The Importance of Standardized Patients in Medical Education

A student who wants to become a doctor will find themselves in school for at least 8 years. During their time there, they’ll study things such as anatomy, pathology, and biochemistry. They will spend countless hours with their noses buried inside textbooks to learn terminology and proper procedures or ethical practices. There are not many chances for students to gain real life experience during their medical education programs. It is especially difficult to experience real life interaction with patients. That’s why a standardized patient program exists. Standardized patients are people who are trained to portray, in a consistent, standardized manner, a patient in a medical situation. A resident of UF’s Pediatric Residency Program in Pensacola Florida made the following comments about Standardized Patients:

“In my medical school, we were exposed to standardized patients from the beginning of our education.  Every medical school does this part of the curriculum differently so it is important to note that.  We had a course in the first 3 years of medical school called Doctoring, essentially to help us learn the tools, questions, and exams that were to be used when we encounter patients.  Standardized patients played a key role to help me practice my toolbox skills with real time feedback.  If you would like to get more specific information about standardized patients from a legitimate source, check out FSU’s Standardized Patients FAQ Page.”

Standardized patients have been around since the 1960s as a method to provide an objective clinical measure to evaluate students. According to UKY's article on SP's, It took quite some time for this program to be established as a medical school curriculum throughout the United States. The goal of an SP is not to accurately act out a certain disease or illness, but to convey the problem in a consistent and measurable way. There are many great actors who do well as SPs, but being an excellent SP doesn’t equate to being an amazing actor. Claudia Garcia, former SP and now a Med Sim Op for Engenium Staffing, says, “I don’t necessarily believe you have to be a good actor. If you think about how a real patient would behave or how you would if presented with that situation, you will be able to behave accordingly.” 

Many viral videos of standardized patients include excellent actors who take the scenario to an immersive level. Such as this video of an emergency trachea medical simulator. The key quality a standardized patient needs the ability to give the same performance to the following student, and the next one, and 20 more after that.

 “Practicing one-on-one with SPs in the learning lab lets students soak in feedback that they are given by the SP.  For the student, being able to practice communication skills before they are responsible for real patients with real problems, allows them to focus on listening to the patient.”

Janice M. Kregor, MD – UK College of Medicine
There are many different types of standardized patient programs ranging from simple counseling sessions, to full physical examinations. These programs are effective in establishing strong communication skills with patients, testing examination skills, interpretation skills, and clinical skills.

To ensure that standardized patients do their jobs in assisting in the learning process of medical students, they must follow The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP). ASPE is the global organization focused on human simulation. The ASPE SOBP provides clear and practical guidelines for educators who work with SPs. Care has been taken to make these guidelines precise and yet flexible enough to address the diversity of varying contexts of SP practice. 

The use of standardized patients allows students to learn essential skills in a measurable way. Immediate feedback on performance from the SP influence positive changes in thinking and actions. Being able to misdiagnose or prescribe the wrong amount to an SP without negative side effects. In a risk-free environment, corrections can be made before making mistakes with real life patients. The flexibility of a Standardized patient is invaluable to the facility using them. They are able to adapt and be flexible for every type of scenario and trainee. The resident from Pensacola also says,

“I think standardized patients were very beneficial in my education.  We were able to practice our questions with them, learn how to perform a broad physical exam then a more focus physical exam, and practice physical exams with them.  Having standardized patients also prepared us for one part of our boards, Step 2 CS (clinical skills).  This exam involved 12 standardized patients in patient rooms and we are graded on how well we interact, ask questions, present ourselves, etc. “ 

Standardized Patients are key pieces to the medical education process. The Benefits are clear. In the standpoint of a standardized patient, Claudia says the program brings “learning to life” and “improves the quality of education”. Claudia continues to say, “The opportunity of learning with a real-life person gives these great health care professionals in training a platform to master their skills and behaviors necessary to practice in today’s healthcare environment.” Being a Standardized Patient can be challenging depending on the persons medical knowledge and ability to improvise. But, as Claudia says, “Knowing that I am part of improving patient care and service is my overall favorite part about being an SP.”

