The idea of Standardized Patients began in 1963 when Dr. Howard Barrows, M.D., began using what he called “Programmed Patients” to introduce medical candidates and professionals to specific disease states without taxing the health of actual patients. Since that time, the use of standardized patients in teaching and evaluating medical candidates across the United States and abroad has grown.

A Standardized Patient (SP) is a “person who has been carefully coached to simulate an actual patient so accurately that the simulation cannot be detected by a skilled clinician”. (Barrows, 1963) While performing the simulation, the SP represents the “gestalt” of the person being simulated; not just the history, but the body language, physical findings, personality and emotions.

The examinations are common that you might have as a real patient in a doctor’s office. For example, candidates may listen to your heart and lungs with a stethoscope; press on your abdomen, looking for tenderness or swelling; look into your eyes, ears, and throat; take your blood pressure; assess your muscle strength; check your reflexes; or check your pulses. Female breast examinations are NOT permitted. However, candidates may ask female SPs to move their bras to listen to the heart. Candidates are urged to use a drape during the examinations, but not all are skilled at this. The candidates do NOT perform rectal examinations, genitourinary, internal pelvic examinations, corneal reflex testing or articulatory thrust techniques. None of the examinations involve taking blood or other samples and you would not be given any drugs.

In your role as Standardized Patient, you will be seeing 4th year osteopathic medical students. You will document the events in the encounter and evaluate the candidate’s interpersonal skills as you have been trained.

Standardized Patients do NOT:

Act as medical test subjects; you will not be asked to take any experimental medicines
Undergo any invasive physical exam procedures; i.e. breast, genital, pelvic, rectal
Give candidates feedback on their performance

The National Board of Osteopathic Medical Examiners could not run an exam without the high quality work that is performed every day by standardized patients.

 

A Doctor of Osteopathic Medicine (D.O.) practices a “whole person” approach to medicine. There is an emphasis on learning about the person who has the disease, rather than just the disease itself. There is also an emphasis on the neuromusculoskeletal system and its influence on health. D.O.s are taught to emphasize prevention of injury or illness in addition to treating the current medical problem.

A D.O. receives training in osteopathic manipulative treatment (OMT). With OMT, osteopathic physicians use their hands to diagnose injury and illness and to encourage the body’s natural tendency toward good health.

Osteopathic physicians receive specialized training in the musculoskeletal system. This helps them to better understand the ways in which an injury or illness can affect different regions of the body, allowing a “holistic” approach to medical care.
Osteopathic physicians are also trained to use Osteopathic Manipulative Treatment (OMT), a hands-on treatment tool. Through the use of OMT, the osteopathic physicians can assist in restoring musculoskeletal balance, which assists in promoting the body’s natural healing ability.

According to the American Osteopathic Association, Osteopathic Manipulative Treatment (OMT) is “hands-on care. It involves using the hands to diagnose, treat, and prevent illness or injury. Using OMT, your osteopathic physician (D.O.) will move your muscles and joints using techniques including stretching, gentle pressure and resistance.”

Because OMT is part of D.O. training it is therefore an essential part of this exam. You will be given more information about OMT and how it specifically relates to your case during training.

 

Standardization means that we strive to give the same basic information consistently to each candidate, dependent upon their interviewing skills during the simulation. The pertinent information obtained by the candidate in the interview leads him/her to the appropriate physical exam and diagnosis. The candidate then utilizes this information in his/her written documentation of the history and physical exam.

Keeping the simulation standardized allows every candidate an equal opportunity to demonstrate his or her skills in key clinical and interpersonal areas.

For our exam, candidates go through 12 encounters (seeing 12 different “patients”) and are evaluated on complex skills under a controlled situation. These skills are:

History taking
Physical examination
Osteopathic Manipulative Medicine and Treatment (OMT)
Doctor patient communication, interpersonal skills, and professionalism

In a typical encounter, the history taking portion is when the standardized patient is interviewed by the candidate. You will learn a script that includes the patient’s chief complaint, medical history, social history, etc., as well as how to answer certain questions. Questions you might be asked include: “What can we do for you today?”; “Can you describe your pain?” and “Are you allergic to anything?”

For the physical examination portion, the candidate is required to perform a physical exam demonstrating his/her skills in physical diagnosis. You will learn in training what to expect during a physical exam of your case.

PLEASE NOTE: This is a hands-on examination; it is routine for the candidate to touch, palpate and otherwise physically examine standardized patients as well as to expose the portions of the body to be examined.

