Important Message for UB Students and Residents Currently on
This website includes all of the material for the standardized patient
project you are currently doing. Please do not read ahead beyond the
visits assigned each week. There is nothing in subsequent visits that will
aid your performance, but reading ahead will certainly disrupt the flow of
the patient encounter in your mind.
In 1999 the University at Buffalo initiated a month long Palliative
Medicine elective for residents and 4th year medical students that
included a new teaching modality we have labeled the Extended Standardized
Patient Scenario (ESPS). The ESPS was designed to incorporate elements of
end-of-life communications and decision making into the matrix of an
ongoing doctor-patient relationship. Over the course of the month, the
student engaged in 6 sessions with a single SP, whose clinical course
demonstrated a 6-month time period with a fatal illness. The extended
scenario took the patient from diagnosis, through anti-neoplastic
treatment, to end-of-life care. The sessions were supplemented with an
evolving (and enlarging) ambulatory medical record that included progress
notes as well as laboratory, radiology, pathology reports.
We welcome other institutions to use all or part of this site in the
development of their own programs. We request that appropriate
acknowledgements be provided when this occurs. Send your reactions and
feedback to Jack P. Freer MD, Dept. of Medicine, e-mail: email@example.com.
A full description of the program is found in: Freer. J.P., Zinnerstrom,
K.L.: "The Palliative Medicine Extended Standardized Patient Scenario: A
Preliminary Report". Journal of Palliative Medicine. 2001, 4:
Elements of ESPS
- Objectives. The primary goal is to enhance
communication skills, but learning palliative care best practices,
including the place of evidence based medicine are secondary goals as
- Timeline. Note: Visit #1 is already in the
chart when the student/resident meets the patient for the first time (in
- Medical Records. This consists of six dated
ambulatory care folders that all include an original H&P from the prior
year. The charts also contain (cumulative) progress notes, lab, radiology,
and pathology reports that correspond to the date of the current visit.
The progress notes are prepared summaries of the prior visits, but the
learner is expected to write a note for the current visit that documents
discussions (such as advance directives) and the medical plan.
- SP instructions. These are standard SP
describing the role, medical history, demeanor etc. There are separate
sheets for each visit, although much of the base information is unchanged.
- Student instructions. This includes general
instructions as well as specific instructions for each visit.
- SP Checklists. These checklists can be
completed on the computer and printed out, or printed our first and filled
- EBM Resources. Life limiting diseases are often
treated quite aggressively for a time, usually by specialists. The
challenge for primary care physicians is to provide understandable
explanations of such treatment options, and to put them into perspective
for the patient. Specifically, patients often need assistance with outcome
data, so that they may apply their own values to the expected outcomes.
The decision to abandon disease specific treatment does not come easily,
and should be made with the best evidence available, explained by a caring
physician who attempts to individualize the decision making for the
- A visit by visit layout is available which
clusters all documents for each visit.
Jack P. Freer, MD
Palliative Medicine Course Coordinator
Karen H. Zinnerstrom, PhD
:Coordinator for Research and Evaluation,
Standardized Patient Program
Diana R. Anderson, EdM
:Coordinator for Training and Evaluation, Standardized
Don Pearce, MSE