SSH Article Summary: Cognitive Demands of Standardized Patients

By Ben Blohowiak

Article Information:

Title: The Cognitive Demands of Standardized Patients: Understanding Limitations in Attention and Working Memory with the Decoding of Nonverbal Behavior during Improvisations.

Authors: Newlin-Canzone, Elizabeth T. PhD; Scerbo, Mark W. PhD; Gliva-McConvey, Gayle; Wallace, Amelia M.

Journal: Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare

Issue: Volume 8(4), August 2013, p 207–214

Copyright: © 2013 by Lippincott Williams & Wilkins, Inc.

Publication Type: [Empirical Investigations]  DOI: 10.1097/SIH.0b013e31828b419e  ISSN: 1559-2332  Accession: 01266021-201308000-00001


This study was designed to look at the challenges of standardized patients (SPs) while in role and to use the findings to enhance training methods. The study investigated the effect of improvisations and multiple task performance on the ability of SPs to observe and evaluate another’s communication behaviors and associated mental work load.

Various tasks can be more taxing on SPs’ cognitive resources than others and the right kind of training may help SPs to manage what they have at their disposal. The purpose of the study was to re-examine the effects of active and passive observing and improvised responses with SPs in clinical scenarios. Experimental evidence suggests that it is more difficult for SPs to recall the nonverbal behavior of learners when SPs have been improvising their own verbal responses to learners’ questions.

This article underscores how it can be difficult to enact case encounters when those enacting the encounters must also attend to the raw material from which feedback, codified through checklists or otherwise, may be based. To address this, research from the field of cognitive science in general supports the strategy of training verbal output and nonverbal behavior scanning automatically as much as possible so as to free conscious attention for the undertaking of non-routine tasks. In this context, that means SP trainers may do well to engage in practices that ensure SPs have their case material, challenge responses, and other things to say prepared and ready to enact without their requiring much in the way of prompting or memory-jogging while in the midst of an encounter.

There are two basic training strategies that can be used to address this; the first involves training SPs to lean on a wide range of pre-identified responses so that they don’t need to fabricate a response on the spot. The other strategy involves clearly identifying the required observations of specific nonverbal behaviors to watch for and to train the SPs to actively scan for these behaviors, especially when also producing improvised speech.

This research also has possible implications regarding learner performance in this environment. The fact that SPs are recruited and trained especially to perform this function and have been shown to have variable performance when producing their own extemporaneous speech in encounters with learners may suggest that some of the challenges that learners themselves face when attempting to attend to the nonverbal behavior and cueing of SPs may be based in similar cognitive resource-allocation dynamics.

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