Developing Teaching Programs Moderator: Ross Scalese, MD Discussant: LuAnn Wilkerson, EdD Comparing Traditional and Computer-Based Training Methods for Standardized Patients Anthony Errichetti and John R. Boulet Abstract Background The use of computer-based training programs in medicine is widespread. To date, however, there has been little or no research conducted to explore how these self-delivered educational programs can be applied to the training of standardized patients (SPs). The purpose of this study was to compare a traditional SP training technique with one that was based on computer-based delivery of case materials and checklist- based scoring criteria. Method Ten SPs were trained to portray 1 of 5 cases. The SPs were paired by case and then randomly assigned to either an experimental (computer-based training) or control (traditional trainer-based training) group. Forty medical students completed a 5-station clinical skills assessment where they encountered both computer- and trainer-trained SPs. Portrayal fidelity and documentation accuracy was assessed via videotape review of the individual encounters. Results With reference to checklist scoring discrepancies, documentation accuracy was significantly greater for those SPs who were trained using the computer- based delivery method. Likewise, based on a summary measure of portrayal fidelity, the performances of traditionally trained SPs were quite realistic but, nevertheless, less dependable than those for the computer-trained group. Conclusion The use of computer-assisted educational programs to train SPs is effective and can lead to performance fidelity gains as well as improved accuracy with respect to the documentation of history taking and physical examination skills. Acad Med. 2006;81(10 Suppl):S91–S94. The recent increase in computer-based training methodologies and associated products has made educational processes more efficient and, arguably, less costly. For standardized patient (SP) examinations, where costs are already high and the standardization of the clinical portrayal is paramount, the use of computer-based training programs may offer some distinct advantages, including the potential to produce more valid and reproducible assessments. When screened appropriately for employment, SPs are highly motivated adult learners who can be taught case and performance assessment materials in a variety of modalities. However, one of the unexamined assumptions in the profession is that the trainer, and not the SP, has a greater responsibility during the training process and that he/she bears the brunt of work to ensure that the product is of high quality. In other educational domains, the use of the personal computers and the Internet to deliver information is becoming widespread. In a recent study, 73% of 178 active community-based primary care preceptors surveyed found they used the Internet routinely to access clinical and/ or research information. 1 For specific training, virtual patients are now used to teach medical students communication skills. 2 In general, online physician education is increasing, with some evidence to suggest that learning efficiency and pedagogical satisfaction is greater than that achieved for existing, paper-based, self-study methods. 3 Nevertheless, based on the available literature, it is not clear whether these types of Internet-based educational activities are more effective than traditional methods, or how their value may be related to their specific content or format. 4 For clinical training activities that utilize SPs, in particular, there is little available evidence to suggest which training methods work best, or how they can be adapted to embrace recent technological advances in educational delivery methods. For assessments that use SPs, research suggests that, with proper training, both portrayal fidelity and documentation accuracy can be quite high. 5,6 Furthermore, depending on the nature of the assessment, SP- and physician (“expert”)-based evaluations of clinical skills are comparable. 7 Portrayal fidelity is commonly assessed via videotape review of select encounters, often incorporating some form of checklist. Documentation accuracy usually involves the procurement of a second set of scores and can be summarized by a number of statistics. With the availability of these quality assurance measures and the introduction of new SP training modalities, it seems reasonable to explore whether or not the incorporation of computer-based instructional activities leads to a better product; that is, SPs who are more accurate in their portrayal and less likely to make documentation errors. The purpose of this paper is to compare the fidelity of SP portrayals and the accuracy of their history taking and physical examination documentation as a function of training method; traditional Correspondence: Anthony Errichetti, PhD, Institute for Clinical Competence, New York College of Osteopathic Medicine, Northern Blvd., PO Box 8000, Old Westbury, NY 11568-8000; e-mail: (terriche@nyit.com). Academic Medicine, Vol. 81, No. 10 / October 2006 Supplement S91