Types of Exams Involving Standardized Patients

Breast Exam
During the second year of medical school, students are instructed on how to perform a thorough breast examination. Standardized patients are employed as both instructors and models for these sessions. These sessions are structured to make everyone involved feel as comfortable as possible, therefore each training session involves only the instructor, model and three to four students in a room. The instructor is responsible for learning all aspects of the breast exam and then relaying this information to the students during a brief lecture. The model is required to expose her breasts during the exam and allow both the instructor to demonstrate and the students to practice the exam on her. The model should be able to give the student feedback on the maneuvers from her perspective. These sessions always follow a thorough lecture given by a physician on the breast exam.

Clinical Performance Examination (CPX)
Please visit the Student Assessment and Program Evaluation Web site for information about this exam.

Interview Only
Before each interview the standardized patient is given a script containing all pertinent information about the character they are to portray. Included in the script are vital statistics, the patient's chief complaint, symptoms of their present illness, family, social and employment background, past medical history, physical mannerisms, and any other details needed to accurately portray this character. During the entirety of the interview, the standardized patient is expected to maintain in character. Their movements, accent, dress and demeanor must all be reflective of the patient they are playing. When the interview is complete, in some situations you may be asked for feedback. In those circumstances, you will no longer need to be in character.

Interview Exams
Throughout their education, the student's interviewing skills are assessed in graded exams. To more accurately simulate an actual clinic, only the student and standardized patient are in the room. After each interview, the standardized patient evaluates the student following a set of criteria developed for the particular case. This evaluation form is then returned to the course director.

Interview/Physical Exams
The Interview/Physical exam is designed to assess the student's communication and physical exam skills. During these encounters, the student interviews the standardized patient then based on the information obtained, performs the appropriate focused physical exam. The standardized patient then grades the student based on the appropriateness of the information obtained and the correctness of the physical procedures performed.

Introduction to the Medical Profession (IMP)
During both their first and second years of medical school the students are required to take a class devoted to learning effective interviewing techniques and physical examination. This course is designed to give them standardized patient contact in a classroom or exam room setting. Both the student's verbal and nonverbal skills are practiced and perfected during these sessions. Standardized patients are used throughout this eight-week course. Each week the patient introduces a different scenario. These interviews take place in front of a small class group so the students can receive feedback from their peers. Many proctors, recognizing the value of patient input, will request additional feedback from the standardized patient. Three to four students interview the patient within the one hour allotted time.

MD 836 Clinical Performance Examination (CPE)
The Clinical Performance Exam (CPE) is given at the end of the third year inpatient Internal Medicine Clerkship, MD 836. The exam typically consists of twelve stations, eight of which use SPs. The other stations focus on X-ray, EKG and blood gas interpretation. Each station consists of a focused history and/or physical on common inpatient internal medicine conditions (chest pain, pneumonia, etc.). Some 36 students take this exam every 16 weeks, usually in mid-November, mid-March and mid-July. Three waves of twelve students complete the approximately three hour exam on a given day.

Physical Examination
Beginning at the end of their first year of medical school and continuing throughout their residencies, the students are required to perform a full physical examination on a standardized patient who will then rate them on the accuracy of their technique and specific competencies. The medical director or a designated physician provides extensive training to the standardized patient for these exams. At the end of approximately 16 to 20 hours of training, a physician will do reliability testing on the standardized patient to insure accuracy and consistency.

During the physical exam the standardized patient wears a hospital gown and appropriate underwear. Bras are not worn as they prohibit the students from properly performing certain portions of the examination. However, draping techniques are taught to the students prior to the exam, and respect for the patient modesty is highly stressed. The exam includes all aspects of the physical except the breast, pelvic and rectal portions. The neurological and musculoskeletal sections of the physical involve a battery of maneuvers such as hopping in place, walking in a straight line, bending and balancing.

The physical exam consists of three sections: the exam itself, scoring by the standardized patient and a feedback session between the patient and the student. The student is given one hour to complete the physical exam. The patient is then given sufficient time to fill out a check-sheet and make notes about weaknesses and strengths in the student's performance. When the standardized patient has completed the checklist, there is a 15-minute feedback session in which the standardized patient reviews the checklist with the student, provides constructive criticism and demonstration of the proper techniques. It is necessary that these sessions be conducted in a professional manner. The standardized patient must be confident and composed when giving feedback. In some situations, standardized patients may have to deal with challenging students. If this is the case, please contact the course director or administrative director immediately

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