THE

STANDARDIZED
PATIENT
PROGRAM
AN ORIENTATION MANUAL

88 College Street
Toronto, Ontario M5G 1L4
Tel: (416) 978-3465 Fax: (416) 978-4646
spp.utoronto.ca

November 2010

Standardized Patient Program, University of Toronto

TABLE OF CONTENTS
The Standardized Patient Program at the University of Toronto
Responsibilities & Expectations ............................................................. 2
General Information ............................................................................... 4
Goals & Priorities of the Standardized Patient Program ........................ 5
SPP Scope of Activities.......................................................................... 6

The Art & Science of Being a Standardized Patient

Advantages of the Standardized Patient................................................ 7
Training for Simulations ......................................................................... 8 For
Simulations in Teaching ......................................................................... 9
SP Etiquette in Teaching Situations..................................................... 10 the
Common Techniques for Teaching with SPs ....................................... 11
Teaching Physical Examination Skills with SPs................................... 12
things
ASCM: The Art & Science of Clinical Medicine................................... 13 we have
What is an OSCE? ............................................................................... 15
Writing/Life: An article by Stan Rogal, SP Associate Trainer .............. 19 to learn
Administrative Stuff before
What to do When You’re Called for a Job............................................ 19
When Will I Work Again? ..................................................................... 21
we
SPP Payroll .......................................................................................... 22
SP Activity Record ............................................................................... 23
can do
SP Resources ...................................................................................... 24 them,
Glossary ............................................................................................... 25
Staff List ............................................................................................... 26 we learn
Maps (road maps, floor plans, and parking information)
by doing
Standardized Patient Program Offices................................................. 28
University of Toronto St. George Campus ........................................... 29
them.
The Downtown Hospitals ..................................................................... 31
The Toronto General Hospital .............................................................. 32
Princess Margaret Hospital .................................................................. 33 -
Toronto Western Hospital .................................................................... 33
Mt. Sinai Hospital ................................................................................ 34 Aristotle
Hospital for Sick Children ..................................................................... 34
St. Michael’s Hospital ........................................................................... 35
Women’s College Hospital ................................................................... 35
Sunnybrook Health Sciences Centre ................................................... 36
Toronto East General Hospital ............................................................. 37
St. Joseph’s Health Centre .................................................................. 37
The Scarborough Hospital – General Campus .................................... 38
North York General Hospital ................................................................ 38

Standardized Patient Program, University of Toronto

 Standardized Patient Program
University of Toronto

Responsibilities & Expectations

We are committed to the educational needs of the trainees and faculty with whom we work, and the well-
being and professional development of the standardized patients who make this program possible. To
ensure the satisfaction of all parties, it is important that you understand the following list of responsibilities
and expectations.

Standardized Patient Responsibilities:

Professionalism:
” I will attend all required training sessions and simulations.
” If unable to attend a training session or simulation, I will contact my trainer as soon as possible so
that he/she can find a replacement.
” I will arrive punctually for all appointments.

On the Job:
” I will portray each role as I was trained.
” In teaching situations, I will provide feedback objectively, and honestly, as trained.
” I will avoid contact with the students “out of role” before or during the simulation.

Confidentiality: Protecting the confidentiality of our learners is essential to providing them with a safe
learning environment. As well, keeping case materials confidential is key to maintaining the integrity of
the examination process, and the understanding that we have with our clients. For that reason –
” I will protect the privacy of students/examinees by not discussing their performance with anyone
except those directly associated with the project.
” I will protect the security of case materials by not discussing the role or sharing case material with
anyone other than staff/faculty directly associated with the project.
” I will keep secure any exam cases, including checklists, and return them to the SP Program at the
completion of the project.
” I will refer all persons who approach me about any case I have portrayed to my trainer.

Standardized Patient Expectations:

” I can expect to be treated with respect and consideration by SPP staff, healthcare professionals,
and students.
” In a physical examination, I can expect to be provided with appropriate draping and privacy,
bearing in mind that these are some of the skills that we are helping the learners to acquire and
they may require our patience and constructive feedback as they learn.
” I can refuse a role if I feel uncomfortable with the topic.
” I can expect to be informed in advance of the nature and purpose of the simulation.
” I can expect to get feedback from the SP Program if my work needs improvement.
” I understand that standardized patient work is occasional.

I have read and understand the above

responsibilities and expectations. Initial: ______________

Standardized Patient Program, University of Toronto Page 1

 General Information about
The Standardized Patient Program
The first standardized patient (SP) was conceived by neurologist Dr. Harold Barrows in the 1960’s. He
found that the real patients available for teaching and examination were not
providing consistent and valuable experiences for his medical students and were
often too sick to practice on. He gathered a group of people who could simulate
medical conditions. The first Canadian program was established at the
McMaster University medical school and, soon afterward, the Standardized
Patient Program began at the University of Toronto.

Times and attitudes have changed profoundly in healthcare and medical

education over the last twenty years. Advances in science and digitizing
technology are revolutionizing healthcare and medical education; innovative Dedicated to
developments in the delivery of course material and evaluation have to keep
pace. The Standardized Patient Program helps to prepare students to meet the promoting
responsibility of patient care by ensuring that students stay in touch with
people, in the context of the clinical challenges they will face. better health
What is the SPP?
outcomes
by improving
• a dynamic educational resource dedicated to enhancing health
professional training; the quality of
• a cohort of over 500 people from a variety of backgrounds including
education, medicine, literary, visual and performing arts; medical
• Standardized patients give feedback from a patient’s unique point of
view;
training
• Emphasize communication and interpersonal skills that enhance the
therapeutic quality of the doctor/patient relationship;
through the
use of
The enhanced doctor/patient relationship results in greater patient satisfaction
and promotes better health outcomes. standardized
patients
- a dynamic
educational
resource.

