Bridging Simulation and Practice in Medical History Taking: A Comprehensive Needs Assessment of Standardized Patient Competencies in Early Clinical Exposure.

INTRODUCTION

Effective medical history-taking is a cornerstone of clinical practice, yet medical students often struggle due to inadequate structured training and feedback. Standardized patients (SPs) play a crucial role in early clinical exposure (ECE) by providing controlled, realistic patient interactions. However, optimizing SP effectiveness requires a systematic assessment of their competencies.

METHODS

This study employed a cross-sectional survey design to identify competency gaps in SPs and key areas for improvement to enhance their role in medical training during ECE. A stratified random sampling method was used to recruit 315 medical students from both preclinical (Years 1-3) and clinical (Years 4-6) cohorts at the Faculty of Medicine, Siriraj Hospital, Mahidol University. Data were collected using a structured questionnaire comprising 36 items across three competency domains: ability, suitability, and credibility. Each item utilized a dual-response 5-point Likert scale to assess both current SP performance and expected competency levels. The instrument demonstrated high content validity, as assessed by three experts (IOC=0.67-1.00), and excellent internal consistency (Cronbach's alpha=0.976). Data analysis included descriptive statistics to summarize the responses and calculate the Modified Priority Needs Index (PNImodified) to prioritize competency gaps. All analyses were performed using SPSS Statistics Version 30.0.

RESULTS

Preclinical students identified realistic role portrayal (PNImodified=0.445), adherence to structured guidelines (PNImodified=0.395), and accurate past medical history portrayal (PNImodified=0.371) as the most critical competency gaps. Clinical students emphasized SPs' ability to observe non-verbal cues (PNImodified=0.143), provide structured feedback (PNImodified=0.141), and give appropriate feedback to the students (PNImodified=0.126). Across both groups, the three most significant competency gaps were structured feedback on history-taking (PNImodified=0.186), realistic role portrayal (PNImodified=0.181), and appropriate feedback delivery (PNImodified=0.180).

CONCLUSION

Addressing these competency gaps through structured standardized patient (SP) training programs will enhance the effectiveness of medical history-taking education in early clinical exposure (ECE). Future research should prioritize the development of competency-based SP training frameworks and structured feedback models that support both learning outcomes and clinical preparedness. These findings underscore the need for targeted training strategies which aim at strengthening SP competencies, particularly in realistic role portrayal and high-quality feedback delivery, which are essential for improving student engagement, clinical reasoning, and overall performance in simulated patient encounters.