Training Standardized Patients for a High-Stakes Clinical Performance Examination in the California Consortium for the Assessment of Clinical Competence

The use of standardized patients in teaching and assessment of clinical skills has become more ubiquitous in medical schools in the United States and Canada since Dr Howard Barrows introduced the first standardized patient at the University of Southern California in 1963. This increased usage is also due to the fact that the national licensing examination in the United States, includes a component to assess the clinical skills of the learners (United States Medical Licensure Examination Step 2 CS). The eight medical schools in California form a Consortium for the Assessment of Clinical Competence, which enables them to develop and implement a common clinical assessment tool, the Clinical Performance Examination (CPX), for final year medical students across the state. All medical schools in the Consortium share the same standardized patient cases and checklists. The standardization of training across the eight medical schools is presented. This paper describes the methods that have been used to train the SPs so that they can portray the gestalt of the patient, provide effective feedback, and reliably evaluate the students at the Keck School of Medicine of the University of Southern California. Quality assurance measures to ensure both performance and checklist accuracy are also described.