title: Key challenges in simulated patient programs: an international comparative case study.
abstract: BACKGROUND
  The literature on simulated or standardized patient (SP) methodology is expanding. However, at the level of the program, there are several gaps in the literature. We seek to fill this gap through documenting experiences from four programs in Australia, Canada, Switzerland and the United Kingdom. We focused on challenges in SP methodology, faculty, organisational structure and quality assurance.
  
  
  METHODS
  We used a multiple case study method with cross-case synthesis. Over eighteen months during a series of informal and formal interactions (focused meetings and conference presentations) we documented key characteristics of programs and drew on secondary document sources.
  
  
  RESULTS
  Although programs shared challenges in SP methodology they also experienced differences. Key challenges common to programs included systematic quality assurance and the opportunity for research. There were differences in the terminology used to describe SPs, in their recruitment and training. Other differences reflected local conditions and demands in organisational structure, funding relationships with the host institution and national trends, especially in assessments.
  
  
  CONCLUSIONS
  This international case study reveals similarities and differences in SP methodology. Programs were highly contextualised and have emerged in response to local, institutional, profession/discipline and national conditions. Broader trends in healthcare education have also influenced development. Each of the programs experienced challenges in the same themes but the nature of the challenges often varied widely.
authors.affiliation: Gippsland Medical School, School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Northways Road, Churchill, Victoria, 3842, Australia. debra.nestel@monash.edu
authors.forename: Debra
authors.initials: D
authors.lastname: Nestel
authors.forename: Diana
authors.initials: D
authors.lastname: Tabak
authors.forename: Tanya
authors.initials: T
authors.lastname: Tierney
authors.forename: Carine
authors.initials: C
authors.lastname: Layat-Burn
authors.forename: Anja
authors.initials: A
authors.lastname: Robb
authors.forename: Susan
authors.initials: S
authors.lastname: Clark
authors.forename: Tracy
authors.initials: T
authors.lastname: Morrison
authors.forename: Norma
authors.initials: N
authors.lastname: Jones
authors.forename: Rachel
authors.initials: R
authors.lastname: Ellis
authors.forename: Cathy
authors.initials: C
authors.lastname: Smith
authors.forename: Nancy
authors.initials: N
authors.lastname: McNaughton
authors.forename: Kerry
authors.initials: K
authors.lastname: Knickle
authors.forename: Jenny
authors.initials: J
authors.lastname: Higham
authors.forename: Roger
authors.initials: R
authors.lastname: Kneebone
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia; D002170:Canada; D002648:Child; D004501:Education, Medical / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019982:Organizational Case Studies; D016544:Patient Simulation; D011786:Quality Control; D013557:Switzerland; D006113:United Kingdom; D055815:Young Adult