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Release: Sept. 3, 2002

UI medical students to receive performance assessments of their clinical skills

University of Iowa medical students are not yet doctors, but with the arrival of state-of-the-art digital audio and video technology, they soon will be able to "play one on TV."

Beginning this fall, third-year students in the UI Roy J. and Lucille A. Carver College of Medicine will receive performance assessments of their patient care and communication skills as they go through the "clinical years" of their medical education, the time students spend primarily in clerkships learning community-based primary care, family medicine, pediatrics and other medical specialties.

The advanced audio/video recording equipment is installed in the patient examination rooms that are part of the clinical suites in the college's new Medical Education and Biomedical Research Facility (MEBRF). The equipment will allow instructors and students to assess the students' performance in a controlled setting, producing a standardized and consistent learning experience.

In order to practice medicine in the United States and Canada, medical students must take the three-part U.S. Medical Licensing Examination (USMLE). The second part of the test, taken during a student's fourth year of medical school, also will include a performance-based assessment component, beginning in 2004. In order to better prepare students for this part of the USMLE and as part of being an accredited medical school, the UI Carver College of Medicine developed its performance-based assessment program.

"Over the past 50 years, educators have increasingly turned to objective paper and pencil testing after evaluation experts, such as the UI's own E. F. Lindquist, faulted educators for basing student assessments on casual and unreliable observations," said George Bergus, M.D., UI associate professor of family medicine and director of the college's performance-based assessment program. "But several of the domains that medical students need to master – including communication, physical examination, and obtaining a clinical history – cannot be tested with a paper test. This led to the search for objective performance assessments so that we could evaluate these complex skills. One way to assess our students in these areas is to observe them in simulated clinical encounters."

MEBRF was built with this specific need in mind, Bergus noted. The facility has four clinical suites, each containing five or six simulated medical examination rooms in which students' skills can be assessed. All of these assessments are recorded on a high-quality digital video system.

"Testing a student's content knowledge with the USMLE has always been a fairly straightforward process," said Ellen Franklin, coordinator of the performance-based assessment program in the college. "With the increased emphasis on a student's clinical performance -- their communication and analytical skills, or 'bedside manner' -- it's become even more important to give students a consistent and comprehensive learning and assessment experience. That's where this program comes in."

In the past, third- and fourth-year students would learn by working with real patients at UI Hospitals and Clinics, under the observation and supervision of a faculty member. While students were learning the skills needed, the types of medical cases students would see could vary.

With the new program, students will supplement that experience by also working with standardized patients, paid volunteers who are trained to play the role of a real patient. Standardized patients show not just the symptoms of an illness or disorder, but also the personality, behavior and mannerisms of a person with a specific illness. The video and audio equipment allows students and instructors to review every detail of the student-patient interaction. The faculty and the standardized patients can assess students' skills and provide feedback.

"The standardized patients are a key component to this program," said Franklin, who recruits and trains the volunteers. "I've recruited a number of people from the community theaters in Iowa City and Cedar Rapids, as well as students in the UI Theatre Arts department, but anyone can volunteer for this program. We're looking for all types of people from all age groups in order to create as 'real' a scenario as possible. We want the full representation of the patient population."

The college actually has used simulated patients for several years, Franklin noted, for first- and second-year medical students to practice taking a medical history, performing a physical examination or taking a blood pressure reading. The standardized patients who will work with third-year students require even more training than simulated patients, she said.

"One major goal of this program is to create a doctor-patient experience that is consistent and equivalent for all the students," Franklin said. "So if I train four people to come in with a headache, they're all going to act the same way. The patients are trained to assess the students after the encounter, as well -- did the student ask the specific questions they are supposed to ask, did the student communicate clearly, and so on. There are a whole series of things the patients check for."

Faculty members prepare the cases based on real patient cases they might see or have seen themselves as doctors, and they are involved in training the standardized patients, Bergus said.

"Our cases are drawn from the professional experiences of clinicians here in the college and other medical schools. The cases are meant to be realistic but straightforward. We try to avoid the esoteric," Bergus said. "Of course, our standardized patients are a very skilled group of people who are able to accurately portray real patients. Often, when I examine a standardize patient during the training phase I forget that I am examining an actor and not a person who really has a medical problem."

The program will begin in mid-September with an ambulatory practice module, which combines internal medicine and family medicine into one 12-week clerkship. At the end of the clerkship, students will take a written test and do the performance-based assessment with four standardized patients representing four typical medical cases. Students also will receive a written test and taped performance assessment at the end of their four-week psychiatry clerkships. Plans for pediatrics, obstetrics and gynecology and other clinical clerkships are in the works, Franklin said.

The new MEBRF is a perfect facility to implement such a program, she noted. Seventeen of the 23 patient examination rooms in the building are equipped with audio/video recording equipment.

"We did a practice run with first-year medical residents last June and it went like clockwork," Franklin said.

The examination rooms are fully equipped to create a realistic setting, just like patient exam rooms at doctors' offices or at UI Hospitals and Clinics.

"It goes without saying that the level of technology is excellent, Franklin said. "We have high expectations for this program, and MEBRF is a great facility for making this happen."

For more information on being a standardized patient, contact Franklin at (319) 335-6787 or by e-mail at

University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online at