Standardized Patient Program, University of Toronto Page 2

 Goals & Priorities
and Priorities

To promote and enhance the therapeutic relationship in the delivery of health

care
• by facilitating the integration of interpersonal & professional behaviours with clinical skills
• by promoting the importance of the human element in medicine and deepening the
awareness of patient needs & expectations

To systematically improve delivery of the health professional curricula

• by broadening the scope of students’ clinical experience through exposure to a full range
of patient scenarios
• by reducing variability in assessment (OSCEs)

To improve the utilization of Standardized Patients as a dynamic learning

resource
• through collaboration with course developers & directors
• through faculty development

To contribute to health professional scholarship

• through research, publications and presentations

Standardized Patient Program, University of Toronto Page 3

 Scope of Activities
The Standardized Patient Program is involved in a huge variety of projects across the healthcare
education spectrum, out into the community at large, in government programs and private industry. We
are used both for teaching and assessment. The activities of the SP Program at U of T include:

1) Domains 4) Topics
Teaching Introductory interviewing skills
Assessment Bioethical issues
Research Breaking bad news
Standard setting Communication skills
Quality Assurance Counseling skills
Cross-cultural interviewing
2) Levels of learning Dealing with difficult patients
Undergraduate Dispute resolution
Postgraduate Domestic violence
Licensure End of life issues
Continuing education Basic and advanced feedback
Faculty development Informed consent
Interprofessional communication
Introduction to history-taking
3) Disciplines we serve Learning and Communication styles
Alternative medicine Medical emergency
Chiropody Medical error disclosure
Dentistry Organ donation counseling
Dispute resolution Pain management
Family medicine Palliative care
Human resources Physical examination skills
Medical technology Sexuality
Medicine
Midwifery
Neonatology
5) Activities
Nursing Case-writing Courses
Occupational & Physical Therapy Curriculum development
Pediatrics Demonstrations
Patient education Exams
Pharmacy Formative evaluation
Private industry Invited presentations
Psychiatry One-on-one tutoring
Radiation oncology Small group sessions
Surgery Train the trainer
Videography
Web-based learning
Workshops

6) Media Production
CD Rom
DVD
Manuals
Photography
Video

Standardized Patient Program, University of Toronto Page 4

 Advantages of
the Standardized Patient
A Standardized Patient (SP) is a healthy person who has been carefully trained to
portray the historical, physical and emotional features of an actual patient. They provide
an exceptional resource for teaching and assessment.

SPs are … What does this mean? What does this require from each SP?

Valid SPs are comparable to a real patient
Available SPs are available at any time and any place. It
is not necessary to rely on real patient cases that
are available only at a given time.
Reliable Symptoms, signs and psych-social aspects
remain stable. The same simulation is always
available and repeatable.
Controllable Situation, setting, level of difficulty, and amount
of information given to the student can be
controlled.
Adaptable The simulation can be interrupted during the
examination or interview (using “time out”) and
students can discuss with the tutor or amongst
themselves any problems or findings. A
resource can be consulted and examination
continued. Discussion of the problem can be
openly discussed in front of the SP (during “time
out”). Students and tutor can do ongoing
evaluations of their performance.
To portray the role realistically.
To be as flexible and accommodating as possible
when called for a job.
To portray the role consistently with each
repetition, and remain standardized with other SPs
playing the same role.
To be flexible in adapting the role to meet specific
needs of the trainee – as directed by the trainer
To maintain the realism and intensity of a role,
even when interrupted with “time outs.” During a
“time out,” the SP remains in role, but “freezes”
and avoids all interaction with trainees and tutor.

Students need not feel any time restrictions and

can take as long as necessary to interview or
examine the SP, using “time out” and “time in” to
put their thoughts together. It is possible to
follow the problem through to the end, as the
future of the case is already known. (NB this is
one of the advantages of using actual patient
histories.)
Able to give SPs are able to give immediate and constructive To give specific, constructive feedback to students
feedback feedback to the students. when required.

NB: Certain teaching sessions will require SPs to

give feedback to the students. SPs will be trained
in giving feedback before being asked to do such a
simulation.

Risk free Students need not be concerned that they will To remember that the SP’s purpose is to focus on
impose any inconvenience, discomfort or harm the student’s needs, and that the SP’s own agenda
on real patients. must not be evident.

Standardized Patient Program, University of Toronto Page 5

 Training for Simulations
During the training session, the SP will be given all the necessary details in order to
portray the “problem” accurately. In addition, the trainer will provide information about
the context of the assignment, so that the SP understands the objectives of the
encounter. Here is the kind of information the SP needs in order to understand the
context:

ˆ Is this role for an exam, or teaching, or something else?

ˆ What is the level of the trainees?
ˆ If this is a teaching session, what are they supposed to be learning?
ˆ If this is an exam, what are they being assessed on? If at any
ˆ Does this role include a physical exam? If so, what kind?
ˆ Will you be required to give feedback after the simulation? time you
ˆ Is any special costume or makeup required for the role?
are in need
The training time will depend on the complexity of the case and the SP’s own
of a review,
experience. SPs may be trained for several roles over a period of time. The more
experience they have, the less time it takes for training. The actual training is divided
or if you
into two sessions: have
• training in the history of the problem
• the dry run questions
or
A lapse between the two sessions of a number of days allows the SP to take home all
the information, review it, practice it, and incorporate it into their daily lifestyle. The dry
concerns
run is the “dress rehearsal.” This session is the last training session SPs have before
they are used with the students. This provides opportunity for:
with the
• the trainer to revise and “finely tune” the simulation simulation,
• the trainer to comment on consistency and “realism” of the simulation
• simulating the problem for the first time and allowing the SP to ask questions arrange
about anything they are unsure of.
some time
Some roles involve making a “return visit” to the doctor – SPs will be trained for any
additional visits and information necessary.
with your
trainer for
this
purpose.

Standardized Patient Program, University of Toronto Page 6

 Simulations in teaching

SPs in Teaching
SPs are used to teach communication skills in a variety of settings. From medical and pharmacy school
curriculum to conference workshops, faculty development workshops, advanced communication courses,
continuing education, patient education and more (see our Scope of Activities).

SPs may help to teach basic interviewing and communication skills or they may be asked to portray very
complex roles designed for residents or practicing physicians. They may or may not be asked to provide
feedback in these sessions. SPs receive specialized training in feedback through the SPP at facilitated
feedback workshops.

