Effect of repeated simulations by standardized patients on intercase reliability

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Abstract
A performance‐based examination consisting of standardized‐patient (SP) cases was given to all senior medical students in five classes at Southern Illinois University School of Medicine. Each class taking the examination consisted of about 70 students, so that each SP case had to be simulated a total of 70 times during the examination. Having 70 simulations of the same case by a given SP naturally raises questions about the ability of the SP to portray the case and to complete checklists consistently throughout the entire examination period. One concern is that, with repeated simulations, SPs might grow tired and become careless in portraying their respective cases and completing checklists, so that measurement error would increase throughout the examination. On the other hand, the practice gained with repeated simulations could increase the consistency of the simulations and checklist completions, so that measurement error would decrease throughout the examination. The present analysis, then, was undertaken to determine if intercase reliability was increasing or decreasing systematically throughout the examination period. In general, the results suggest that repeated simulations by SPs had little or no effect on the intercase reliabilities of the checklist or written examination scores.

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