Int J Cancer Manag. 2021 May; 14(5):e113183. Published online 2021 June 8. doi: 10.5812/ijcm.113183. Research Article Training and Validation of Incognito Standardized Patients for Assessing Oncology Fellows’ Performance Regarding Breaking Bad News Mandana Shirazi 1 , Amir Hossein Emami 1 and Afsaneh Yakhforoshha 2, * 1 Tehran University of Medical Sciences, Tehran, Iran 2 Qazvin University of Medical Sciences, Qazvin, Iran * Corresponding author: Department of Medical Education, Qazvin University of Medical Sciences, Qazvin, Iran. Tel: +98-283340153, Email: a.yakhforoshha@qums.ac.ir Received 2021 January 23; Revised 2021 March 04; Accepted 2021 March 07. Abstract Background: Standardized patient (SP) has been applied to measure learner’s communication challenges such as breaking bad news (BBN). When utilizing SP-based assessment, 2 steps should be considered in SP training; assessing SPs portrayal as the real patient (authenticity) and how SPs checklist fill out reproducibility. Objectives: In this study, we described the process of training authentic and consistent SPs for evaluating oncology fellows’ perfor- mance regarding BBN in Iran. Methods: In this cross-sectional study, 8 eligible SPs took part in a 3-day educational meeting. Four different scenarios were devel- oped regarding cancer patients along with corresponding checklists representing common presentations of illness. The accuracy of SPs portrayal was evaluated by experts, using a previously validated rating scale during observation of their role-playing. The re- producibility of SPs’ portraits was measured, using a test-retest approach. The inter-rater agreement of the SPs’ ability to fill out the BBN scale was measured by comparing the correlation between the SPs, who completed the scale, and oncologist faculty members’ judgments, which is considered a gold standard. Results: The findings of this study indicated that the cut-off score for the SPs’ portrayal validity was 95%. The reliability of SPs por- trayal was acceptable (r = 0.89). The inter-rater agreement between SPs and experts in filling the BBN scale (k = 0.82), as well as, the consistency of filling the BBN scale between SP groups were highly acceptable (k = 0.86). Conclusions: The present study has demonstrated that if SP is trained appropriately, they shave a high degree of reliability and validity to assess oncology fellows’ performance regarding BBN skills. Keywords: Standardized Patient, Breaking Bad News, Assessment 1. Background Breaking bad news (BBN) is a complex communication task that is a common occurrence for clinicians working with oncology patients. Being aware of how bad news is shared between providers and patients is essential in the examination. Consequently, different formats of assess- ment tools (e.g. detailed checklist and global rating scales) have been developed, as well as the assessor (e.g. standard- ized patients and independent raters) (1). Moreover, the need for valid assessment of medical stu- dents’ preparation in communication skills has been em- phasized in evidence. This issue is particularly important for the high-stakes exam, in which decisions of students’ Pass/Fail are made (2). It was proposed that Standardized patients (SPs) play a vital role in ensuring more objective means for assessment, particularly in the field of CS (3). Therefore, it is worthwhile to consider whether the use of SPs assessment has been also applied in North American medical schools and Licensure examinations (4, 5). At this point, certain studies have employed SPs for assessing CS and BBN (6-8). Some studies indicated that adequately-trained SPs could be satisfactory alternatives to faculty raters (9, 10). On the contrary, other studies indicated less agreement be- tween SPs’ and instructors’ ratings (11-13). Based on the pre- vious research, intensive rater training is one of the most key points in achieving the consistency of scoring (14). 2. Objectives A common concern regarding educators, who adopt the use of SPs for performance assessment, is to train SPs Copyright © 2021, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.