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Cincinnati Simulation Lab Creates Standardized Patient Program

By Misoor Goueli, MD, MBA
Staff Physician, Cincinnati Veteran Affairs Hospital Assistant Professor, Department of Medicine, University of Cincinnati
CVAMC Simulation Lab, Medical Director
Cincinnati VA Medical Center

CINCINNATI - A simulation approach using standardized patients (SP) can greatly improve a facility’s ability to teach provider/patient communication skills. Anecdotally, VA based simulation labs suffer from a lack of SP specific expertise and will often hire outside SPs or forego the SP experience all together. The Cincinnati VA Medical Center (CVAMC) took an approach to bring a limited SP program to life within the VA simulation environment.

Initially the idea of bringing an SP program to the simulation lab seemed like a daunting task. Luckily, CVAMC has a robust voluntary services program and is situated near the University of Cincinnati College of Medicine (UCCOM), which features a highly functioning, dynamic SP program. Accordingly, CVAMC elected to leverage these two resources to 

The first step taken was to approach voluntary services with a proposal for services. A formal proposal was drafted that included a work description, time commitment, expectations and outcomes that were expected to be achieved. The work description was modeled after the University of Central Florida program, which can be found here.

Once volunteers were secured, the next task was to onboard them appropriately. For this, staff turned to the Association of Standardized Patient Educators (ASPE) standards of best practices for guidance; with the consultation of the experts at UCCOM an orientation session was created for volunteers to attend. The orientation specifically focused on three of the five ASPE domains: maintaining a safe work environment, case development and appropriate SP training. The remaining two domains, SP program domain and SP professional development, were felt to be out of scope for Veteran centric goals.

With oriented volunteers, CVAMC was ready to create and implement its first SP simulation. For this, suicide awareness and prevention were chosen. Prior to exposing any learners to this simulation, three formal training sessions were conducted with scripts and scenarios provided to the volunteers prior to the first session. 

Training session 1 was on-script. In this session, staff provided the SPs an orientation to the basic medical knowledge involved in scenario creation. Simulation staff and SPs talked through the scenario in its entirety multiple times, attempting to discover intrinsic flaws embedded in the script itself.

Training session 2 was off-script. In this session, staff ensured the SPs had internalized the role they would be playing. The volunteer’s knowledge of the character was assessed by conducting a round robin question and answer session. Questions asked were specifically about the character and were intentionally nuanced, requiring the volunteers to extrapolate about the character. After satisfactory responses were obtained, staff then proceeded to conduct the simulation in the actual simulation environment. The content expert (CE) was intimately involved in this practice session. Specifically, the CE monitored the SPs to ensure accurate character portrayal. Not only was the CE monitoring the tangible information provided by the SP, but they also monitored all the non-verbal elements of the simulation. Any character inconsistencies within the simulation were addressed, and the simulation was re-run until they were corrected.

The final training session, session 3 was off-script. As this was the first SP-based simulation, the experts at UCCOM were asked for assistance. To create a robust simulation, staff ran the simulation many times. Each time the learner (played by simulation staff) provided a different response to the SP. Staff explored how the SPs would conduct themselves in simulations where the learner struggled significantly. The UCCOM experts provided the SPs with strategies to handle various learners. The CE was involved in this step to ensure the fidelity of the character portrayal.

After this final training session, staff were ready to run their first SP session with actual learners. Staff elected a group of content experts for this pilot session. Using the provided feedback, staff modified the program slightly, and now run the suicide awareness program regularly. Staff are now in the maintenance stages of this program. The key to this step is to remember that SPs are adult learners. Staff have found a good deal of success by treating SPs with respect and debriefing them after every simulation using the 360-degree approach that is inherent to any good simulation program.

This article discussed the approach CVAMC staff took to create an SP program. While there are many ways to create a new SP program, they all rely on the same things: SP recruitment, orientation and training. 

Special thanks to: Dr. Michael Sostok/Maureen Asebrook (UCCOM); Debra Bartoshevich (South Texas VHCS); and Eddie Leonard (CVAMC).


Levine, A., DeMaria, S., Schwartz, A. & Sim, A. (2013). The comprehensive textbook of healthcare simulation. New York, NY: Springer.

Lewis, K. L., Bohnert, C. A., Gammon, W. L., Lyman, L., Smith, C., Thompson, T. M., Wallace, A., & Gliva-McConvey, G. The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP). Advances in simulation 2017, 2:10.

STANDARDIZED PATIENT JOB DESCRIPTION . (n.d.). Retrieved April 15, 2019, from