Systematic Review of Standardized Patient Use in Continuing Medical Education.
INTRODUCTION
The standardized patient (SP) has assumed a fundamental role in undergraduate medical education since first conceived over 50 years ago. While widely used in student training and assessment of communication and clinical examination across health disciplines, little is known how SPs enhance knowledge or skill development among professionals. We conducted a systematic review to determine the effectiveness of SPs in continuing medical education (CME) programs.


METHODS
Authors independently searched for studies published between 1966 and 2016, describing CME initiatives using SP encounters as practice for participants compared with those which did not. Studies assessing virtual patients or mannequins or employing SPs for assessment only were excluded. Learning outcomes were characterized according to the Kirkpatrick framework for determining the effectiveness of training programs.


RESULTS
Four hundred eighty-eight studies were identified, but only five were eligible for analysis. Most were conducted with small numbers of primary care physicians in North America. CME topics related to opioid prescribing, breast cancer examination and cancer screening, smoking cessation, and chronic asthma management. In the two studies testing knowledge, no difference was found between intervention and control groups (Kirkpatrick level 2). Improved behaviors were demonstrated in breast cancer patient examination and interview and decreased opioid-prescribing rates among selected participants in two studies (Kirkpatrick level 3). Only one study investigated patient outcomes and found reduced rates of uncontrolled asthma in practices of physicians who were assigned to SP practice encounters in the CME training (Kirkpatrick level 4).


DISCUSSION
There is little rigorous outcome study of CME programs incorporating SPs. Given the necessary human and fiscal resources associated with their use, our review highlights the need to reconsider the SP role in CME unless further purposeful evaluation to determine participant behavior change and related patient outcomes is pursued.