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are perhaps more intuitive, effective educational modalities be identically replicated across multiple trainees, and pose
regarding the more frequent, lower acuity clinical encounters tremendous situational variability rendering provider perfor-
have not been well characterized. Tactical medical programs mance difficult to quantifiably assess.
and medical directors continue to seek educational platforms
and unconventional training strategies to develop and aug- Standardized patient encounters may offer distinct advan-
ment these enhanced patient assessment and medical deci- tages in TEMS provider education, specifically to develop
sion-making skills. enhanced proficiencies evaluating and managing patients pre-
senting with lower acuity clinical issues. The SP is trained to
accurately interact with trainees and respond realistically to
Standardized Patient Methodology questions and diagnostic maneuvers. SPs perform the above
consistently thereby presenting multiple trainees with a nearly
The use of the “standardized patient” methodology for tacti-
cal medical provider education is a novel approach that has identical clinical problem set. An SP is not by definition affil-
not been previously reported to the best of the authors’ knowl- iated with the TEMS program, minimizing the likelihood of
edge. A standardized patient (SP) is an individual trained to tolerating “shortcuts” whether in obtaining a medical history,
portray patients in a consistent and highly realistic manner obtaining vital signs, and performing a thorough physical ex-
during scenarios for the instruction and assessment of clinical amination. The SP provides objective feedback to trainees in
skills. These professionals offer medical trainees a measurable the aforementioned areas of performance as well those less
and reproducible experience to learn and to be evaluated in quantifiable aspects of patient care such a professionalism and
a simulated clinical environment. SPs are also trained to pro- demonstrating empathy.
vide verbal and written feedback to trainees on history taking,
physical examination, and general communication and inter- Case Presentation
personal skills. Recruitment of standardized patients is stra-
4-6
tegic and distinct from the use of role players, which carries Seventy tactical medics employed by a federal law enforcement
the risk of what has been described as a “loss of sociologic operational medicine program underwent standardized pa-
fidelity.” The Association of Standardized Patient Educators tient clinical encounter training in January and February 2020.
7
(ASPE) has defined standards of best practice with the under- Medics worked in teams of two or three, rotating through six
lying values of safety, quality, professionalism, accountability, single-patient clinical encounters lasting 20 minutes each, plus
and collaboration. These standards establish guidelines for an additional 10 minutes per case for comments and feedback.
effective outcomes and the safe application of SP-based educa- The clinical scenarios provided were: earache, back pain, chest
tional endeavors for all stakeholders. 8 pain, eye pain, headache, and abdominal pain. Encounters oc-
curred in ultra-realistic simulated clinical examination room
The use of standardized patients as an adjunct to traditional settings, although medics were generally required to work out
approaches to medical education has been described across a of their issued medic bags, using diagnostic tools they carried
wide variety of conventional medical provider types and spe- including any point-of-care testing equipment.
cialties. This method of education provides additional real- Every medic pair encountered the identical SP for each respec-
ism that is often lacking with traditional lecture, simulation, tive clinical scenario (Figure 2). Each scenario required medics
9
and manikin based teaching. Studies have demonstrated im- to obtain a comprehensive medical history and review of sys-
proved clinical performance and recall when didactic teach- tems, obtain vital signs, perform point-of-care testing if indi-
10
ing techniques are paired with SP education. Additionally, cated, and systematic physical examination. Medics were also
learners who participated in training programs that utilized required to formulate and verbalize medical decision-making
SPs showed improved technical skills, communication and to include a specific disposition. Verbal reports in some in-
team management when compared to those programs which stances were required to either simulated EMS personnel or
focused on traditional forms of education. 11,12 SP methodology medical control physicians.
is recognized as a valid and reliable adjunct for training and
evaluation in the undergraduate and graduate medical educa- All SP encounters were observed remotely by medical con-
tion settings by the Liaison Committee on Medical Education trol physicians or program educators via closed circuit video
(LCME) and the Accreditation Council for Graduate Medical and sound. Evaluators recorded evaluative comments regard-
Education (ACGME). 5 ing specific performance metrics via standardized assessment
forms (Figure 3). At the conclusion of this training exercise,
all evaluations were reviewed by the program medical director
Standardized Patients in TEMS Education
and aggregate feedback provided to medics in a large group
The provider-patient interface is logically critical to all sce- setting at a subsequent date.
nario-based training and there are multiple potential ways to At the conclusion of all SP encounters, anonymous learner
incorporate this into TEMS educational strategies. The con- feedback as per the program’s routine educational quality as-
ventional “role player” approach, as widely utilized in trauma surance measures provided educational planners with broad
scenarios, may be least preferable for lower acuity medical impressions of the perceived efficacy of this training exercise.
complaints, as the tremendous inherent variability cannot The vast majority of participants reported finding this training
usually provide the necessary precision in terms of patient re- exercise to be realistic and that standardized patients provided
sponses to either thoughtful history taking or detailed physical greater consistency than other types of role players they had
examination by trainees. TEMS provider rotations in clinics, previously experienced. Most respondents felt more comfort-
urgent care centers, or emergency departments are intrinsically able with these types of clinical encounters after this educa-
realistic but present often insurmountable challenges. These tional experience and nearly all felt the SP scenarios enhanced
experiences are often complex to arrange, require longitudi- their overall sick call capabilities. Anecdotally, evaluators
nal engagement to acquire adequate patient contacts, cannot

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