Letters to the Editor
I appreciate the thoughtful comments of Luke and Smith. I absolutely agree that despite the great value of using patients for teaching communication skills, there are situations in which standardized patients (SPs) are more appropriate for that purpose, particularly as students progress in their training and might need practice with challenging situations that real patients might not be able to reliably reproduce, or that might discomfit them.
Well-trained SPs are also likely better able than untrained real patients to give formative feedback. Anecdotally, however, students have occasionally indicated that they find feedback from real patients to be quite powerful. It is possible that training real patients in feedback skills could provide students with particularly meaningful learning experiences, which could be an area for future study. In particular, because of the issues of verisimilitude and development of empathy that Luke and Smith identify, I agree that the integration of real patients into interviewing practice—with or without the training suggested above—has the potential to improve communication skills training for medical students.
Sarah L. Clever, MD, MS
Assistant professor, Department of Medicine, and assistant dean for student affairs, Johns Hopkins University School of Medicine, Baltimore, Maryland; email@example.com.