In addition to medical roles (e.g. chest pain, headache), we also train SPs in more complex scenarios
such as psychiatric roles and ethical roles. These scenarios are broader in scope, and can be more
demanding on the SP. In response to the needs of our multicultural population, the students are also
instructed in cross-cultural issues, such as how to interview a patient through an interpreter.

There are no limits as to how SPs can be used in teaching so it is difficult to describe or anticipate all of
the situations you may find yourself in. Often there will be other SPs involved at the same location and
there may be support staff like a project coordinator or a trainer. Sometimes you will find yourself on your
own at a location. You should always know the logistics of any situation before you go out as your trainer
or the person that booked you will have reviewed them with you. If you are uncertain about any details,
location, time, or what will be expected of you PLEASE call your trainer, the project coordinator or if you
can’t reach them try the office, someone will be able to help you.

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SP Etiquette in Teaching Situations

1. It’s a good idea to meet with the tutor a few minutes prior to your simulation to
discuss the structure of the encounter and review any questions you may have
eg. will they be using time outs, do they want your feedback, etc..

2. Do not speak with the students “out of role” before or during the simulation – if
at all possible, avoid seeing them out of role.

3. A “time out” is a valuable learning process for the student. When you are in a
“time out” period it is important for you to continue the simulation (i.e. facial
expressions, body language, etc.). However, DO NOT interact with the student
or group until “time in” is called. Note: your subsequent performance must not
be modified by the discussion during the “time out” period.
It is
important
4. Do not allow a tutor or faculty member to change your simulation. You have
been trained from an actual patient case with the realistic physical findings, to maintain
history and psychosocial problems of that patient. If the tutor wants to change
your simulation, explain that you need to remain as you were initially trained a high
and refer him to the SP Program Director. However, if the tutor wants to “tune”
your effect (to increase your anxiety or decrease your anxiety, for example) or
quality
your “setting” (e.g. clinic, office, emergency room, etc.), this is appropriate.
Please record this change so that future faculty can make decisions about this
simulation
fine “tuning.” at all times.
5. Feedback is given at the end of the encounter. It is not appropriate to give As an SP
feedback during a “time out” or between students. Again this will add to the
realism of the SP if feedback is given only when you are finished with your you are re-
performance and “out of role.”
sponsible
for this.

Standardized Patient Program, University of Toronto Page 8

 Common Techniques
for Teaching with SPs
When preparing for an SP assignment in a teaching situation, it is helpful to know different techniques.

1. One Complete Interview after another

A number of students is chosen to interview the SP. They may wait outside the room or they may stay in
the class to observe the other interviews. Each student completes an interview with feedback provided
after each interview.

„ Advantages: the classmates who are observing see three complete interviews with varying
approaches to a problem. Feedback to each student remains specific and high in quality.

„ Disadvantages: student(s) waiting outside don’t have the benefit of observing & anxiety levels
may rise as they wait. Interviewers who have observed the others may find it difficult to
“forget” what they have seen & heard so that the encounter seems less realistic each time.

2. Tag-Team Approach
The SP scenario runs from beginning to end with “time-in/time-out” breaks during which students switch
into the interviewing chair. The interview continues from where the previous student left off.

„ Advantages: all the students are potential interviewers so it keeps the class focused.

„ Disadvantages: the SP does not come out of role until the end of the teaching session
(perhaps after several students) so the quality and specificity of the feedback may diminish.

3. Alter-ego
Two students interview the SP as one. One student conducts the interview the other shadows them,
offering suggestions. Either student may call “Time Outs” to confer about the progress of the interview.

„ Advantages: the student has the support of a peer and time to shape questions and
responses. This technique is helpful for students who are shy or reticent in front of others.

„ Disadvantages: start/stop process. The flow of the interview is sacrificed.

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4. Collective interview
The SP is asked questions by individuals from the audience more like an interview show.

„ Advantages: no student is put on the spot as the interviewer. A lot of content can be covered

„ Disadvantages: The focus is on the content rather than communication. There is little
development of rapport with the patient in this model. SP is in the hot seat.
5. One-Way Mirror
A student interviews an SP alone in a room while being observed by the class behind a one-way mirror.
Following the interview, feedback is given to the student with the class & teacher present.

„ Advantages: the experience is more realistic for the student.

„ Disadvantages: there is no safety net of “time-outs”. The experience is more intense than in
a classroom setting.

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 Teaching Physical Examination
Skills with SPs
Giving students an opportunity to practice physical examination skills with a Standardized Patient enables
them to:
ƒ practice new skills in a safe environment
ƒ obtain feedback from the SP regarding how the examination feels from the patient’s point of view
ƒ experience what examination of a healthy person feels like, which provides them with a
benchmark with which to assess patients with physical findings

In most physical simulations for teaching purposes there is no “role”, the SP is a body part and the
students take turns learning to perform the examination. Occasionally symptoms, pain or range of motion
are required in teaching situations and the SPs would be trained accordingly. These requirements are
more common in simulations for assessment purposes

Dr. Dale McCarthy, a trainer with the Toronto SP Program, has produced a training video that introduces
the physical examination. This video is available for viewing upon request at the SPP office and is
recommended for anyone who has not done a physical examination session for teaching purposes.

Standardized Patient Program, University of Toronto Page 11

ASCM:
The Art & Science of Clinical Medicine
One of the SPP’s most significant contributions to medical education at U of T is our involvement in the
ASCM course. This course teaches communication and physical examination skills to first and second
year medical student. Curriculum for the two years is organized as follows:

Year 1

This course is organized in hospital-based groups of 5 to 6 students, and will take place 1/2 day each
week of the academic year. The first semester, September to January, is devoted primarily to
communication skills, and includes the following:

1. Listening skills;
2. Non-verbal communication;
3. Questioning techniques;
4. Empathic interviewing;
5. Cross-cultural and gender issues in the doctor/patient
encounter;
6. Ethical issues in the doctor/patient encounter;
7. Components of the biomedical history; and,
8. Writing and presenting patient interviews

Selected components of the normal physical

examination, primarily related to the cardiorespiratory
system, will also be presented. The second semester, February to May, will be devoted to learning the
techniques of the normal physical examination, and to refining and practicing the communications skills
learned in semester one.

