Cargando…
Simulated patients and their reality: An inquiry into theory and method
Simulated standardized patients (SSP) have emerged as close to a ‘gold standard’ for measuring the quality of clinical care. This method resolves problems of patient mix across healthcare providers and allows care to be benchmarked against preexisting standards. Nevertheless, SSPs are not real patie...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Pergamon
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9077327/ https://www.ncbi.nlm.nih.gov/pubmed/34865913 http://dx.doi.org/10.1016/j.socscimed.2021.114571 |
_version_ | 1784702096727080960 |
---|---|
author | Das, Veena Daniels, Benjamin Kwan, Ada Saria, Vaibhav Das, Ranendra Pai, Madhukar Das, Jishnu |
author_facet | Das, Veena Daniels, Benjamin Kwan, Ada Saria, Vaibhav Das, Ranendra Pai, Madhukar Das, Jishnu |
author_sort | Das, Veena |
collection | PubMed |
description | Simulated standardized patients (SSP) have emerged as close to a ‘gold standard’ for measuring the quality of clinical care. This method resolves problems of patient mix across healthcare providers and allows care to be benchmarked against preexisting standards. Nevertheless, SSPs are not real patients. How, then, should data from SSPs be considered relative to clinical observations with ‘real’ patients in a given health system? Here, we reject the proposition that SSPs are direct substitutes for real patients and that the validity of SSP studies therefore relies on their ability to imitate real patients. Instead, we argue that the success of the SSP methodology lies in its counterfactual manipulations of the possibilities available to real careseekers – especially those paths not taken up by them – through which real responses can be elicited from real providers. Using results from a unique pilot study where SSPs returned to providers for follow-ups when asked, we demonstrate that the SSP method works well to elicit responses from the provider through conditional manipulations of SSP behavior. At the same time, observational methods are better suited to understand what choices real people make, and how these can affect the direction of diagnosis and treatment. A combination of SSP and observational methods can thus help parse out how quality of care emerges for the “patient” as a shared history between care-seeking individuals and care providers. |
format | Online Article Text |
id | pubmed-9077327 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Pergamon |
record_format | MEDLINE/PubMed |
spelling | pubmed-90773272022-06-07 Simulated patients and their reality: An inquiry into theory and method Das, Veena Daniels, Benjamin Kwan, Ada Saria, Vaibhav Das, Ranendra Pai, Madhukar Das, Jishnu Soc Sci Med Article Simulated standardized patients (SSP) have emerged as close to a ‘gold standard’ for measuring the quality of clinical care. This method resolves problems of patient mix across healthcare providers and allows care to be benchmarked against preexisting standards. Nevertheless, SSPs are not real patients. How, then, should data from SSPs be considered relative to clinical observations with ‘real’ patients in a given health system? Here, we reject the proposition that SSPs are direct substitutes for real patients and that the validity of SSP studies therefore relies on their ability to imitate real patients. Instead, we argue that the success of the SSP methodology lies in its counterfactual manipulations of the possibilities available to real careseekers – especially those paths not taken up by them – through which real responses can be elicited from real providers. Using results from a unique pilot study where SSPs returned to providers for follow-ups when asked, we demonstrate that the SSP method works well to elicit responses from the provider through conditional manipulations of SSP behavior. At the same time, observational methods are better suited to understand what choices real people make, and how these can affect the direction of diagnosis and treatment. A combination of SSP and observational methods can thus help parse out how quality of care emerges for the “patient” as a shared history between care-seeking individuals and care providers. Pergamon 2022-05 /pmc/articles/PMC9077327/ /pubmed/34865913 http://dx.doi.org/10.1016/j.socscimed.2021.114571 Text en © 2021 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Das, Veena Daniels, Benjamin Kwan, Ada Saria, Vaibhav Das, Ranendra Pai, Madhukar Das, Jishnu Simulated patients and their reality: An inquiry into theory and method |
title | Simulated patients and their reality: An inquiry into theory and method |
title_full | Simulated patients and their reality: An inquiry into theory and method |
title_fullStr | Simulated patients and their reality: An inquiry into theory and method |
title_full_unstemmed | Simulated patients and their reality: An inquiry into theory and method |
title_short | Simulated patients and their reality: An inquiry into theory and method |
title_sort | simulated patients and their reality: an inquiry into theory and method |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9077327/ https://www.ncbi.nlm.nih.gov/pubmed/34865913 http://dx.doi.org/10.1016/j.socscimed.2021.114571 |
work_keys_str_mv | AT dasveena simulatedpatientsandtheirrealityaninquiryintotheoryandmethod AT danielsbenjamin simulatedpatientsandtheirrealityaninquiryintotheoryandmethod AT kwanada simulatedpatientsandtheirrealityaninquiryintotheoryandmethod AT sariavaibhav simulatedpatientsandtheirrealityaninquiryintotheoryandmethod AT dasranendra simulatedpatientsandtheirrealityaninquiryintotheoryandmethod AT paimadhukar simulatedpatientsandtheirrealityaninquiryintotheoryandmethod AT dasjishnu simulatedpatientsandtheirrealityaninquiryintotheoryandmethod |