Virtual Standardized Patients for Assessing the Competencies of Psychologists

Background

Traditional approaches to training clinicians in the interpersonal communication skills needed for assessment, diagnosis, and interview performance rely upon a combination of classroom learning and role-playing with human standardized patients. The importance of interpersonal communication is reflected in recent requirements for communication evaluation in medical schools. The Accreditation Council for Graduate Medical Education (ACGME, 2007) has emphasized the importance of interpersonal and communication skills in training clinicians. Residents are expected to: (1) create and sustain a therapeutic and ethically sound relationship with the patient; (2) use effective listening skills, eliciting and providing information using effective nonverbal, explanatory, questioning, and writing skills; and (3) work in an efficient manner with others. However, evaluation studies have revealed methodological deficiencies in many cases (Chant et al., 2002) and limited positive training effects (Hulsman et al., 1999). In an effort to increase interpersonal communication assessment, standardized patients (paid human actors) have been recruited and trained to exhibit the characteristics of an actual patient, thereby affording novice clinicians a realistic opportunity to practice and to be evaluated in a mock clinical environment. Although a valuable training approach, there are limitations with the use of human standardized patients. For example, human standardized patients are expensive and cost several thousand dollars per student. Further, given the fact that there are only a handful of sites (for over 130 medical schools in the U.S.) providing standardized patient assessments of the clinician in training’s communication ability as part of the U.S. Medical Licensing Examination (USMLE), the current model provides limited availability. Whilst training programs commonly make use of standardized patients to teach interview skills, the diversity of the scenarios standardized patients can characterize is limited by availability of human actors. Further, there is the economic concern related to the time and money needed to train standardized patients. The inclusion of a standardized patient in an OSCE tends to cost approximately $10 per hour and then there is the additional $34 per student for involvement in an OSCE Cusimano et al. (1994).