8 Things to Know about Standardized Patients

By: Eric Brown, Standardized Patient advisor at NYCSPREP

USMLE Step 2 CS is an American clinical skills assessment exam designed to protect the health and safety of health care consumers. Standardized patients play a vital role in this exam so if you are interested in becoming an SP, these FAQs will help you determine if working as a standardized patient is right for you.

Who Would You be Testing as a Standardized Patient?

Standardized patients are used for testing doctors who aspire to become residents in the U.S. program of graduate medical training and so the examinees may be inexperienced medical students or proficient doctors.

What are the Common Examinations that a Standardized Patient may have to Undergo?

Since you would be playing the role of a real patient in the doctor’s office, the examinee may monitor your heart rate and lungs using a stethoscope, look for signs of tenderness or swelling, press your abdomen, check your eyes, ears and throat, assess your muscle strength, check your blood pressure, your pulse and your reflexes.

While female breast examinations are not allowed, the SP may be asked to move or loosen the bra to listen to the heartbeat. Occasionally, the examinee may touch the breast area if needed. The examinees do not perform genital and rectal examinations or corneal reflex tests as these examinations are not permitted. Also, none of the tests involve taking blood or other specimens. Standardized patients are also not prescribed any drugs.

Is the Standardized Patient Required to Undress During Physical Examinations?

The USMLE Step 2 CS requires that SPs wear hospital gowns to facilitate physical examinations but you can keep your undergarments on underneath the hospital gown. In certain cases, the examinee may check the pulse below the patient’s underwear but there is no need to remove the underwear for this purpose. Female standardized patients may be asked to move or loosen the bra if the examinee needs to listen to the heart. In certain cases, the SP may also need to remove the bra completely but training is provided to handle this sensitive situation. Total nudity is never needed since breast, rectal and genital assessments are not permitted during this clinical skills assessment test.

Are the Physical Examinations Safe?

Yes. All the physical examinations conducted during the clinical skills assessment are recorded via video monitors to ensure complete safety and do not cause any harm to the standardized patients.

Is Being a Standardized Patient Similar to Being a Research Subject?

No, it is completely different because research subjects are administered drugs or made to follow certain diets in order to study the outcome. But in the case of USMLE Step 2 CS, SPs are only used to simulate the clinical conditions for examinees.

What is a Standardized Patient Expected to Say during the Interview?

Standardized patients are trained to depict the patient role assigned to them. A complete medical history of the patient is given to the SP for prior learning. This history includes everything from the reason to see the doctor and the past medical records to the patient’s social information and lifestyle. The training process is designed to teach the standardized patient to speak, feel, and react just as a real patient would, to a physical examination.

Is Being a Standardized Patient Similar to Acting?

No. While being an experienced actor helps, you can be a good SP even if you have never been on the stage before because you are thoroughly trained.

Are the Doctors Aware that Standardized Patients are not Real Patients?

Yes, all the examinees taking the USMLE Step 2 CS exam know that they are diagnosing standardized patients in a simulated clinical environment but they are instructed to conduct the interview and physical examination just the way they would when dealing with real patients.

About the author: Originally from Philadelphia, Eric Brown is a resident of New York, where he works as a standardized patient (SP) and advises NYCSPREP with their Clinical Skills Course. In his free time, Eric likes unwinding by watching baseball and can be found at the game when the Phillies (his home team) are playing. If you have any questions about standardized CS exams or courses at NYCSPREP, email Eric at eric.brown@nycsprep.com or visit www.nycsprep.com.

#LifeofaMedStudent has no financial relationship with Eric or NYCSPREP.

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