The candidate is also evaluated on their doctor patient communication, interpersonal skills and professionalism; how they communicate with the SP and how they relate to the SP as a person not just a patient. You will be trained on how to assess these elements with the examination format.

 

There are certain qualities we look for in selecting standardized patients for our program:

Reliable – NBOME runs a high-stakes examination where medical students from all over the country come to take the test. SP’s attendance and continuity of performance ensure that we provide a quality exam.
Superb recall skills – In order to asses a candidate’s skills, SPs must be able to accurately recall and record what questions were asked and answered and what physical examinations were done after each of the 12 simulated encounters.
Ability to follow direction – There are specific rules and protocols all SPs must follow. These rules ensure a smooth and consistent exam. It is therefore important for SPs to follow directions both during training and when in the exam.
Ability to think quickly within the context of your case – While case developers and trainers work to come up with answers to every question a candidate could ask, there will be some questions that were not anticipated. It is important for an SP to be able to think on their feet and provide a believable response so as to not ruin the verisimilitude of the simulated encounter.
Flexibility – While NBOME runs “by-the-numbers”, sometimes changes need to be made during an exam session (e.g. changing exam rooms, switched to Standby, case details). An effective SP is able to adapt to any changes with good humor and cooperation.
Fairness – An effective SP is able to score candidates based solely on how they performed and not allow any personal biases (positive or negative) to affect their scoring.
Ability to portray a case believably – While we do not require Academy Award© winning performances, an effective SP is able to portray the affect and physical findings of the case in a believable way. The more natural your reactions and impressions are the more realistic and consistent the simulations will be.
Reliable - We list it twice because it is that important!

 

Some further points to consider

Accuracy - It is always important to give the facts correctly and consistently. This way we ensure each candidate enjoys fair and equal treatment.
Confidentiality - Your ability to maintain confidentiality and not discuss case information or candidate performance with other SPs and those outside of NBOME is essential.
Conflicts of Interest - As NBOME is a high-stakes testing center with confidential testing information, we cannot employ individuals who work at an osteopathic medical School or a Testing Prep Center (e.g. ETS, Kaplan).
Consistency - The major goal for these encounters is to control the consistency (i.e. standardization) and quality in the candidates’ experiences interviewing and performing the physical examination. Therefore, it is important for you to be consistent both with information you give to each candidate and the way you give it.
We realize you will respond differently to different individuals and you will be asked different types and quantities of questions. Your performance will vary some. Your major task as a standardized patient, however, is to give the best performance you can for each individual.
Attire - SPs are dressed in hospital gowns while in the exam. A robe will be available to you to wear between encounters or when leaving the exam room. Gowns and robes for you to change into are available. You are required to bring and wear white crew socks for the exam and clean, appropriate (non-revealing) undergarments. No T-shirts, tights or pantyhose. We ask that you limit or eliminate the use of cologne. The rooms are small, and it can become overpowering.

 

Being an SP can be a satisfying exercise in acting (i.e., practice being in the moment/seeing each doctor as the “first” doctor you have seen for the problem, etc.) However, there is no room in this job for creative license (developing a character, inappropriate ad-libbing). This work has nothing to do with finding dramatic moments or playing to an audience. It has everything to do with disciplining yourself within the needs of the patient’s case and the exam. It can be very repetitive, since exactly the same simulation must be done for every candidate. Some actors find it difficult or annoying, and we cannot use them. Other do fine work as SPs. Remember, too, that the cases must remain confidential. You would not be permitted to use the material in any public or private performance or to include your patient’s name on your resume. SPs act as human test items, providing the candidates an opportunity to demonstrate what they know.

 

This job is not easy, and it is not for everyone. You would be in a hospital gown during your entire exam shift. Smoking is not permitted in the building, and you must remain in the building throughout your shift, including during lunch and breaks. This job requires intense concentration while you are being interviewed and examined by the candidates. You must be able to respond exactly as the real patient would, and only as that patient would. You must be able to maintain not only the patient’s character but also simulate his/her physical condition during the encounter with the candidate and be able to do this may times in succession without any changes. After the encounter, you must be able to remember and record what the candidate did. You must be able to respond quickly to feedback from training staff who give you guidance about improving your job performance. Being an SP is hard work, and we demand a high level of job performance.

Still interested?

Please take a moment to complete the online application via the following link: https://www.nbome-pe.org/SPApplication.

