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In   on April 15, 2021

Standardized Versus Simulated Clients

Key Takeaway

A standardized client is used in exams and has been trained to replicate their performance for every examinee. Simulated clients are used in learning programs and have more flexibility to adapt their performance to suit each participant’s needs.

Simulation as a methodology offers an immersive, real-world opportunity for examinees and learners to showcase or practice competency-based skills in particularly relevant or challenging professional situations. Acting as patients, clients, health professionals, employers or in other key roles, we train both standardized and simulated clients (SCs) to recreate a variety of scenarios and contexts that emulate real life.


What's the difference?


A Standardized Client is an individual who has been trained to simulate the historical, physical, and emotional features of a real clinical problem in a reliable and valid manner. This role is standardized with a Standardized Client Trainer (SCT) so that the SC presents the same material and affect as closely as possible to the other SCs portraying that same role and in each interaction with an examinee. This form of simulation is most often used in exams. Standardization of the client ensures reliability and validity of exams, as all examinees experience the same interaction. Standardization of clients is mandatory in all Touchstone Institute exams.


A Simulated Client, on the other hand, has more freedom with their role as a client. They are given the applicable, overarching information in regards to their medical encounter and are able to engage and interact with the role and its participants in a distinct way depending on how each scenario may play out. Each interaction may produce and simulate varying encounters based on the learner’s actions. These roles are generally more applicable within learning programs, and simulated clients are often also trained to provide feedback to the learner they are interacting with. There is rarely an opportunity to receive feedback from a client/patient once they enter their residency or practice, thus making the SC feedback particularly valuable. Feedback is an essential part of learning, and when given properly, it can improve confidence, self-awareness, and enthusiasm in training.

Purpose Simulation for exams is used to measure competence in a specific skill under controlled circumstances. Simulation for learning is designed to teach specific skills in a flexible and formative environment.
Training In exams, standardized clients are trained to provide specific responses when certain conditions are met. For example, an SC can only give up health history when asked specifically about health history. Simulated clients are trained to use their role information to support learning. They adapt to learner communication efforts in order to give the learner practice in a realistic encounter.
Portrayal SCs for exams must always portray their roles in a consistent and standardized manner for each examinee, with little to no variation. SCs are able to tailor their portrayal in learning program simulations according to the learner’s efforts and approaches.
Objective In exams, the goal for the examinee is to demonstrate their competence in specific clinical areas. In learning programs, the goal is to practice skills in a controlled environment. These skills may be clinical in nature or may be communication-focused.
Delivery During exams, examiners do not engage with examinees to help steer the simulation. Learners may be encouraged to use trial and error, time in and out as needed. SCs may offer feedback to learners from the client point of view.
Feedback In most exams, SCs do not provide feedback on the encounter to the examinee. However, SCs may be asked to score certain aspects of the interaction. In learning programs, SCs are trained to provide verbal feedback based on their experience interacting with the learner during the simulation.


on April 15, 2021
What's the difference between standardized and simulated clients?
on October 13, 2020
Findings demonstrated relatively high inter-rater reliability and intra-rater reliability, and that CLB-based speaking descriptors (CLB 6-9) provided sufficient information for raters to discriminate examinees’ oral proficiency.