General Objectives

1. To learn the components of the traditional medical history and physical examination.
2. To learn the process skills by which such information is best collected in the doctor/patient
interaction.
3. To develop verbal, non-verbal, and written communication skills in both obtaining and giving
information.
4. To develop the psychomotor skills necessary to correct technical performance of the physical
examination, and interpretation of abnormal findings.
5. To develop a non-judgmental, patient-centered approach to the doctor/patient interaction, in order
to promote the physical, emotional and social well-being of patients. This includes a sensitivity to
communicating with people from different cultural, community and religious backgrounds.
6. To develop humanistic attitudes of honesty, fairness and compassion towards patients, peers and
other members of the health care professions.

Year 2

The course is organized in hospital based groups of 6 students and will take place on Thursday mornings
each week of the academic year. The course will begin with a review of the general clinical examination
taught in ASCM-1 as well as the components of the written case report. The majority of the year will be
directed to learning the focused history and physical examination with respect to general medical practice
as well as the specialized areas of geriatrics, pediatrics, psychiatry and surgery. Students will learn the
components of the oral presentation. Throughout the year groups at each hospital will be rotating

Standardized Patient Program, University of Toronto Page 12

between specialty areas. During most ASCM-2 sessions there will be an opportunity for a clinical
encounter. Students will have the opportunity to practice history taking skills, physical examination skills,
oral presentation skills and written presentations.

General Objectives

1. To strengthen skills in history taking and physical examination

2. To learn how to do a focused history and physical examination.
3. To integrate knowledge of disease states to begin generating differential diagnosis for clinical
presentations.
4. To learn to perform an oral case presentation.
5. To strengthen skills in the written case presentation.
6. To learn the difference between normal aging and disease.
7. To learn the features of the clinical encounter specific to the elderly patient.
8. To learn the features of the clinical encounter specific to infants and children.
9. To learn psychiatric interviewing techniques and how to perform a mental status examination.
10. To learn features of the musculoskeletal examination.
11. To learn the surgical approach to the abdomen, and other systems.
12. To learn the approach to the ophthalmologic and otolaryngologic examination
13. To strengthen awareness of cultural differences that affect the doctor patient interaction.
14. To practice the patient centred approach to the clinical encounter.
15. To strengthen interviewing, communication and interpersonal skills, and professionalism.
16. To learn an approach to breast disease and how to perform the clinical examination of the breast.
17. To learn how to do a digital rectal examination.

An ASCM interview or “history taking” session looks something like this:

• one group of 5-6 students with a tutor and an SP

• typically, one student interviews the SP for several minutes
• then the student will comment on the interview (e.g. were they comfortable, where did they get
stuck, was there an uncomfortable topic)
• then the SP gives feedback about the interview (I felt relaxed when you said that, I felt that some
of your comments were judgmental and that made me uncomfortable).
• Finally, the other students and the tutor discuss the encounter. Suggestions might arise from the
discussion, and the student can return to the interview trying a different approach.

As the students become more advanced in their interviewing skills, they are introduced to a series of
more difficult communication scenarios, such as breaking bad news to someone who has just lost a loved
one, or counseling a patient about a life-threatening illness.

As the students become more advanced in their interviewing skills, they are introduced to a series of
more difficult communication scenarios, such as breaking bad news to someone who has just lost a loved
one, or counseling a patient about a life-threatening illness.

An ASCM physical examination session looks something like this:

• a group of students, a tutor and an SP

• the SP is a “body” and does not normally have a complaint or problem although they may be
trained to mimic abnormal physical findings. This enables students to experience examining
normal and abnormal findings in a patient.
• the session will be focused on one part of the body i.e. a chest exam, or a liver palpation
• the instructor may demonstrate the techniques to be used or they may ask a student to jump in
• the instructor will remind the students about proper draping techniques
• sometimes the SPs will be asked to give feedback on the student’s touch (e.g. too rough, or not
firm enough) or rapport (making eye contact, checking in with the patient, etc)

Standardized Patient Program, University of Toronto Page 13

 What is an OSCE?
An OSCE (pronounced OSKEY) is an objective structured clinical examination. It is a performance-based
exam in which students are observed demonstrating various clinical skills as they rotate through a series of
stations. Each station usually tests a different component of clinical competence such as taking a history,
conducting a physical examination, ordering diagnostic tests, making a diagnosis, planning treatment, or
communicating with patients.

The OSCE is objective because examiners use

a standardized checklist (of expected clinical
behaviours) for evaluating students. It is
structured, or planned, so that every student
sees the same problems and is asked to
perform the same tasks. The OSCE is said to
be clinical because the tasks are
representative of those faced in real clinical
situations. And finally, it is an examination.

Most OSCE stations require the candidate to

interact with the SP, under the observation of an
examiner. The candidates rotate from room to
room, until they have completed all the stations.
Some stations have a written component, or
require the candidate to demonstrate a
manoeuvre on an inanimate model.

Our SPs are used in undergraduate and postgraduate OSCEs, as well as exams for foreign medical
doctors, physiotherapists, nurses, chiropractors, and pharmacists. We administer licensing exams for
national licensing boards like the Pharmacy Examination Board of Canada and the Medical Council of
Canada. In these cases, the same exam is held in several sites simultaneously with standardization of
patients extending across the country in order to create a fair and standardized exam.

SP Responsibilities in an OSCE
The standardized patient’s primary responsibility in an OSCE is to help to maintain the consistency and
fairness of the exam by providing standardized and realistic portrayals.

Standardized patients who participate in an OSCE are responsible for:

• adherence to the goals of the exam and the purposes of the roles they play, not to pursue their own
goals in terms of performance or influencing the medical system
• complying with the procedures of the exam itself, such as correctly following the rotations and
timings, and completing necessary paperwork.
• keeping exam materials and the nature of their roles CONFIDENTIAL
• remaining in role at all times while they are in the OSCE station.

