Using Unidentified Standardized Patients to Evaluate Housestaff Delivery of Preventive Services

Background: Scheduling unidentified standardized patients (SPs) into physician outpatient practices to assess quality of care and physician performance has been used infrequently for housestaff evaluation. The article's purpose is to describe the feasibility and acceptability of using unidentified SPs for evaluation of housestaff performance of the clinical breast examination and other preventive practices in the outpatient setting. Description: SPs, posing as new patients with an uncomplicated medical history, were scheduled under pseudonyms into the clinics of 20 randomly selected consenting residents. Following each encounter, the SPs completed an evaluation checklist on prespecified aspects of the history and physical. Evaluation: Four (20%) of the residents who actually had an SP encounter suspected that they had seen an SP, and 7 (21%) of the 34 consenting housestaff who actually did not see an SP thought that they had. At the end of the study, none of the housestaff had expressed a reluctance to participant in the unidentified SP evaluation and 39 (83%) stated they would participate in a similar evaluation in the future. Seventeen (36%) of all surveyed housestaff felt the SP evaluation had no effect on overall patient care, whereas 30 (64%) felt it had a positive effect on patient care. Conclusions: The use of unidentified SPs in the outpatient setting is a feasible method of evaluation that was acceptable to the majority of internal medicine housestaff at our institution without appearing to negatively impact on patient care.