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Interprofessional simulation and education: physical therapy, nursing, and theatre faculty work together to develop a standardized patient program.


A well-conceived training program for standardized patients (SPs) can increase their effectiveness in portraying actual patients. This article describes the development of an SP program that allows graduate and undergraduate students to engage in interprofessional experiences in a multifunctional simulation center. Three academic programs at a midwestern university developed an interdisciplinary course that trains undergraduate students as SPs for nursing and physical therapy simulation experiences. The SP program has opened doors for interprofessional collaboration beyond current simulation experiences and has exposed the university community to simulation.


Standardized Patient--Simulation--Interprofessional Education Nursing Education--Physical Therapy Education


A standardized patient (SP) is a person carefully recruited and trained to take on the characteristics of a real patient, affording students the opportunity to be evaluated on learned skills in a simulated clinical environment (Dickter, Stielstra, & Lineberry, 2015; Sarmasoglu, Ding, & Elgin, 2015; Street & Hamilton, 2010). The amounts and types of training SPs receive have been reported in the literature. Methods for training associated with a low-stakes simulation encounter include the details of the case and how the SP is expected to portray the patient, how to improvise when asked unexpected questions, and role-playing sessions to prepare for the encounter (Dickter et al., Newlin-Canzone, Scerbo, Gliva-McConvey, & Wallace, 2013). In one study, four hours were spent training 11 SPs for their role in a simulation experience for surgery residents. These SPs were paid an hourly rate of $35 for their time (Sudan, Clark, & Henry, 2015).

McWilliam and Botwinski (2010) examined the effectiveness of providing no training for SPs in an Objective Structured Clinical Examination (OSCE) for students enrolled in a four-year nursing program. Three of the SPs were nurses themselves or had a family member who was a nurse. The investigators found that lack of training was a factor in the low reliability of the simulation experience; SPs were not at the same knowledge level and gave unintended cues to students. They concluded that SPs should be trained so that all students participating in the OSCE receive the same type and quantity of feedback during and after their examination.

A well-conceived training program can increase the effectiveness of SPs' portrayal of actual patients. In 2012, our university, located in the Midwest, opened a multifunctional simulation center for lifelong learning where participants engage in interactive, immersive experiences that provide opportunities for critical thinking. The department of physical therapy, the theatre program, and the nursing program worked together to provide SP experiences for both physical therapy and nursing students. This article describes the development of an SP program that allows both graduate and undergraduate students to engage in interprofessional experiences at the multifunctional simulation center. The program has enhanced learning opportunities for students participating in simulation.


Initial Attempts

In the spring of 2013, three academic programs--physical therapy (PT), nursing, and theatre--collaborated to recruit SPs for interprofessional simulation experiences for graduate and undergraduate students. The programs used nursing, PT, and theatre students as SPs to simulate real-life situations in a variety of ways.

Following these experiences, faculty representing the three academic programs determined there was a need for standardized patient training. The following academic year, the three programs developed an interdisciplinary course that trains undergraduate students to take on the role of SP for nursing and PT simulation experiences.

To develop the course, faculty investigated SP programs and attended several conferences to gather information. They also collaborated with a professional SP/actor/teacher in the design of the SP course, which was offered as a one-hour independent study course titled "Training the Standardized Patient"; two undergraduate students enrolled.

Each week, the theatre department worked with the students using a combination of short lectures, followed by role-playing and oral exams to ensure understanding of each topic presented. In addition, each week, the participating students could apply the concepts taught by participating in nursing simulations. The students in the SP course were educated to portray a patient in a PT simulation experience.

Following the simulation, an OSCE, students were asked to complete a satisfaction survey using a five-point Likert scale. The results of the data collected uncovered a trend toward greater satisfaction and performance scores in those students who interacted with the SPs enrolled in the SP course. The findings supported ongoing investigation into this important area of research.

Expanding the Course

After the success of the pilot, the Core Implementation Committee at the university approved the course to count as one of three required hours of artistic mode. All students at the university are required to have a three-hour artistic mode course in order to graduate. Courses offered to fulfill this requirement are usually a one-hour course or a three-hour course; the SP course was approved to count as a one-hour credit toward the artistic mode requirement. Eight undergraduate students enrolled in spring 2015; seven are pre-med undergraduates and one is an undergraduate nursing student.

In response to the pilot data, the faculty made improvements to the flow and delivery of content in the independent study course. Now the course meets weekly with each class period focused on a different aspect of acting. During the first class, students are presented with an assigned scenario that they will portray in the culminating simulation experience for a PT examination. Thus, students can apply class topics, such as nonverbal communication, verbal communication, empathy, and believability, to their assigned case. Throughout the course, the students demonstrate understanding of the acting concepts through role-playing and oral exams.

