Three studies of the effect of multiple standardized patients on intercase reliability of five standardized‐patient examinations

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Abstract
Standardized‐patient (SP) cases have been used in a postclerkship examination to assess clinical competence of five classes of senior medical students at Southern Illinois University School of Medicine. Two or more (multiple) SPs have been used to simulate at least half the cases in each examination administered to date. The present studies were conducted to determine the effect of multiple SPs on intercase reliability. In Study 1, for each class, generalizability analyses were performed to determine the intercase reliabilities for cases using a single SP and for cases using multiple SPs. Study 2 was conducted to compare the intercase reliabilities of those few cases that were used in two different classes, simulated by single SPs in one class and by multiple SPs in the other. Study 3 was undertaken to determine directly by statistical analysis of the multiple‐SP cases only, the contributions of multiple SPs to measurement error and, hence, reliability. The results of all three studies showed little or no effect of multiple SPs on reliabilities of total, checklist, or written scores.