Assessing the Believability of Standardized Patients Trained to Portray Communication Disorders

Abstract

Purpose: The purpose of this study was to evaluate the believability of standardized patients portraying individuals with communication disorders as part of a larger study in which standardized patients help train medical and allied health students about communication disorders.

Method: Two women portrayed persons with aphasia, and 2 men depicted persons with dysarthria associated with Parkinson's disease. Two stakeholder groups rated believability. Speech-language pathologists rated believability of videos online. Persons with aphasia rated aphasia videos during in-person sessions with the researchers.

Results: Targeted believability was 80 or higher (0-100 scale; 0 = not at all believable, 100 = very believable). For speech-language pathologist raters, average ratings met the target for the portrayals of the aphasia characteristics of word-finding problems, agrammaticism, nonverbal communication, and overall portrayal but not for auditory comprehension problems. Targets for the portrayals were met for the dysarthria characteristics of reduced speech movements, reduced loudness, reduced intonation, flat affect, and overall portrayal but not for speech rate. Ratings for different standardized patients portraying the same case were not significantly different from each other on most characteristics. Ratings from persons with aphasia were highly variable.

Conclusion: Standardized patients who do not have communication disorders can portray disorder characteristics in a believable manner.

Figure 1.

These graphs show the data from the speech-language pathologist (SLP; n = 34) ratings regarding the presence versus absence of communication disorder characteristics for the (a) aphasia standardized patients and (b) dysarthria standardized patients. Different communication disorder characteristics are presented along the y-axis, while the percentage of SLPs who indicated they detected that characteristic in each standardized patient is reported on the x-axis. APH1 = aphasia standardized patient 1; APH2 = aphasia standardized patient 2; DYS2 = dysarthria standardized patient 2; DYS1 = dysarthria standardized patient 1.

Figure 2.

These graphs present the mean and standard deviation of the SLP ratings for each communication characteristics for the (a) aphasia standardized and (b) dysarthria standardized patients. On the website, the speech-language pathologist raters saw a numeric scale from 0–10, with 10 = very believable. The data were converted to a 0–100 scale (by multiplying by 10) for analysis to allow comparisons with the data from the aphasia participants in this article and data from the students involved in the communication skills training (to be reported in a future article) who all did the ratings by using a 100-mm visual analog scale on paper. The rating scale is from 0–100, with 100 = very believable. Asterisks indicate characteristics for which the believability differed significantly between the two standardized patients (p < .05). APH1 = aphasia standardized patient 1; APH2 = aphasia standardized patient 2; DYS2 = dysarthria standardized patient 2; DYS1 = dysarthria standardized patient 1.

Figure 3.

This figure presents the data for the participants with aphasia rating believability of the two aphasia standardized patients. Data points are for individual persons with aphasia. Data for aphasia standardized patient 1 (APH1) are presented with Xs, and data for aphasia standardized patient 2 (APH2) are presented with dots.