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

Acad Med. 1994 Jul;69(7):567-70. doi: 10.1097/00001888-199407000-00013.


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.

MeSH terms

  • Clinical Competence / economics*
  • Cost-Benefit Analysis
  • Costs and Cost Analysis
  • Diagnosis
  • Education, Medical / economics*
  • Educational Measurement
  • Faculty / organization & administration
  • Louisiana
  • Physical Examination
  • Program Evaluation
  • Salaries and Fringe Benefits
  • Teaching / economics*
  • Teaching / methods