Academic Psychiatry 26:133, September 2002
© 2002 Academic Psychiatry
Of Standardized Patients and OSCEs
Paul C. Mohl, M.D.Deputy Editor
Key Words: Objective Structured Clinical Examination (OSCE) • Standardized Patients
Psychiatry has been well behind other specialties of medicine in employing various kinds of standardized clinical situations in evaluation. This slow start has been largely due to unique features required to reproduce clinical psychiatric situations, but if this special issue is representative, psychiatry is catching up—very rapidly.
The idea of this special issue was triggered by the submission of what became its centerpiece, Brian Hodges' manual on how to develop and implement a psychiatric objective structured clinical examination (OSCE). Canadian psychiatric educators, and the group in Toronto in particular, have become leaders in creative approaches to psychiatric education and evaluation methods. Although they were not the first to attempt and report on the implementation of an OSCE in psychiatry—that honor belongs to Southern Illinois University, the institution of two of our commentators for this issue—the Toronto group's manual demonstrates that they have developed the most extensive and sophisticated system for carrying one out.
The OSCE is just one model for using standardized patients in psychiatric evaluation. The other, still in development, is their use in a variety of teaching and evaluation situations. Quite serendipitously, two accompanying original articles demonstrate their use with medical students and in introducing psychotherapy to first-year residents. By far the most ambitious effort is being attempted by the American Board of Psychiatry and Neurology (ABPN). It has long wrestled with issues of reliability in its Part II examinations. A guest observer from the American Board of Medical Specialties, who was observing the team on which I was examining one year, marveled, "I've never before seen an examination that has such high validity but low reliability!" I believe this observer was impressed with the inherent (face) validity of observing a psychiatrist actually interview a patient, but the unreliability inherent in the variability in patients seen and examiners used. Glenn Davis is the ABPN trustee who is overseeing the exploration of whether actors can reliably be substituted for real patients. If they can, then the reliability of Part II would be increased dramatically with little or no sacrifice in validity. Rachel Yudkowsky is carrying out many of the studies for the ABPN in its exploration of this possibility. Hence both were asked to comment on the topic for this issue.
Perhaps the person who first used actors and actresses, and who has the most in-depth experience with what is involved and the risks, is Jerry M. Lewis. His experience in using actors for a very different purpose—namely in a creative effort to help residents develop empathy, become aware of their own countertransferential tendencies, and learn interviewing—has been well documented in the now classic To Be a Therapist.
Our hunch is that ten years from now psychiatric OSCEs will be a staple, perhaps even a requirement, for residencies and medical student educational programs. Standardized patients will be ... well ... standard for Part II of the Boards. It is our hope that this special issue will be a stimulus to that evolving process.
This article has been cited by other articles:
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N. A. Vaidya
Psychiatry Clerkship Objective Structured Clinical Examination is Here to Stay
Acad Psychiatry,
May 1, 2008;
32(3):
177 - 179.
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