Who Can Be the Standardized Patient in Disaster Medical Full-Scale Exercise, Freshman, or Professional?

Background: Disasters cannot be predicted, so being well-prepared is important before a disaster strike. Good preparation needs constant practice and improvement, and full-scale exercise can provide both. The standardized patients (SPs) in a full-scale exercise to simulate patients are vital because they can provide realistic effects to exercise participants. However, there was no literature about who is capable of being an SP. We investigated the relationship between the SPs' current occupation and previous experience with their fidelity and participants' performance. Methods: Three identically designed full-scale exercises were conducted for three different emergency medical teams (EMTs) with the scenario of post-earthquake mass casualty incidents. Forty SPs were used in each exercise. Exercise objective and detail scenario were told to the SPs before exercise, and mock wound makeup was applied to the SPs. Each SP's occupation and previous experience were recorded before exercise. The SP's previous experience was defined as previous exercise experience and previous disaster medicine education. The SPs' fidelity (SPF) was rated using a 5-point Liken scale (1 = poor and 5 = excellent). The participants' performance (PP) was also rated using a 5-point Liken scale (1 = poor and 5 = excellent) according to the accuracy of each SP's triage result and management. The SPF and the PP were evaluated by clinicians with disaster medicine specialties using the same standard. The relationship between the SPs' occupation and the SPF along with occupation, and the PP were analyzed by analysis of variance (ANOVA). The data of the SPF and the PP in the SP groups divided by previous experience were analyzed by the Student's t-test. Results: The SPs' occupations were medical student, nurse, physician, and members of EMT. There was no significant difference in the SPF and the PP between occupations (p = 0.382 and 0.416. respectively). Both the experienced and the inexperienced SP groups show no significant difference in the SPF (p = 0.339). Significantly better PP was noted in the inexperienced SP group (p <0.001). Conclusions: The SPs' background does not influence the performance of either SPs or exercise participants. We proposed that the success of using freshmen as SPs in full-scale exercise depends on the pre-exercise design and the SP instruction and training.