possible with the current projects and then match schedule needs to availability. One might work a few hours over the course of months or have frequent hours for a few weeks. The sessions take place on weekdays during regular business hours, so SPs would have to be available during those times. Once an SP agrees to work on a particular day, it is essential that they meet that work commitment.

There is no standard; it depends on the nature of the particular session. Some sessions consist of a few hours for a single week. Others will involve multiple dates and/or a full day event. Learner sessions with SPs usually take place during weekdays, most often during the hours of 8:00 am - 5:00 pm, so SPs need to be available at those times.

SPs must adhere to the following responsibilities and expectations:

• Understand that this is an occasional job opportunity.
• Be accurate in portraying the case.
• Be an excellent listener.
• Unbiased view of gender, race, religion, sexual orientation, national origin, physical characteristics, etc.
• Want to contribute to the training process of excellent health care professionals.
• Be willing to be videotaped for educational purposes.
• Provide feedback from the patient’s perspective (when the case calls for it).
• Ability to take constructive criticism and make changes with a positive attitude when asked

SPs must adhere to the following responsibilities and expectations:

• Be reliable and punctual.
• Check their email frequently and respond promptly to confirm with Trainers.
• Be prepared and engaged; pay attention to details.
• Have strong written and verbal communication skills.
• Keep all information regarding the case, participants and other SPs confidential.
• Be responsible for room organization and cleanliness.

Professionalism mandates that we are part of a community of professionals and act in accordance with common ethics, values and standards. CHIPS is committed to maintaining an environment where all individuals are treated with respect and dignity. Harassment, whether verbal, physical, written or visual, is unacceptable and will not be tolerated. From the time SPs arrive on campus, and until they leave after an event, they are representing CHIPS. SPs must behave professionally in their language and their actions. If SPs experience any difficulties with other SPs, learners, faculty or staff, we ask that they address these concerns in detail as soon as possible with our staff. As an employee of The University of Tennessee Health Science Center, it is a professional obligation to abide by these guidelines. Failure to do so may result in disciplinary action and/or termination.

We conduct audition interviews to find out if potential SPs are suitable for the job and assess their comfort level in this environment by participating in role-play activities. We also conduct background checks to see if an individual is a good fit before an offer is made. Characteristics we look for are a positive attitude towards the healthcare industry, comfortable with their own health and in dealing with health professionals, reliability and punctuality; someone who understands confidential matters and can be unbiased; someone who is comfortable with the possibility of portraying the same role multiple times in a work day and having repeated examinations. We are not looking for individuals who want to pursue their own agenda with health care providers or the medical system.

Probably, if they are suitable in other ways. Sometimes a medical condition could be very helpful to the Learner during the encounter. Other times, the health condition could prohibit the Learner from meeting the desired outcome of the simulation. There are no guarantees about the types of case scenarios that are available, and some medical conditions are not suited for certain roles. Past or present medical conditions should not discourage an interested applicant from participating.

This job is interesting and can be fun, but would not be described as easy. Being an SP is not a good fit for everyone. While performing a case, it requires intense concentration and recall, the SP may be interviewed and examined by as many as 4 to 10 Learners, completing a scoring checklist after each Learner all in succession with short breaks between each round.

Being an SP requires energy, discipline and concentration:

• Must be able to respond exactly as the patient would from the case scenario, never as themselves.
• Must be able to maintain not only the patient’s character, but also simulate their physical condition, and do so repeatedly in a consistent manner.
• As soon as the encounter is over, an SP must recall the Learner's performance and be able to record it on an electronic checklist from a computer in 5 - 10 minutes.
• May also be required to provide verbal feedback directly to the Learner.
• SPs will repeat these tasks many times in succession without change.
• Being an SP takes energy, memorization, discipline, concentration, excellent communication skills and a high level of comfort with constructive feedback.

Working as an SP is a unique chance to make a difference in educating future health care professionals. Generally, SPs are people-oriented, outgoing and enjoy getting to help the learners and work with faculty/staff/Fellow SPs. The sessions are always new and interesting because the learners are growing and evolving. Literature suggests that people who work as SPs are more capable of benefiting from the health care system and are more satisfied with their own healthcare providers.

We are looking for all ages, genders, physical types, ethnic groups, and diverse backgrounds to represent the various types of patients they will be portraying. We need individuals who are strong communicators, who can learn quickly, accept direction, and adapt easily to a variety of different situations. Many SPs typically work for us long term; however, this job is not always the best match and we occasionally have turnover due to an SP taking a full-time job or work is discontinuing due to habitually missing or canceling projects they have accepted, and/or consistently being unable to meet program expectations.

Yes. There are cameras mounted throughout CHIPS in each patient room, the SP Training room, hallways, classrooms and even the elevators so that we can simulate different healthcare settings throughout the building. During events, exam rooms are always under some form of observation, whether recorded, observed and/or live streamed, we ask that SPs be professional and conscientious of what they say and do at all times. Cameras are set to privacy mode at the beginning and end of exams when SPs are changing. Private restrooms are also provided for additional changing areas. Simulations are almost always recorded and recordings may be observed for educational or quality assurance purposes. Video recording serves several purposes; it provides an opportunity for Learners to reflect on their skill level, and it provides faculty and staff with the opportunity to re‐watch interactions with learners who might need additional support. Direct observation of SPs also helps to ensure the educational programing is running as expected.

The quality of the SP performance is priority at CHIPS. Quality assurance is maintained by observation during training and the encounters with Learners. The goal is to provide each SP with the information and support that they need to succeed. SPs maybe observed by their peers and our staff. Learners and faculty may also review the videos.

If an SP is familiar with a Learner, we would avoid scheduling them together to ensure that the assessment is fair and unbiased.

The manikin used for medical simulation are similar to mannequins used in stores, in that both are human shaped models used to simulate the human body. Instead of being used to show off clothing, medical manikins are used to help simulate medical, surgical, or clinical scenarios that we would not want done on the SP. SPs may work with manikins during Hybrid simulations by playing the role of a family member. For example, a manikin would be the patient, while the SP plays the distraught family member, allowing Learners to address both the needs of the patient as well as the needs of the family to heighten the realism of the encounter. There are many types of manikins used for medical simulation, just like store mannequins, there are many styles and types of manikins used for different kinds of simulations. There are birthing simulators, newborn simulators, simulators that go into cardiac arrest, and even dental simulators. They can range from high fidelity to low, which represents how realistic the manikin is. A high-fidelity manikin may move, speak, react, and give facial expressions. A low-fidelity manikin is much simpler.  A high-fidelity manikin would be used to learn how to deal with a patient who is coding or was a part of deadly incident. A low-fidelity manikin would be used to teach how to insert an IV or how to perform CPR.