Uses and limitations of simulated patients in psychiatric education

Objectives: The use of standardized patients (SPs) is becoming prominent as a learning and evaluation tool in both undergraduate and graduate medical education. As increasing attempts are made to extend this tool to psychiatric training and education, it has been suggested that SPs can be useful not only to expose students to the variety of psychopathologic states, but also to teach and assess complex interpersonal processes such as em-pathic engagement and psychodynamic psychotherapy. The author argues that current enthusiasm for this modality should be tempered with caution about its limitations. Methods: Current uses of SPs in psychiatry as described in the psychiatric education and general medical education literature are critically reviewed. Results: Inherent problems in the use of SPs in psychiatry are described as they relate to the nature of empathy and the uniquely interpersonal nature of psychiatry. Conclusion: SPs are useful additions to our educational toolbox but have intrinsic limitations for our field due to psychiatry's roots in the nature of empathy and the patient-psychiatrist relationship. Standardized patients are most appropriate for exposing trainees to a variety of psychopathologies and testing very discrete skills; the use of SPs is most problematic for teaching psychotherapy and assessing complex interpersonal skills, such as em-pathic responsiveness.