title: Using standardized patients to assess the geriatrics medicine skills of medical students, internal medicine residents, and geriatrics medicine fellows.
abstract: OBJECTIVE
  Medical schools and residency programs are placing additional emphasis on including clinical geriatrics competencies within their curricula. An eight-station, Geriatric Medicine Standardized Patient Examination (GSPX) was studied as a method to assess bedside geriatrics clinical skills over the continuum of medical education from medical school through residency and fellowship training.
  
  
  METHODS
  The GSPX was administered to 39 medical students, 49 internal medicine residents, and 11 geriatrics medicine fellows in 2001-02. Reliability of standardized patient (SP) checklists and rating scales used to assess examinees' performance was measured by Cronbach's alpha. Validity was measured by surveying the examinees' assessment of fairness, individual case length, difficulty, and believability, and by faculty standard setting for each level of trainee.
  
  
  RESULTS
  Reliability was high (alpha =.89). All levels of examinees found the SPs to be believable, station lengths to be adequate, and rated the GSPX as a fair assessment. Students rated the cases as more difficult. Previous experience with similar real patients increased significantly with level of training (Pearson's r =.48, p <.0001). Faculty set passing scores that increased from students to residents to fellows. However, GSPX scores decreased with level of training (r = -.25, p =.01).
  
  
  CONCLUSIONS
  The GSPX is a reliable measure of geriatrics medicine skills with adequate face validity for examinees at all levels. However, GSPX scores did not increase with level of training, suggesting that a single form of the examination cannot be used across the continuum of training. Potential modifications to the GSPX that might provide more discrimination between levels of training are currently being explored.
authors.affiliation: Center for Clinical Skills, Department of Medicine, Univesity of Hawaii John A. Burns School of Medicine, Honolulu 96817, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Nagoshi
authors.forename: Shellie
authors.initials: S
authors.lastname: Williams
authors.forename: Richard
authors.initials: R
authors.lastname: Kasuya
authors.forename: Damon
authors.initials: D
authors.lastname: Sakai
authors.forename: Kamal
authors.initials: K
authors.lastname: Masaki
authors.forename: Patricia Lanoie
authors.initials: PL
authors.lastname: Blanchette
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004504:Education, Medical, Undergraduate; D004521:Educational Measurement / Q000379:methods*; D005257:Fellowships and Scholarships; D005853:Geriatrics / Q000193:education*; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D014481:United States