Use of specialized standardized patients to improve student's ability to formulate differential diagnoses in advanced health assessment

Advanced health assessment is one of the core courses in all advance practice nursing (APN) programs.  Historically, the focus of this class has been on ensuring that students can perform a complete head to toe physical exam and understand the findings of that exam. The taking of the health history is a process that students and faculty can tend to overlook in this course. Often, students are presented with blocks of material that are not integrated until a diagnosis and management class.  However, advanced health assessment is the perfect course to begin integration of pathophysiology, diagnostics, history and the physical exam.  An advanced assessment class needs to successfully merge the physical exam with the health history with the end result being the formulation by the student of differential diagnoses. 

Standardized patients have long been used in assessment classes and are typically given a case scenario and told to "act out" a typical diagnosis.  These interactions are often used at the end of the course to evaluate the students’ progress.  However, using these interactions throughout the course as pedagogy is more effective. Through the use of specialized (nursing educated) standardized patients (SSP), the interaction between student and patient can be individualized, deepened and include robust dialogue concerning a focused complaint. Having a patient that understands the meaning behind each question posed by the student is crucial to the success of this interaction and provides the student with an actual opportunity to practice not only physical exam skills, but to practice the art of history taking skills. The ideal SSP is an APN, often a lab instructor, which is skilled at guiding students through the deductive reasoning of the interview process. He must be able to answer questions posed by the student to help the student formulate differential diagnosis; a skill that historically, standardized patients have not had. 

This presentation provides information on improving the use of standardized patients by incorporating simulated focused exams using an SSP into an advanced health assessment course.  Case study development and logistics will be discussed.  Handouts containing previously used case studies and rubrics will be distributed.