Date of Award

Spring 2014

Document Type


Degree Name

Doctor of Philosophy (PhD)



Committee Director

Mark Scerbo

Committee Member

Ivan Ash

Committee Member

James Bliss

Committee Member

Gayle Gliva-McConvey


Standardized patients are individuals trained to realistically portray specific physical and psychological symptoms and evaluate healthcare trainees on their patient interaction skills. Prior research suggests that individual differences among standardized patients often result in assessment variance. This study examined the effects of cue serial position and evaluation format on individuals' perceptual awareness and recognition accuracy of verbal and nonverbal clinical cues. It was predicted that implementing periodic evaluations would reduce participant working memory load and permit better awareness and recognition of relevant clinical cues than the traditional post-scenario evaluation format. The concurrent evaluation benefit was also expected to mitigate the well-documented serial position decrement for information occurring in the middle of a scenario. The results suggested that verbal and nonverbal cues appearing early or late in the scenario were generally more salient than those appearing mid-scenario, but observers were better able to recognize both when permitted to offload working memory through periodic evaluation. The study also investigated the impact of a single inconsistent, unprofessional behavior exhibited by the simulated healthcare provider (SHP) on participant ratings of the SHP's clinical competence. The behavioral isolate did not influence participants' overall rating regardless of where it occurred in the scenario. Further, the isolate affected the segmental ratings of both evaluation groups when embedded early in the scenario and also affected the ratings of the concurrent evaluation group when embedded later in the scenario. This implies a reluctance on the part of retrospective participants to integrate new or conflicting information as the scenario progressed and further suggests that a successful SHP performance is unlikely to be negatively impacted by a single isolated act of unprofessionalism.


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