Creating and implementing standardized patient protocols for teaching patient-centered communication skills

Inga Karton, Marta Velgan

Keywords: standardized patient, communication skills, patient centricity


In healthcare, a simulated patient (SP), is a person trained to act to simulate the symptoms or problems of a real patient. SPs have been successfully used for education, health care professional evaluation, as well as basic and applied medical research for several decades already including for teaching communication to medical students. Motivational Interviewing (MI) is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion. Motivational Interviewing Standardized Patients (MISP) have been used by MI researchers, and MI evaluators for many years. The study conducted in 2021-23 was design to measure the effects of implementation of a MISPs in both learning and assessment of skills within the subject of Patient-centered Communication of 3rd year medical students.


The aim of study was to implement MI-based, standardized patient-assisted learning in the communication skills curriculum of the medical faculty of the University of Tartu.
133 students participated in the main study, 41 of them formed the research sample. Coders evaluated pre-post training MI-based interviews (n=82). Interviews were conducted with SPs based on standardized protocols. Global scores and behavior counts were coded according to the MITI (Motivational Interviewing Integrity Code vers 4).


Changes over time were statistically significant for Partnership (t=-2.893; p=0.006), Empathy (t=-3.108; p=0.003) and Cultivating Change Talk (t=-3.435; p=0.001). In Behavioural Counts the number of Complex Reflections increased statistically significant extent (p=0.001) and there was a positive tendency in the decrease of Persuasion (p=0.052).


Both the pilot study and the main study indicated the improvement of skills and the growth of self-confidence and, above all, the appreciation of communication skills as a doctor.

Points for discussion:

different possibilities of teaching communication skills in the auditorium

advantages and disadvantages of standardized patients compared to roleplays with co-learners and real patients


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