It’s important to remember that, for the candidates, the OSCE can often be a worrisome experience. Their
performance on the exam may determine whether or not they pass a particular course. For high-stakes
licensing exams, failing the OSCE will place a huge obstacle in the way of their career plans. We need to be
mindful of the candidates’ apprehensions, and strive to provide a seamless and comfortable exam so that
they can do their best.

Standardized Patient Program, University of Toronto Page 14

Training for an OSCE
You will be provided with a detailed patient profile, including information about the patient’s
• chief complaint • family history
• history of present illness • social history
• past medical history • affect and behaviour

Chief complaint: This is the reason the patient is seeking help. To ensure standardization, all SPs playing
the same role use a precisely worded statement in every simulation e.g. "I've had a pain in my stomach for
about two weeks and I don't know why. I thought I'd better find out what's going on."

History of present illness: This is a description of all symptoms, including such details as:
• onset • quantity
• duration • intensity
• progression • alleviating and aggravating factors
• frequency • associated symptoms
• location • current medications
• description • precipitating events
• radiation • temporal/environmental/physical considerations
• quality

Sometimes a timeline will be provided to clarify the order of events in the story:
e.g. 2 months ago - pain started
3 weeks ago - had tests (Xrays of the gastrointestinal tract)
2 days ago - visit to ER for severe pain

Past medical history: This includes facts that are relevant to the present illness and those which are not, e.g.
• past illness • accidents/injuries
• hospitalizations • allergies
• operations • past medications

Family history: This includes significant health problems of:

• parents • extended family members (if appropriate)
• siblings • spouse and children (if appropriate)

Social history: If appropriate to the station, information will be provided about:

• marital status • habits (drugs, caffeine, alcohol, tobacco)
• living environment (where and with whom) • sexual history
• educational background • diet and appetite
• socio-economic level • sleep
• work (type, environment, occupational • hobbies
hazards or exposures) • general sense of well-being

Patient affect and behaviour: The patient's level of anxiety, affability, physical appearance (including hygiene
and dress), voice tone and volume, body language, mannerisms, etc. These details impact the candidates
understanding of the patient.

Prompts
In some cases the SP is required to prompt the candidate. For example, if the candidate has not mentioned
the possibility of cancer by the six-minute mark, the SP might say: “I'm worried this might be lung cancer“.
When prompts are called for, you will be given the precise wording and time at which they are to be used.

The case author may also include an assortment of questions the candidates are likely to ask, along with
appropriate answers as guidelines for how SPs should respond.

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Training Sessions for OSCEs

OSCEs can take various formats. Usually two sessions of 1.5 to 2.0 hours are required for an OSCE role.

Standardization: So that every candidate has an equal opportunity, it is important that the simulation
remain as consistent as possible from the first to the last performance. The trainer will explore the
following issues with the group:
• what information may be volunteered to the candidate
• what information must be elicited from the SP
• prompts (if required)
• strategies for responding to good open-ended questioning or poor questioning
• strategies for responding to unanticipated questions ie. neutral answers
• strategies for making the transition in and out of role – especially important in a very difficult or
highly emotional scenarios

Group training is invaluable to the art of standardization, because each SP can practice doing an interview
with all SPs present, and observe their colleagues playing the same role. The trainer will play a variety of
candidates so that SPs are exposed to good, bad and mediocre interviews during their training. A practice
"script" may be provided to enhance the training session. The trainer will try to include all possible questions
that may be asked by candidates so that SPs are not surprised on the day of the exam. It is important to
remember that, even though SPs are thoroughly trained, they should strive to sound as natural and
spontaneous as possible. The more realistic the portrayal, the better the candidate performs.

Videotaped interviews may be used in cases where the whole group is not be able to meet together.

Possible Training Techniques

• Discussion of the role with the whole group clearly laying out context and expectations.
• Review of any support material pertaining to the role.
• A ‘round robin’ (each member takes a turn answering a question as the patient) to help to imbed
details of the role early on in training.
• Practice interviews: one SP plays doctor and one the patient while the others observe. This helps to
gain a better understanding of the complexities of the role. It also helps to clarify checklist items as
the SPs determine what can be given away and what must be elicited.
• Trainers may encourage questions – often aspects of the role have not been thought through or
clinical information needs to be clarified. Invariably a candidate will ask something that wasn’t
anticipated in training. Imagining & discussing a day in the life of the person you are portraying will
prepare you for most questions and will ensure that neutral answers are given which will not affect the
case.
• Mistakes made by SPs during training are great learning opportunities for other SPs in the session so
don’t worry when mistakes happen, that’s what the training sessions are for!
• You may be assigned something specific to observe while an interview is conducted. For example,
one observer watches for content errors, another focuses on the affect being portrayed, another the
timing etc. This keeps everyone thoroughly engaged during the session.

Dry runs:
This is the final training session, taking place within a few days of the OSCE, and sometimes on-site,
immediately preceding the exam. A person knowledgeable in the subject of the station may act as the
candidate and conduct the interview. The interview will be timed as it is to be done in the OSCE. This is the
time for any last minute fine tuning of the role.

In licensing exams on the day of the OSCE, the SPs for each particular station will get together and
demonstrate the role for the examiners before the OSCE begins. This is the step that really ensures a
standardized station. It also allows the examiners to practice using the checklist

Standardized Patient Program, University of Toronto Page 16

Simulation in an OSCE
Maintaining the accuracy of a simulation through the day isn’t easy – especially when the role is emotionally
draining or physically demanding.

Rotations
Some roles require rotations where there may be 2 or 3 SPs rotating through a station. Your trainer will have
informed you if you will be in rotation. The exam
coordinators will give you a rotation schedule where
required. Sometimes, moving in and out of a very
emotional role can be stressful, so fewer transitions
are appropriate.

