New methodology for using incognito standardised patients for telephone consultation in primary care

Context Many countries now use call centres as an integral part of out-of-hours primary care. Although some research has been carried out on safety issues pertaining to telephone consultations, there has been no published research on how to train and use standardised patients calling for medical advice or on the accuracy of their role-play. Objectives This study aimed to assess the feasibility and validity of using telephone incognito standardised patients (TISPs), the accuracy of their role-play and the rate of detection. Further objectives included exploring the experiences of TISPs and the difficulties encountered in self-recording calls. Methods Twelve TISPs were trained in role-play by presenting their problem to a general practitioner and a nurse. They were also trained in self-recording calls. Calls were made to 17 different out-of-hours centres (OOHCs) from home. Of the four or five calls made per evening, one call was assessed for accuracy of role play. Retrospectively, the OOHCs were asked whether they had detected any calls made by a TISP. The TISPs filled in a questionnaire concerning their training, the self-recording technique and their personal experiences. Results The TISPs made 375 calls over 84 evenings. The accuracy of role-play was close to 100%. A TISP was called back the same evening for additional information in 11 cases. Self-recording caused extra tension for some TISPs. All fictitious calls remained undetected. Conclusions Using the method described, TISPs can be valuable both for training and assessment of performance in telephone consultation carried out by doctors, trainees and other personnel involved in medical services.