A mixed methods study of student perceptions of using standardized patients for learning and evaluation

Abstract

Background

Educators recognize the value of using standardized patients (SPs) when teaching and evaluating clinical skills in rehabilitation entry-to-practice education programs but have published little supporting evidence and have yet to evaluate programmatic SP use from a student perspective. This study explored occupational and physical therapy students’ perceptions of SP use in their professional education.

Methods

Recruiting current and graduated students, we conducted a two-phase mixed-methods sequential-explanatory study integrating data from a quantitative survey (phase 1) and qualitative focus groups with representative students (phase 2). Quantitative data were used to direct the second phase and informed selection of a purposive sample to participate in four focus groups (N=12).

Results

The 24-item online survey obtained a 32% response rate (N=167). Mean ratings were high, but significant differences were found between the four subsections of Teaching, SP Experience, Feedback, and Evaluation (P=0.000). Secondary analyses revealed significant differences based on sex, program, and age. Qualitative analysis revealed that students found SP use especially helpful earlier in their program to bridge classroom teaching and clinical practice. Students in the occupational and physical therapy programs approached SP interactions differently in terms of the authenticity, personal investment, and value of SP feedback. Educator feedback was perceived as reflective of technical skill, and SP feedback reflective of therapeutic value, which students prioritized differently. Students identified a preferential continuum of options for learning and practicing skills, ranging from peers and instructors through SPs to actual patients.

Conclusion

SPs were perceived as most useful early on in the professional education program, serving to bolster self-confidence and prepare students for clinical fieldwork. Discipline-specific differences impact the perception of SP use and value. Educators need to be aware of pragmatic and contextual issues when using SPs for examination purposes, including repeated exposure to the same actor.

Keywords:

• occupational therapy
• physical therapy
• teaching

Supplementary material

Simulated Clients

At the School of Medical Rehabilitation, Simulated Clients are used for teaching students in both the occupational therapy and physical therapy programs.

The following statements relate to your experience with Simulated Clients in the OT or PT program.

Respond to each question by marking the box that most closely reflects your opinion regarding the statement.

Table

Respond to each question by marking the box that most closely reflects your opinion regarding the statement. Use N/A only if the statement does not apply to your SMR experience.

Table

Teaching/Education

Simulated Clients are used in various aspects of the education process. For example, occupational and physical therapy students practice skills related to interviewing, communication, clinical assessment and interventions.

The following statements will relate to your experience with Simulated Clients as a learning tool.

Respond to each question by marking the box that most closely reflects your opinion regarding the statement.

Table

Respond to each question by marking the box that most closely reflects your opinion regarding the statement. Use N/A only if the statement does not apply to your SMR experience.

Table

Feedback

Feedback is an important component of the learning process. Receiving feedback allows students the opportunity to gain insight into their performance, learn from their mistakes and gain confidence in their abilities.

The following statements relate to your perceptions/experiences with receiving feedback about your Simulated Client interactions.

Respond to each question by marking the box that most closely reflects your opinion regarding the statement.

Table

Examinations

Simulated Clients are also used for practical examination and Objective Structured Clinical Exam (OSCE) purposes. Many different components are examined, including communication and physical assessment skills.

The following statements will relate to your perceptions/experiences with Simulated Clients in exam situations.

Respond to each question by marking the box that most closely reflects your opinion regarding the statement.

Table

Participant demographics

Age:

• 

Sex:

○	Male
○	Female

Program:

○	OT
○	PT

Year of graduation (or expected graduation year for students):

○	2006
○	2007
○	2008
○	2009
○	2010
○	2011

Previous (Non OT/PT) Education:

□	Diploma (please specify in space provided below)
□	Some University, but no degree completed
□	University Degree: B.A.
□	University Degree: B.Sc.
□	University Degree: Other (please specify in space provided below)
□	Masters (please specify in space provided below)

Previous Education Specifics (only respond if prompted in above question):

• 

Acknowledgments

Funding for this project was provided through a grant from the Centre for Higher Education Research and Development (CHERD), University of Manitoba. The authors would like to express their appreciation to statistician James Douglas Staley for assistance with the quantitative analysis; Lisa Salter and Jeannette Logan for their work as RAs, including focus group facilitation; and all of the study participants for their willingness to share their experiences openly and honestly.

Authors’ contributions

EMG was responsible for administration of the grant and oversight of the study, contributed to the development and implementation of the study design, provided oversight of the quantitative analysis, and contributed to the qualitative analysis and interpretation. PFW contributed to development and implementation of the study design, provided oversight of the qualitative analysis, and contributed to the quantitative analysis and interpretation. GMP participated in development and implementation of the study design and provided contributions to qualitative and quantitative data analysis and interpretation. EMG wrote the first draft of the manuscript, and all authors reviewed and contributed to the final version.

Disclosure

The authors declare that they have no competing interests.