Analysis of the costs and benefits of using standardized patients to help teach physical diagnosis

BACKGROUND: Although a majority of medical schools use standardized patients (SPs) for teaching or evaluating students, the costs and benefits of such programs have not been examined in depth. In 1992-93 the Tulane University School of Medicine reduced by 40% the faculty-precepted sessions in its physical diagnosis program in order to incorporate seven focused examinations using SPs to teach basic examination skills. METHOD: Costs for the revised program included costs for SPs, staff, supplies, and faculty. Faculty cost was estimated at a minimum to equal hourly salary and at a maximum to equal this salary plus potential collectible billings. An objective structured clinical examination (OSCE) was used to assess the skill acquisitions of 150 second-year students in 1991-92, before SPs were used, and in 1992-93, when SPs were used. An unpaired t-test was then used to compare the OSCE performances of the two groups of students. Chi-square analysis was used to compare the evaluations of the physical diagnosis program by the 1992-93 and 1991-92 students. RESULTS: The cost of incorporating SPs into the program was 43, 800. The amount of time spent teaching by faculty was reduced by 608 hours, costing between 33 (salary) and 108 (salary plus potential revenue) per hour. Thus, the total savings in the cost of faculty time was between 20, 064 and 65, 664. Despite the reduction in faculty involvement, the students' performance on the OSCE did not change, and the students' evaluations of the course became significantly more favorable. CONCLUSION: The incorporation of SPs as instructors in the physical diagnosis program was accomplished at a minimal cost and resulted in an increase in students' enthusiasm for the purpose, with no loss of skill acquisition as measured by the OSCE.