Uploading a recent photo is important, as much of our recruiting is based upon portrayal demographics and this is how you are selected for available cases.

If you are not able to submit your application online you may print it and send a recent photo to the mailing address below:

NBOME
101 West Elm Street
Suite 150
Conshohocken, PA 19428
Attn: SP recruitment

Your information will be entered into the potential SP database and, depending on our current needs, you may be invited to attend an onsite recruitment session. During the recruitment sessions several staff members will be available to answer your questions and assess your “fit” for currently available or upcoming cases. You will be asked to share a story about a positive and negative medical experience you have had and be given a sample case to portray to gain a general sense of your recall ability. When a case becomes available that you would be a good match for, we will contact you to begin training! Prior to hiring you will be required to complete a medical questionnaire, undergo a brief physical examination and sign a confidentiality agreement, as well as other personnel forms (W-4, I-9, etc). Even if we do not use you right away, we will keep your application on file for one year for any future needs.

 

Starting pay for training is $18 per hour. Once you have successfully completed the full training and are scheduled for an exam, the rate increases to $20 per hour. All SPs are evaluated annually and eligible for salary increases based on performance, professional and personal standards met throughout the year. Lunch/dinner is provided during the exam and parking is onsite and free.

 

That is uncertain. The work is part-time, as needed. We schedule SPs based candidate demand for the exam, the need for the case that SPs are trained for based on our very strict form requirements and their availability to work. While there is no guarantee of minimum hours per week, you will be scheduled to portray your case often enough to remain sharp. During our busiest months, we may operate up to 6 days a week with both day and evening shifts. You would need to be available for these hours, though not every day. All SPs are expected to work at least some weekend and evening work when needed. Once you are scheduled, you must work that shift. An SP needs to be available for at least 8 sessions a month to remain standardized and familiar with case materials and scoring policies. Priority is given to applicants who have full availability on a regular basis. Availability is indicated online via a webpage to help keep your calendars up-to-date and accurate. SPs who are repeatedly unavailable for the minimum 8 required sessions may be dismissed.

Once you have been hired as a Standardized Patient (SP) at NBOME, you will be scheduled for training on a specific case. To aid in your training, you will be assigned to an SP trainer who will guide you through several training sessions where you will learn the details of your case, including character background and case portrayal details. Your trainer will be your contact person throughout your training, pre-testing and live exam days for any questions, concerns, or clarifications with your case portrayal and content. Your trainer is also your point person for scheduling questions and other personnel issues. During your training, you will establish the most convenient means of communication with your trainer, either by phone or e-mail. E-mail access, while not obligatory, greatly simplifies the frequent communication you’ll be having with your trainer concerning scheduling and other issues related to your ongoing training.

 

The morning exams are from 8:00 AM to 3:30 PM. The evening exams are from 2:00 PM to 9:30 PM. Standardized Patients may arrive 15 minutes prior to the start of the shift. Lockers are supplied for you to store personal items and clothing. There is a plastic bin located in each exam room for you to store personal belongings while you are in the exam. There is a meeting in the SP Center at 9:00 AM (3:00 PM for afternoon sessions) daily for announcements from the trainers.

 

Unreliability/ Lateness without calling
Violating confidentiality
Inappropriately improvising character, case details
Problems recalling case details
Inability to take direction on performance
Removing exam materials, equipment
Failure to score candidate after encounter
Failure to notify control room or TOD of computer error message

 

The NBOME works with a diverse population of candidates and standardized patients. It is expected that we all maintain an atmosphere of respect, courtesy and cooperation.

 

Our clinical skills testing center is very accessible by public transportation.

The R6 Norristown Regional Rail Train stops at the Conshohocken station which is very close to our center. From train platform, go up steps to overhead bridge and turn towards West Elm Street. Turn left on West Elm and enter first driveway on left. Address is on the building: 101 West Elm Street. Our testing center is in Suite #150

The 95 Septa bus route makes two stops which are close to the center. Fayette and Elm Street, walk west and we are the first driveway on left. The bus also stops at the R6 Conshohocken station stop for which you can follow above directions. Copies of the Septa schedules for these routes are available at www.septa.org. and in the Trainer’s office.

 

There is a free parking lot for all employees of NBOME located behind the building. You may access the parking ramp from Oak Avenue. Please do not park in the visitors’ lot or in specially designated parking spots, as your car may be ticketed.