The use of standardized patients to evaluate family medicine resident decision making.

BACKGROUND AND OBJECTIVES This study was intended to assess the usefulness of standardized patients (SPs) in the evaluation of family medicine residents' clinical decision-making skills in ambulatory settings. METHODS A pool of SPs was trained about the symptoms of one of three clinical conditions (depression, headache, or irritable bowel syndrome). These patients were then surreptitiously incorporated into the office hours of 11 residents on one occasion during their second year and once during their third year of training. A different SP was used at each encounter, but the same clinical case was presented each year for that particular resident. The SPs were given a questionnaire after each office visit to evaluate whether the resident completed elements of history, physical exam, clinical decision making specific to their case, and to report their satisfaction with the encounter. In addition, the assessment component of the resident's progress notes for each SP visit was reviewed by a single examiner to determine if the correct diagnosis was made by the resident. RESULTS The residents showed a statistically significant decrease in the percentage of checklist items completed for all clinical cases from the second year (82.70%) to the third year (75.55%). However, the average patient satisfaction was unchanged, as was the number of correct diagnoses, even though fewer questions were asked. CONCLUSIONS The use of SPs is a feasible and potentially useful method for evaluating family medicine resident decision making. Several factors may account for the differences in resident performance with SP scenarios.