Other class sessions focus on learning to use the scoring sheet, touring the simulation center where the OSCEs take place, and participating in a comprehensive training session with faculty. At the end of the semester, the students participate in the PT simulation experience. Data from their interactions will be compared to data from untrained SPs.

Score Sheet to Evaluate Student Performance

Various assessment tools are used by SPs to provide meaningful feedback to the students involved as learners in simulation experiences (Dickter et al., 2015; Sarmasoglu et al., 2015). Similarly, the SPs are taught to use a detailed, objective score sheet, developed by the first author, to provide feedback to students based on the patient's perception of satisfaction with the care they received. The SPs immerse themselves in the scenario and truly become the patient so they can relay information back to the student about the care they receive.


The cost to train SPs is typically a large part of the simulation budget in SP programs (Newlin-Canzone et al., 2013; Sudan et al., 2015). By creating a course paid for by students, implementation of the SP course has lowered the cost of training and using SPs for simulation.

The SP course has been a benefit for students. Participants are able to count this course toward one of three artistic modes required for graduation while improving their communication skills, developing empathy for the patients they portray, and gaining appreciation for the liberal arts. In 2015, all the undergraduate students enrolled in the course were interested in pursuing careers in health care. The course exposed these students to medical, PT, and nursing terminology and allowed them the opportunity to interact with students currently engaged in health care programs. They had the opportunity to participate in simulation, which they will be expected to do in health care graduate school programs.

The training of these undergraduate students has benefits beyond the university as there is a need for SPs in the local area as well as other metropolitan areas. SP employment is an excellent source of income for recent graduates and helps students in the health professions increase their client-to-clinician communication skills. This experience may also be helpful in medical school admission interviews.

The delivery of the SP course has presented challenges. One difficulty has been with coordinating faculty and student schedules. In addition, bringing together three different departments to teach one course requires an understanding of how each discipline regards the purpose of the simulation and how SPs will be utilized to meet various student and faculty outcomes. Currently, in the theatre program, the number of acting roles on stage available to students cannot keep up with their desire to participate. We have plans to encourage theatre students to take the SP course and in that way, we will offer acting assignments that require a less intensive time commitment compared to full-length plays.

Research is being conducted to determine the amount of training needed for SPs to simulate real patient scenarios in a real and authentic way. Students will continue to be recruited for the SP course to increase the pool available for simulation. Those students who have successfully completed the course will form the core of an SP pool that will be sustained even after students graduate from the university.

doi: 10.5480/15-1652

Marcie C. Swift, PhD, PT, FAAOMPT, is an assistant professor in physical therapy education at Rockhurst University, Kansas City, Missouri. Tobey Stosberg, MSN, MAE, RN, is an assistant professor and director of the Seelos Simulation Center at Rockhurst University Research College of Nursing. For more information, contact Dr. Swift at


Dickter, D. N., Stielstra, S., & Lineberry, M. (2015). Interrater reliability of standardized actors versus nonactors in a simulation based assessment of interprofessional collaboration. Simulation in Healthcare, 10(4), 249-255. doi:10.1097/SIH.0000000000000094

McWilliam, P., & Botwinski, C. (2010). Developing a successful nursing objective structured clinical examination. Journal of Nursing Education, 49(1), 36-41. doi:10.3928/01484834-20090915-01

Newlin-Canzone, E. T., Scerbo, M. W., Gliva-McConvey, G., & Wallace, A. M. (2013). The cognitive demands of standardized patients: Understanding limitations in attention and working memory with the decoding of nonverbal behavior during improvisations. Simulation in Healthcare, 8(4), 207-214. doi:10.1097/SIH.0b013e31828b419e

Sarmasoglu, S., Ding, L., & Elgin, M. (2015). Using standardized patients in nursing education: Effects on students' psychomotor skill development. Nurse Educator, [pdf only], doi:10.1097/NNE.0000000000000188

Street, P., & Hamilton, L. (2010). Preparing to take objective structured clinical examinations. Nursing Standard, 24(34), 35-39.

Sudan, R., Clark, P., & Henry, B. (2015). Cost and logistics for implementing the American College of Surgeons objective structured clinical examination. American Journal of Surgery, 209(1), 140-44. doi:10.1016/j. amjsurg.2014.10.001
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Article Details
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Author:Swift, Marcie C.; Stosberg, Tobey
Publication:Nursing Education Perspectives
Article Type:Report
Geographic Code:1USA
Date:Nov 1, 2015
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