Science Fiction No More - Medical Simulation embraces Virtual and Augmented Reality

Depending on how broad you want to define the word ‘simulation’ there are examples of simulations all around us. A simulation could be high tech, computerized and complicated; Or it could be a simple play with props and actors such as standardized patients re-enacting a situation. Kramer does it really well in Seinfeld. With the rapid advancement of technology, we are now seeing new forms of simulations. In 2010, the first prototype of a Virtual Reality (VR) headset was designed by Oculus Rift. Although the technology is nearly 10 years old, VR is recently being implemented into training platforms in the medical field. These new mediums for education and training can mean big changes for how future doctors and nurses learn and perform their trade.

Virtual Reality in Medical Simulation

Have you ever heard of a game called Surgeon Simulator? It is a virtual reality video game where you play as a Surgeon (as the title implies). The game is not serious at all. In fact, it is a darkly humorous, entertaining game where you are given different objectives to complete such as a heart transplant or removing a kidney. Using controllers that detect your arm motions, you can pick up different tools and, literally, hammer away (at their ribs so that you can reach the persons heart). The game doesn’t take itself very seriously, but you can clearly see how something like this can be used in the future for training purposes. There’s no risks involved and the only costs to experience this simulation is the headset, the hand controls, and the game itself. Virtual Reality Medical Simulations as an educational and a therapeutic tool is on the rise. These Serious Games are being used in classroom settings to increase interactivity and engagement with students.

Outside of the educational field, Medical Simulation Virtual Reality is being used as a medium for Therapy and Practice. Virtual Reality has had great impact in healthcare industry. There are facilities that are using VR to assist the elderly to help them walk, or the allow them to experience scenarios they normally cannot experience anymore. Some VR programs are used to immerse children into fun scenarios before they receive something “scary” and “painful” like a flu shot . There are even cases where “patients are using virtual reality as an alternative to anesthetics during surgical operations”. Due to its immersive capabilities, patients become so distracted with their virtual surroundings that they only need local anesthetics to deal with painful surgery. Adding VR to the medical equation can result in cheaper solutions for both providers and patients.

Augmented Reality in Medical Simulation

Augmented Reality is a relatively new technology that is gaining attention in the training field. For those who are not aware, Augmented Reality is technology that uses a device to capture your surroundings and then project computer-generated images onto the medium you are using to view the real world. The medium could be a headset, a computer, or even your phone. The key difference between Augmented Reality medical simulations and Virtual Reality simulations is that you still interact with your real-life environment. If you wanted to, you could use an actor or standardized patient and project a realistic wound on their body.

We’ve seen how popular AR technology can be back in 2016 when Pokémon Go released for mobile devices. In 2014, a company named SimX constructed Medical Augmented Reality training software. The software projects patients that you can interact with on whatever surface you are working with. You are able to work with others as you work with a patient and ask them questions, use tools and charts to check their vital signs, and even perform emergency actions. The best part about the software is that it uses your android smartphone and $20 headset which is 1/30 the cost of current medical simulation technology. For example, high-fidelity manikins can cost up to $100,000 and require trained Sim Operators to set-up, maintain and operate. On the other hand, software can be fine-tuned and upgraded at any time. Currently, AR medical simulations is being considered for use in plastic surgery. The AR system can help in planning and confirming reconstruction. The 3D simulation of the body surface will provide a visual reference of the final appearance.

