Objective Structured Clinical Exam

The Importance of Being Authentic
Utilizing Persons with Disabilities as Standardized Patients
University of South Florida
Laurie Woodard, M.D.
UMDNJ - New Jersey Medical School
Kenneth Robey, Ph.D.
Tufts University
Paula Minihan, Ph.D., M.P.H.
University of South Carolina
Catherine Leigh Graham, MEBME
University of Massachusetts, Tufts University
Linda M. Long-Bellil, Ph.D., J.D.
State University of New York, Buffalo
Andrew Symons, M.D., M.S
Persons with Disabilities (PWD) as Standardized
Patients (SP)
• SP Purpose:
– to teach or assess clinical skills or assess while encouraging
perspective taking and reflection
• SP model: suited for teaching about PWD
control clinical scenario
create teachable moments
promote self assessment/reflection
appreciate PWD expertise re living with disability
• PWD as SP Results: Most programs have found that PWD
are very effective teachers
A very effective way to teach students/residents about
• Actors feigning disability are not credible faking:
– Atrophied muscles
– Dysarthric/slurred
– Deafness
– Devices used for
– Blindness
– Contractures
– Communication
– Spasticity
patterns often used by
– Ptyalism/drooling
a person with an
– Poor head control
intellectual disability
USF – Education/SP Experiences
• Disability module integrated into required 3rd year
primary care clerkship, can be modified for Residents
– PWD incorporated into module in various ways:
• Home visits, panel discussion, service learning projects, as SPs
• PWD as SP used in 2 separate experiences
– Model Patients – Educational session
• Hands-on session in a simulated exam room that promotes reflection
– OSCE – Evaluative session
• One of several OSCE experiences providing formative feedback during
Prior to the OSCE
• Students watch a vignette from the movie
– A pt with SCI goes to ortho for shoulder pain and
tx is suboptimal.
– After vignette, group discusses how physicians
could help the doctor in the movie be a more
effective clinician.
USF - Model Patient Experience
• Students/Residents interview & briefly examine PWD in
simulated clinical exam room
• PWD/caregiver briefed on program goals, then tell their
stories, guide students in appropriate etiquette
• Each student/resident sees 4 patients
• Pt & Medical faculty observe: live video/one way mirrors
• Concludes with learning circle & written reflection
• PWD are recruited from USF medical practice & by other
• Based on shoulder case developed by Tufts Medical
– PWD is a manual chair user who presents with a painful
• Shoulder pain symptoms worsening over past few weeks
• Earlier episode had resolved with rest & PT
• Overuse from occupation, care-taking responsibilities,
disability-related use
• Refusal to return to previous doctor because she seemed
uncomfortable with patient’s disability
• Social supports essential to treatment plan
• Patient fears eventual loss of function and independence if
problem becomes chronic
• SPEs with ASD & parent play out scenario as close
to real life as they want/can handle (no script)
• Student/Resident interviews and examines PWD
• Evaluated on medical + functional history, PE adapted for
PWD, patient centered plan
• SP and faculty observer give immediate feedback, using
check list – formative evaluation
USF - Students Examining Patients during
Model Patient Session
USF - Primary Care Clerkship
“Patients with Disabilities” Module
Common Themes
• Teaching students/residents how to communicate
appropriately and effectively
• Providing students/residents with an opportunity to
interact with and become more comfortable with PWD
• Debunking common notions about PWD
– Inability to speak for themselves
– Poor quality of life
– Poor health inevitable
• Authenticity: Actors without disabilities…
– Cannot mimic
– May reinforce negative stereotypes especially off script
• Recognition of patient expertise about own condition
– Rich lives, jobs, families, responsibilities, future plans
• Understanding disability ≠ poor health
– Concepts of thinner margin of health, secondary conditions
• Provides special teachable moments
– Communication devices, transferring patients to exam tables,
talking with caregivers present
• Evaluation can be tricky
– Consistency - script vs. telling own story
– Lack of consensus regarding competencies that are observable
– SPs who evaluate must be trained
• Attendance of PWD
– Recruitment of people with requisite skills may already have full
time employment
– Stamina
– Fluctuating health status
– Transportation difficulties

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