Clinical performance assessment using standardized patients: a primer.

The clinical performance assessment (CPA) exam using standardized patients is being used with increasing frequency in medical education. A standardized patient (SP) is an individual who has been taught to portray a patient problem in a way that does not vary from student to student. These exams usually take the format of the Objective Structured Clinical Examination (OSCE), comprised of short "stations" designed to assess a discrete skill, or the simulated clinical encounter (SCE), where stations are fewer in number but of longer duration. While both formats have a place in student assessment, they measure different skills. CPAs have been found to be both reliable and valid. Longer tests tend to be more reliable than short ones, and raters and case specificity are the most likely factors in lowering reliability in SP-based exams. Validity studies have found differences in performance in expected directions and correlations between scores on SP-based exams and other measures. Work on developing standard-setting procedures is being done. Both the OSCE and SCE formats have application for family medicine education. Basic skills and higher-level thinking can be assessed and learning prescriptions developed, but some concepts, such as continuity of care, are difficult to evaluate. Collaborative efforts among family medicine educators should be encouraged.