Are standardized patient ratings influenced by patient perceptions of the preceding examinee?

Background: Standardized patient (SP) examinations depend on observer accur acy in rating clinical performance. Purpose: To determine whether SP recall of preceding examinee performance i nfluenced ratings of subsequent examinees. Method: SPs rated the clinical performance of 168 examinees who completed 8 clinical encounters. Examinees were paired randomly, with one always follo wing the other into SP encounters. Regression analyses established the rela tion between ratings of preceding and subsequent examinees. Results: SP recall of preceding examinee performance had little influence o n ratings of subsequent examinees. Ratings of subsequent examinees were pul led in the direction of ratings of preceding examinees. Conclusions: Although most SPs are not influenced by their impression of th e preceding examinee's performance, observed effects for 6 patients indicat e the potential for such biases. The cumulative effect of such biases shoul d be minimized by having examinees follow different examinees into patient stations. The patient's role in recording and assessment should be minimize d. Copyright (C) 1998 by Lawrence Erlbaum Associates, Inc.