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Open Access Research article

Key challenges in simulated patient programs: An international comparative case study

Debra Nestel1*, Diana Tabak2, Tanya Tierney3, Carine Layat-Burn4, Anja Robb2, Susan Clark3, Tracy Morrison1, Norma Jones5, Rachel Ellis2, Cathy Smith6, Nancy McNaughton2, Kerry Knickle2, Jenny Higham7 and Roger Kneebone3

Author Affiliations

1 Gippsland Medical School, School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Northways Road, Churchill, Victoria, 3842, Australia

2 Standardized Patient Program, University of Toronto, 88 College Street, Toronto, ON M5G 1L4, Canada

3 Department of Surgery & Cancer, Imperial College London, Praed Street, London, W2 1PD, UK

4 University of Applied Sciences Health Sciences, Lausanne (HECVSanté), Av. de Beaumont 211011 Lausanne, Switzerland

5 The Harry Partnership, 159 Green Lanes, London, N16 9DB, UK

6 Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, M5G 1VF, Canada

7 Faculty of Medicine, Imperial College London, Exhibition Road, London, UK, SW7 2AZ

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BMC Medical Education 2011, 11:69  doi:10.1186/1472-6920-11-69

Published: 25 September 2011



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.


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.


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.


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.