Do Standardized Patients Have Concerns About Students Not Captured by Traditional Assessment Forms?

Area of Science:

• Medical Education
• Clinical Skills Assessment
• Standardized Patient Methodology

Background:

• Standardized patients (SPs) are crucial for assessing medical students' clinical skills.
• Traditional numerical rating forms may not fully capture SPs' nuanced concerns.
• SPs often express "off the record" feedback not included in standard assessments.

Purpose of the Study:

• To explore "off the record" concerns expressed by SPs regarding medical students.
• To develop and implement a narrative assessment item to capture these concerns.
• To enhance the totality of SPs' perspectives in student evaluation.

Main Methods:

• A "Concerns" item was added to traditional assessment forms for a 3rd-year clinical skills examination.
• SPs were prompted to identify students with "gut-level" concerns and provide narrative explanations.
• Data were analyzed using quantitative and qualitative methods across three medical schools.

Main Results:

• Approximately 40% of 551 students had concerns recorded by SPs.
• Qualitative analysis revealed major concern categories: communication/interpersonal skills, history taking, and physical exam.
• Narrative comments identified potential problems missed by traditional scores in 84% of communication, 42% of history, and 48% of physical exam concerns.

Conclusions:

• The "Concerns" item, a narrative method, adds value beyond traditional quantitative scoring.
• It effectively identifies and characterizes problematic student performance not captured by standard forms.
• This approach provides a fuller voice to SPs' perspectives, aiding student development.