Virtual Reality and Augmented Reality technology present a cheap, engaging solution to education. According to Healthy Simulation, medical simulation is the experiential learning every healthcare professional will need, but cannot always engage in during real-life patient care. Medical Simulation is utilized to practice patient safety, cognitive thinking, team based communication, and skills based action necessary during a life or death situation. VR and AR technology are not yet perfect. Standardized Patients are able to give you realistic one on one communication experience and reactions. Manikins allow you to touch and feel what you are working with. Some VR and AR simulations have feedback on their controllers to simulate making contact with an object, but it’s not exactly the same as interacting with a real person or object. Technology has been growing so quickly, that we may start experiencing the ability to touch and feel computer generated simulations. It wasn’t long ago when current technology was thought of as unrealistic science fiction. Being in the field of Simulation has allowed me to see this industry grow to what it is today. The technological leaps that are being made every day makes predicting what simulations look like in the next 10 years impossible. Upgrades in wearable technology and the testing of embedding chips in our brains seems like sci fi, but it no longer is. It’s really exciting thinking of what medical simulations could become in the near future.

Is Medical Simulation a Growing Market?

Is Medical Simulation a Growing Market?

Medical simulation has been used for some time by the military to class any training for medical staff involved in various preparation for EMT, nurses or surgeons. These types of simulations were actually derived from the aviation industry. Back during the First World War, pilots would use simulation-based learning practices to train for flying aircrafts.

To put it bluntly the military adopted these simulation-based learning practices and placed a lot of emphasis on preparing their employees for training in hostile environments. Think of combat casualty care and how to treat the wounded in a war zone. According to Science Direct, Medical simulation training,

“trained young surgeons who could perform surgery in combat areas; improved methods of resuscitation; Increased the availability of antibiotics and chemotherapeutic agents used as adjuncts to surgery; and improved means of transportation, including aircraft, for movement of convalescent patients over long distances, even to the continental United States.”

There are obvious benefits of medical simulation training not only in combat, but also in our everyday hospitals. These benefits include improving patient safety, preparing first time professional experiences, capturing the variety of possible patient problems, and the ability to tailor the range of difficulty when it comes to medical tasks. Constant training, practice, and learning helps improve the process. Developing “muscle memory” for those situations has been proven to save limbs and lives.

The Air force and the Navy have two large programs that use simulation to prepare and train staff – Air Force Medical Modeling and Simulation Training (AFFMMAST) and Navy’s Medical Modeling and Simulation Training (NMAST). The Army uses the Medical Simulation Training Center (MSTC) program – with more of a focus on Combat casualty care. During a fully immersive simulation learners enter into a realistic medical scenario where a high-fidelity patient manikin is being wirelessly operated by a simulation technical staff member. There are even times where a medical actor or standardized patient will be used instead to help drive the realism to the simulation. We have had success training standardized patients in the use of Human Patient simulators. They have the technical acumen to understand how to operate computer equipment or Audio Visual equipment. Standardized patients are already familiar with many of the medical terms we use during our Simulation Scenarios.

The lessons learned by these programs have been transferred to other Hospital environments. The NLN or National League for Nursing has approved the use of Simulation when training undergraduate nursing students - up to 50% of the study can include simulation. Our own experience at Engenium has shown a huge increase in the use of Simulation in Nursing programs and the feedback from (Initially) skeptical nurses has been welcomed by our own team of medical simulator operators.

At the moment, estimations show that the medical simulation market will grow at a CAGR of 15.2% from 2016 to 2021. That will be an estimated 2.27 Billion USD by 2021. According to Marktsandmarkerts, “This is primarily attributed to the increasing focus on training of medical practitioners, rising healthcare costs, growing focus on patient safety, and rising demand for minimally invasive technologies”.

In conclusion, the Medical Simulation is a growing Market. As started before, the benefits of using simulations can save lives. There are many major drivers to the global market of medical simulations. For example, there is the rising costs of healthcare and the demand for minimally invasive treatments. According to Transparency Market Research, these types of simulations have helped healthcare practitioners understand better procedures to prevent fatal mistakes while treating individuals. With 44,000 to 98,000 yearly deaths around the globe caused by medical errors during treatment, patient safety has become an extremely important growth driver for the Medical Simulation Market as an educational tool for students, doctors and surgeons.