Maintaining Consistency
There are many simple ways that can help SPs to
maintain consistent simulations:

• SPs doing the same role check on each other

between rotations
• Trainers touch base with SPs doing difficult roles
• Refreshments! There are usually breaks for SPs
at regular intervals.
• Prepare & debrief – the trainer will explore with SPs techniques they can use on exam day that will
help them move in & out of role

Support Staff
An OSCE is a complex event with many logistical challenges that must operate precisely and efficiently.
For this reason, some SPs who are not doing simulations are given the opportunity to perform “Support
Staff” roles – tasks that ensure that the OSCE runs smoothly, e.g. -
• sign-in staff – assist with registration of candidates, SPs, examiners
• timekeepers – keep track of the timing schedule, and announce when the signals should be sounded
• bell ringers/door knockers/whistle blowers – sound the signals that mark the passage of different
components of the exam
• candidate escorts – lead candidates to the different stations
• chaperones – accompany candidates to the washroom
• Post-encounter probe (PEP) collectors – pick up exam papers throughout the day and deliver to the
marking room
• clerical staff – sort exam papers
• set-up/take-down staff – set up furniture, signs, equipment and exam materials before the exam and
tidy up afterwards
• catering – set up meals and snacks for participants

Some SPs enjoy doing these tasks occasionally as a break from simulations, while others prefer not to work
as support staff. The program respects these preferences.

Standardized Patient Program, University of Toronto Page 17

Writing Life
by Stan Rogal

During the last couple of years, I've been to doctors with the following complaints: accident injuries, heart
condition, ulcer, fear of AIDS, ruptured spleen, schizophrenic child, paranoia, delusions, suicidal feelings, and
antisocial tendencies.

I am not a hypochondriac; this is how I make money to support my writing habit. From conversations at
parties, I realize that my part-time occupation adds new meaning to the term ‘odd job’. You see, I am what is known
as a Standardized Patient, or SP.

Lest you are considering cashing in on this easy way to earn a living, imagine the following scenario: You
enter a doctor's office. The doctor extends a hand and offers some pleasantry. You immediately begin a
verbal assault complaining about how long you've been kept waiting, how this delay is costing you money,
how the doctor doesn't know anything, how the government is right to shut down hospitals, since doctors earn
too much and spend most their time on the golf course anyway. Why not just set up shop on the 18th green
and be done with it? Or; after being asked what brings you in today, you reply that you can’t get it up, or can get
it up but can't put it in, or maybe you're in some way attracted to the doctor.

You watch the doctor squirm and sweat while attempting to take control of the situation. You feel slightly
sorry for the doctor, but you continue regardless, knowing that it’s your job. After 10 or 15 minutes, the
interview ends, everyone relaxes, and there is discussion. The doctor usually comments that the textbooks
never prepared him/her for this.

The scenarios I've described take place in a classroom and are designed to offer hands-on training to students in
the medical department at the University of Toronto. Even though these are dramatizations, the anxiety and
tension they elicit are very real. These types of patients are a medical student's worst nightmare, and students
prefer to face them for the first time under artificial conditions. That’s where I come in. I am trained to portray a
real patient based on actual case studies, including pertinent history and symptoms. We are labeled ‘standardized’
because each of us who portrays, for example, John Doe, migraine sufferer, provides the same information in more
or less the same fashion, albeit with the individual physical and personal differences a doctor would encounter
anyway.

The stakes rise when student candidates are placed in a test situation. They move from room to room over
a two or three hour period and are confronted with ‘patients’ who display everything from sore backs to
ruptured spleens to knife wounds. On some test days, the waiting room resembles a scene from Night of the
Living Dead, with SPs made up to sport black eyes, first-degree burns, and bloodied wounds and generally
prepared to writhe and scream in pain at the sound of the bell or the touch of a clumsy hand.

It sounds like a comical situation, but candidates pay big bucks to take these tests and the number who
advance is low. There's no room for unprofessional attitudes on anyone's part. There are quiet roles, as well,
and some extremely emotional parts. In one scene, I play a man who has struck his wife for the first time and is
now feeling utterly remorseful. After four hours of anguish and real tears, it is difficult – if not impossible – to
simply drop the character. After I leave work and go home, I have to contend with the emotional and physical
spillover.

Speaking of spilling over into real life, I recall an incident with an acquaintance who overheard me discussing a
recent role with friends. Having only picked up part of the conversation, he thought I was married and had recently
been diagnosed with AIDS, and had me pegged as soon-to-be-departed. For weeks afterward, he spoke to me in
‘hushed tones’. I don't know whether someone finally clued him in, or whether the sheer number of my growing
‘conditions’ eventually forced him to ask.

It's clear that with this job, one must be careful what one says and to whom. It's almost like being a writer –
except that people I meet at parties seem to find being a paid patient more interesting.

Stan Rogal is a writer and actor who lives in Toronto. His latest book, Personations (Exile)

Standardized Patient Program, University of Toronto Page 18

 What to do
when you’re called for a job
Things you need to know:
(Your trainer will cover most of this information in the
training session.)
ˆ Date of job
ˆ Location of job
ˆ Time you should check in before the simulation
ˆ Name of person you should check in with
ˆ Actual start and finish time of the job
ˆ When will the training take place?
ˆ What is the rate of pay?
ˆ When will you get paid for this job?
ˆ What role will you be doing?

Things you need to do:

ˆ Write the details in your calendar and your SP Activity Record
ˆ Review the role before the day of the simulation to be certain of the details

Quality Reports:
” Some teaching situations, in
which you will be providing
It is a good idea feedback, require a Quality
to fill in the first Report with your real name
box before you on for the tutor (ASCM and
begin each Pharmacy 429).
assignment so ” Quality Reports are returned to
the SPP Director who will then
that your forms forward copies to you. They
are ready to be provide valuable feedback from
handed to each clinicians on the realism and
instructor you usefulness of the roles. Also,
work with. you will find it helpful to read
their comments on your
performance and feedback to
the students.

Standardized Patient Program, University of Toronto Page 19

Things to do after a simulation:
1) Debriefing:
• It’s often helpful to ‘debrief’ after a simulation, especially if the role is emotionally
demanding.
• If there are other SPs working at the same site, you may want to chat with them after the
simulation
• Call your trainer if you have any concerns or comments about the role, your performance,
the trainees, or the tutors
• If you are on your own, are unable to meet with other SPs to discuss the simulation or
can’t reach your trainer:
♦ Write about your experience and how you felt, this is particularly important if you have
issues or concerns about something that happened so that you have documented the
details;
♦ Give yourself a treat, especially after an emotionally demanding role. Try a bath or a
shower, a long walk, listen to soothing music anything that allows you to clear away the
emotional state of the role.

