Date of Award

Summer 2011

Document Type


Degree Name

Doctor of Philosophy (PhD)



Committee Director

Mark W. Scerbo

Committee Member

James P. Bliss

Committee Member

Poornima Madhavan

Committee Member

Gayle Gliva-McConvey


Standardized patients (SPs) are people trained to present a medical case for teaching and assessing medical students and they simultaneously perform several demanding tasks including portraying the patient, assessing the learner, and providing feedback. This study investigated the effect of improvisations and multiple task performance on the ability to observe another's nonverbal (NV) behaviors and rate their communication skills. Subjective reports of mental workload and stress were also obtained. The first study involved undergraduates interviewing for a job. Type of interview (rote and improvisational) and type of observation (passive and active) were manipulated within groups. Based on theories of attention and working memory, participants were expected to observe the fewest NV behaviors, provide the least accurate ratings, and report the highest levels of mental workload and stress after the active improvisational condition. The results indicated that the ability to observe and assess the interviewer was negatively affected for active observations and during improvisations. Mental workload was high after active improvisational observations and stress was higher after all active observations. The second study was conducted with SPs and followed a similar format with an additional between-subjects variable experience (novice and experienced). The results indicated that both active observations and improvisations negatively influenced only the SPs' ability to observe the learner. The results showed the same pattern found in the first study for the mental workload and stress data. Most importantly, SPs missed over 75% of NV behaviors during active improvisational encounters. In conclusion, theoretical models of attention and working memory were useful for understanding the cognitive challenges faced by SPs. In particular, the SPs had difficulty observing the learner and found it and more mentally demanding when simultaneously assessing the learner and portraying the patient particularly during periods of improvisation.