title: Instructiveness of real patients and simulated patients in undergraduate medical education: a randomized experiment.
abstract: OBJECTIVE
  Few studies have compared the instructiveness of real patient contacts with simulated patient (SP) contacts. Although most of these studies found no difference, students often comment that the instructiveness of both encounters is dissimilar. The aims of this study were to evaluate which contact (real patient or SP) is perceived as most instructive by students and which variables contribute to this.
  
  
  METHODS
  The authors performed an experiment involving 163 first-year medical students, randomized to having a real patient contact (n = 61) or SP contact (n = 102). Quantitative (questionnaires) and qualitative (focus groups) methods were used to evaluate the perceived instructiveness of the contact.
  
  
  RESULTS
  The general instructiveness of both real patient contacts and SP contacts was marked high. Several differences between the evaluations of real patient contacts and SP contacts were found. For example, students considered real patient contacts less helpful in practicing communication skills and considered the real patients' feedback less relevant. The focus group interviews yielded explanations for many of the differences found. Students regarded real patients as more authentic. However, SPs were better informed about the purpose of the consultation and provided the student with more specific feedback.
  
  
  CONCLUSIONS
  Students consider authenticity an important advantage of real patients. Their difficult recruitment is an important disadvantage, however, SPs have important advantages compared with real patients--for example, their feedback. The choice of real patient contacts or SP contacts for medical education depends on factors like the phase of the curriculum and the aim of the encounter.
authors.affiliation: Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. L.Bokken@EDUC.unimaas.nl
authors.forename: Lonneke
authors.initials: L
authors.lastname: Bokken
authors.forename: Jan-Joost
authors.initials: JJ
authors.lastname: Rethans
authors.forename: Quirijn
authors.initials: Q
authors.lastname: Jöbsis
authors.forename: Robbert
authors.initials: R
authors.lastname: Duvivier
authors.forename: Albert
authors.initials: A
authors.lastname: Scherpbier
authors.forename: Cees
authors.initials: C
authors.lastname: van der Vleuten
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D016544:Patient Simulation; D010808:Physical Examination / Q000379:methods; D010817:Physician-Patient Relations; D036301:Qualitative Research; D011795:Surveys and Questionnaires