2) Remember to sign out or if you are out on a teaching assignment and the session went longer than
expected make sure to call in the additional time to your trainer.

3) Remember role security

• If you did a secure exam role, make sure you hand in all training materials to your
trainer.
• If this was not a secure role, file it safely in your own “SPP Role File” so that it’s
handy for a quick review next time you’re asked to do that role.

Standardized Patient Program, University of Toronto Page 20

 When will I work again?
We often get calls from SPs wondering when they will be sent out on their next job.

You will find that SP work can be very sporadic, but don’t get discouraged. Some SPs prefer to work
infrequently, perhaps doing only the occasional weekend exam.
Others want to work more frequently. We need to get to know
what your preferences are, your level of availability, and your
range of skills.

Because of the nature of our business, it’s difficult to predict what

jobs the future holds, or what demographic groups will be
required. Sometimes there will be a big project approaching, or
a particularly busy period, and we’ll be able to give you some
indication of upcoming work. But most of the time this just isn’t
possible.

Most of our work occurs during business hours and large exams
tend to happen on weekends. Because of the sporadic nature of
this work most SPs have other jobs. They are actors, writers,
students, teachers, and retired professionals, to name a few.

Availability: If you are anticipating a time when you won’t be available for SP work please call and let us
know the dates when you would like to take a “leave” from the program, and then call us back when
you’re available for work again. We’re always happy to accommodate when we have notice.

Cancellations: Most SPs have to cancel a training or simulation booking at some time, perhaps because
of a work conflict or an audition, we try to accommodate this when it happens - and wish you the best on
your audition. However, repeated cancellations (even for a good reason) will discourage us from calling
you, because you may appear unreliable.

Please Note
An interview is not a guarantee of work with us. We will call you if we have a place for you in our roster
and/or we feel you are suited to this work. If your contact information or availability should change do let
us know. Call 416-978-3465 and leave a message so that we can update your file.

Standardized Patient Program, University of Toronto Page 21

 SPP Payroll
What we need from you:
• A void cheque for the current account to which you want your pay to be
deposited. If this account changes you must let us know.
• We need your full name (as it appears on your birth certificate) and your
social insurance number. You cannot be paid without this information.
• You may be asked to stay for a simulation longer than anticipated. If this
happens, please let us know to ensure that you are paid for the extra time.

How you get paid:

• Standardized patients are employed as casual employees with the University
of Toronto, and are on a bi-weekly pay schedule (ask for a payroll schedule
or download one from our website).
• After a training session, simulation, or exam, your trainer or project
We can’t
coordinator will submit your hours and rate of pay. pay you
• Every two weeks your information is submitted by us to U of T Payroll.
• Your pay for any work or training done in a two-week period is directly without …
deposited to your bank account the following week. You will receive a
notification in the mail detailing the amount of your pay and deductions.
1. voided
Keeping records: cheque
• It’s a good idea to record all of your training and simulation sessions on an
SP Activity Record (see over), so that you have something to check your pay 2. SPP
notification against. applic-
• SPs are paid for a minimum of two hours for training and simulation.
ation form
Understanding the SPP pay scale 3. U of T tax
• As we tell our new SPs, SP work will not put bread on the table! (But it will
put some jam on your bread!) The SPP is a self-funding program and form
receives no funds from the university, and this prevents us from paying SPs 4. U of T
as generously as we would like.
• There are set rates for certain roles: direct
o Most training sessions - $12/hr
o Most simulations - $15/hr deposit
o Physical examination (non-invasive) - $20/hr form
o Breast exam - $25/hr
o Male rectal exam - $35/hr 5. a photo-
• Rates for other jobs are individually considered based on the budget for that
project, and sometimes on the demands of the role. Your trainer will tell you
copy of
your rate of pay at the training session. your
Whom to call if you have questions …
social
• Call your trainer or project coordinator if you have questions about your rate insurance
of pay or how many hours you worked. card
• Call the payroll department at the SPP if you have questions about the timing
of your pay, problems with your direct deposit, or any changes to your
personal information.

Standardized Patient Program, University of Toronto Page 22

 SP Activity
Payroll Record
Schedule For the Year 2005
Every SP activity you participate in, whether its training or simulation, should be noted on your personal
SP activity record. It’s a good idea to compare your pay against this record, to ensure that you have been
paid for all hours worked.

Standardized Patient Program, University of Toronto Page 23

 SP Resources
Videos
(These are available for viewing upon request)
• Dale McCarthy’s introduction to the physical examination
• How to Run an OSCE – a guide to running an OSCE, this video gives a great picture of what an
OSCE looks like
• The Ethics OSCE – 14 encounters with SPs playing roles about ethical issues
• Communication Challenges - Ten SP scenarios, each tackling a different communication
challenge
• Cross-Cultural Interviewing – two SP scenarios addressing cross-cultural challenges
• SP Orientation video (TBA)

SPP Library
(This library is located at our training office)
• medical dictionaries
• pharmaceutical references
• textbooks on diagnosis and clinical methods

Websites
• The University of Toronto Standardized Patient Program – spp.utoronto.ca
• The University of Toronto - www.utoronto.ca
• The Association of Standardized Patient Educators - www.aspeducators.org
(This is an international educational organization providing support, resources and educational
opportunities to medical educators involved in SP methodology)
• Online medical dictionaries:
o cancerweb.ncl.ac.uk/omd
o www.online-medical-dictionary.org
o www.nlm.nih.gov/medlineplus/mplusdictionary.html
• A bibliography by Dr. Karen Szauter of journal articles that deal with teaching or assessment
using standardized patients - oed.utmb.edu/SP/bibliography.htm
• Gray’s Anatomy of the Human Body, www.bartleby.com/107
• Virtual Hospital: A digital library of health information -
lib.cpums.edu.cn/jiepou/tupu/atlas/www.vh.org/index.html
• NSH Direct Online Health Encyclopedia - www.nhsdirect.nhs.uk/articles/alphaindex.aspx
• Medem Medical Library - www.medem.com/medlb/medlib_entry.cfm
• The Merck Manual of Diagnosis and Therapy - www.merck.com/mrkshared/mmanual/sections.jsp

