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The Use of Standardized Patients in the Plastic Surgery Residency Curriculum: Teaching Core Competencies with Objective Structured Clinical Examinations

Davis, Drew M.D.; Lee, Gordon M.D.

Plastic and Reconstructive Surgery: July 2011 - Volume 128 - Issue 1 - p 291-298
doi: 10.1097/PRS.0b013e31821962d2
Special Topics

Background: As of 2006, the Accreditation Council for Graduate Medical Education had defined six “core competencies” of residency education: interpersonal communication skills, medical knowledge, patient care, professionalism, practice-based learning and improvement, and systems-based practice. Objective structured clinical examinations using standardized patients are becoming effective educational tools, and the authors developed a novel use of the examinations in plastic surgery residency education that assesses all six competencies.

Methods: Six plastic surgery residents, two each from postgraduate years 4, 5, and 6, participated in the plastic surgery–specific objective structured clinical examination that focused on melanoma. The examination included a 30-minute videotaped encounter with a standardized patient actor and a postencounter written exercise. The residents were scored on their performance in all six core competencies by the standardized patients and faculty experts on a three-point scale (1 = novice, 2 = moderately skilled, and 3 = proficient).

Results: Resident performance was averaged for each postgraduate year, stratified according to core competency, and scored from a total of 100 percent. Residents overall scored well in interpersonal communications skills (84 percent), patient care (83 percent), professionalism (86 percent), and practice-based learning (84 percent). Scores in medical knowledge showed a positive correlation with level of training (86 percent). All residents scored comparatively lower in systems-based practice (65 percent). The residents reported unanimously that the objective structured clinical examination was realistic and educational.

Conclusions: The objective structured clinical examination provided comprehensive and meaningful feedback and identified areas of strengths and weakness for the residents and for the teaching program. The examination is an effective assessment tool for the core competencies and a valuable adjunct to residency training.


Palo Alto, Calif.

From the Division of Plastic and Reconstructive Surgery, Stanford University Hospital and Clinics.

Received for publication July 9, 2010; accepted October 13, 2010.

Presented at the 78th Annual Meeting of the American Society of Plastic Surgeons, in Seattle, Washington, October 23 through 27, 2009, and at the California Society of Plastic Surgeons Annual Meeting, in Dana Point, California, June 5 through 8, 2008.

Disclosure: All funding for this project came from the Stanford Division of Plastic and Reconstructive Surgery. Neither of the authors has any financial interests to disclose.

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Gordon Lee, M.D., Division of Plastic and Reconstructive Surgery, Stanford University Hospital and Clinics, 770 Welch Road, Suite 400, MC 5715, Palo Alto, Calif. 94304-5715,

©2011American Society of Plastic Surgeons