Use of Internet Based Chat in a “Remote Live Standardized Patient” Skills Training

Mary P. Metcalf, Ph.D., MPH, Susan Wilhelm, Ph.D., Amanda Buchanan, M.A., Karen Rossie, DDS, Ph.D., T. Bradley Tanner, M.D.

Clinical Tools, Inc.


Clinical skills assessment exams using Standardized patients (SPs) are an established component of medical school education, including the current USLME Step 2 CS exam™. The authors have developed a novel method for conducting SP encounters using web-based chat technology (e.g. Google® chat). “Remote Live Standardized Patient” (RLSP) interviews are conducted entirely online. The interview requires active learner participation focused on clinical skills, and represents a unique solution to teaching specific skills and affecting behavior. We are not aware of other educators using chat for this purpose.

We have been pilot testing chat-based OSCE-style exams1,2 since 2007. In 2009 we have begun using RLSPs to teach skills, as well as evaluate them. The instructional RLSP key components include an interactive SP actor, an EMR like interface, and a “Hats Off” mode, which allows the student learner to “ask a preceptor” or research information during the encounter. Each learner’s performance is evaluated by standardized measures and by the RLSP actor feedback. This interactive, responsive web environment allows the RLSP interview to simulate a broad spectrum of learner/patient encounters, from initial screening through diagnosis and treatment.

Advantages include 1) decreased SP training cost and time commitment, 2) more flexible SP scheduling and recruiting since all encounters occur online, 3) elimination of face-to-face constraints of verisimilitude errors and correlation of actor physical appearance compared to the “patient”, and 4) instant availability of chat conversation transcripts for review and learner feedback. Potential limitations include missing the “whole person” experience afforded by face-to-face encounters, including the ability to assess body language and demonstrate physical exam skills. Since face-to-face SP encounters also suffer from realism limitations (i.e. the actor does not typically have the “patient’s” presenting symptoms), we feel that the advantages of an RLSP balance and actually outweigh the drawbacks.

Use of web-based chat or its equivalent may have significant appeal to the current generation of Internet-savvy medical students. The RLSP experience appears to be a viable alternative to the traditional face-to-face SP interview, allows cost savings, and prepares students for Step 2 CS-style exams.


This work was funded in part by NIH grants R44AA016724, R25 HG02266 and R44 DA022069 to T.B. Tanner. Human subjects research was reviewed and approved by the Clinical Tools’ IRB, and informed consent was obtained from medical students who participated in referenced studies. All authors are currently employed by Clinical Tools, Inc. Dr. Tanner is the owner and Principal Investigator for the research.


  1. Tanner, T.B. and Metcalf, M.P. Assessing the Potential Value of Remote Standardized Patients Tied to Online Learning. Poster presented at the 12th International Association of Medical Student Educators, July 25-29, 2008, Salt Lake City, UT.
  2. Metcalf, M.P., Tanner, T.B., Wilhelm, S.E., and Buchanan, A. Use of a Remote Standardized Patient to Teach Clinical Skills to Undergraduate Medical Students. Poster presented at the 2009 AMIA Spring Congress, May 28-30, 2009, Orlando, FL.