PURPOSE: A major challenge facing plastic surgery training programs is the need to provide quality education in aesthetic surgery. As important as technical skills, but much more difficult to teach, are the communication and patient selection skills essential to the successful practice of aesthetic surgery. In addition, recent directives from the ACGME have prompted residency directors to seek creative ways to teach and assess the more subjective core competencies such as communication skills and professionalism. Standardized patients, actors who reproduce scripted clinical scenarios, have been used in medical education for over 40 years. The purpose of this study is to determine the effectiveness of a standardized patient program for teaching communication and patient selection in aesthetic surgery.

METHODS: Six actors were selected and given detailed scripts, character descriptions, and clinical scenarios in which they would model a patient seeking an initial consultation for aesthetic surgery. Six residents were each given the opportunity to interview a different standardized patient for 30 minutes while the other plastic surgery residents and faculty members observed. Sessions were videotaped for future viewing. Following the interview, all participants completed a questionnaire and discussed whether the patient was a suitable candidate for the desired procedure. Personality factors, patient motivations, and expectations were addressed. To assess program effectiveness, four written simulations were administered to faculty members and residents before and after the educational program. For each simulation, a faculty standard was developed and tested using analysis of variance and Fisher's PLSD post-hoc test. An accuracy score was determined from the number of times the resident's answers differed from the faculty standard. The pre-test accuracy scores for the 6 residents were compared to their post-test score using a paired t-test. Residents and faculty members were asked to evaluate the effectiveness of the program using a 6-item questionnaire. Faculty time commitment and expense were assessed.

RESULTS: On three of four paper simulations, the Fisher's test indicated that one faculty member's responses differed significantly from the others, thus was excluded from the faculty standard. On the fourth simulation, the faculty members did not vary significantly in their responses to the simulation. The mean pre-test accuracy score for the residents was 2.33 ± 0.42, and the mean post-test score was 1.00 ± 0.52. This difference was statistically significant (p=0.01) indicating that residents judged cue importance more accurately after the training program than before. Upon the 6-item questionnaire, both faculty and residents strongly agreed that it was a worthwhile exercise (faculty mean 6.2 out of 7, resident mean 6.3). They also strongly agreed that the standardized patients were well prepared and believable (faculty mean 6.0, resident mean 6.3) and that standardized patients should have a permanent role in the plastic surgery curriculum (faculty mean 6.1, resident mean 6.0). One faculty member contributed 14 hours developing and implementing the program. The total cost of the program was $357.84.

CONCLUSION: Standardized patients can be an effective tool in teaching residents to evaluate candidates for aesthetic surgery. The residents' responses on paper cases more closely approximated the faculty's answers after the experience than before. Faculty and residents alike rated the experience highly, and the cost was nominal. Adding a standardized patient experience to the plastic surgery curriculum can provide instruction in traditionally difficult-to-teach areas such as communication and patient selection
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