Feedback Workshop and Materials

• Constructive Feedback 101 – A guide to fundamentals of Standardized Patient feedback -
http://spp.utoronto.ca/images/download/feedback%20101.pdf

Standardized Patient Program, University of Toronto Page 24

 Glossary
Here is a list of some acronyms and terms that you may encounter as an
SP. Your trainer will help you with all of the medical terminology you need
to know in order to understand and play a role, so we have not included
any here. However, you may want to do some research of your own and
can consult the reference books in the SPP library. You may also wish to
check out these free online medical dictionaries:
• cancerweb.ncl.ac.uk/omd/
• www.online-medical-dictionary.org

Acronyms
ASCM Art and Science of Clinical Medicine
A required course for all medical students that introduces them to basic patient
interviewing and physical examination skills.
ASPE Association of Standardized Patient Educators
An international organization to promote and support the development and advancement
of SP education and research
CFPC College of Family Physicians of Canada
The credentialing body for family physicians across Canada
CPSO College of Physicians and Surgeons of Ontario
The self-regulatory body for the medical profession in Ontario
CRE The Donald R. Wilson Centre for Research in Education
U of T organization dedicated to the achievement of excellence in research and practice
in health professional education. The SPP is housed in this center, located in the TGH
DFCM Department of Family and Community Medicine
Department at University of Toronto that trains residents to become Family Physicians
DOCH Determinants of Community Health
A required course for all medical students that teaches students to be aware of the social,
physical and emotional needs of individual patients and communities as a whole.
GTA Gynecological Teaching Associate
A specially-trained teacher who instructs trainees in how to conduct an internal
gynecological exam, using her own body.
IPE Interprofessional Education
IMG International Medical Graduate
A physician who received their medical training in a country other than Canada – they
must obtain a license in order to practice in Canada
IPG International Pharmacy Graduate
A pharmacist who received their medical training in a country other than Canada – they
must obtain a license in order to practice in Canada
MCC Medical Council of Canada – the licensing body for physicians in Canada. Their nation-
wide OSCEs use standardized patients
OCP Ontario College of Pharmacy - governing body of Ontario pharmacists that delivers
quality assurance through their Practice Review
OISE Ontario Institute for Studies in Education
OSCE Objective Structured Clinical Examination
This form of exam is used to test students’ clinical skills, and uses standardized patients
to ensure a consistent and fair test for all students
PE Practice Eligible Weekend
An SPP course that teaches patient-centred interviewing skills to practicing physicians
PEBC Pharmacy Examining Board of Canada
The national examining board that licenses pharmacists in Canada. Their nation-wide
OSCEs use standardized patients
PEP Post Encounter Probe
The written component of an OSCE station completed after an encounter with an SP

Standardized Patient Program, University of Toronto Page 25

PRP Pre-Residency Program
PT Physical Therapy
QA Quality Assurance
A College of Pharmacists of Ontario program that involves standardized patients in its
interview component
SI Successful Interviewing
A course offered by the Standardized Patient Program to teach patient-centred
interviewing skills to medical residents.
SOO Simulated Office Oral
An exercise for medical residents using standardized patients, either for teaching or
assessment, and used in the CFPC credentialing process
SPP Standardized Patient Program
TGH Toronto General Hospital
UHN University Health Network
A hospital group consisting of Toronto General (TGH), Toronto Western (TWH), and
Princess Margaret Hospitals (PMH).
U of T University of Toronto

Glossary
Academies
The University of Toronto medical school divides its students into three academies, to enhance the
educational experience of the students:
• Fitzgerald Academy – based at St. Michael’s Hospital
• Peters-Boyd Academy – based at Sunnybrook and Women’s College Health Science Centre
• Whitman-Berris Academy – based at Mt. Sinai, Toronto General, and Toronto Western Hospitals
Clerk
At the University of Toronto, medical training spans four years, the first two years being the “preclerkship”
and the final two years being the “clerkship.”
Feedback
After a simulation, the SP is often asked to comment on how the interview made them feel as the patient.
Fellow
A graduate holding a paid position (a ‘Fellowship’) for a limited number of years, to pursue a specified
branch of study.
Preceptor
A tutor or instructor assigned to a group of students
Resident
A trainee who has graduated from undergraduate medical training and is now completing the “specialty”
component of their training, e.g. Psychiatry, Family Medicine, Surgery. Residents are often referred to as
PGY1, PGY2 (postgraduate year 1, 2, etc)
Round-robin
A training method in which the trainer conducts an interview going around the table and asking a different
question of each SP. Preceptors may also use this format for interviews
Standardized Client
A standardized patient acting as a client in an encounter with a physiotherapist, etc.
Standardized Family
Sometimes health professionals are required to interact with entire families – the SPP has roles written for
various family groups
Standardized Patient
A person who is trained to portray the symptoms or problems of a patient
Time-out
During a simulation a “time-out” can be called by the trainee or facilitator in order to discuss the
interaction or ask for suggestions. At this point another trainee can step in. During the time-out the SP
disengages from the encounter by looking at the floor, while at the same time maintaining the patient’s
affect.

Standardized Patient Program, University of Toronto Page 26

 Staff List
SPP Office Staff:
Rosa Arteaga ............................. Administrative Assistant
Lina Baltakys .............................. Accounting Clerk
Lorena Dobbie ............................ Session Educator (CEHPEA)
Rachel Ellis ................................ SP Relations/Program Operations Manager
Ana Garcia ................................. Business Officer
Kevin Hobbs ............................... Session Educator (CEHPEA)
Jacquie Jacobs .......................... Session Educator (CEHPEA)
Kerry Knickle .............................. Academic SP Educator
Cameron MacLennan................. Education Media Specialist
Nancy McNaughton.................... Associate Director, Research
Greg Morris ................................ SP Educator and Project Manager
Joanne O’Reilly………... ............ Business Systems Manager
Anja Robb................................... Director
Stan Rogal ................................ Academic SP Educator (CEHPEA)
Diana Tabak ............................... Associate Director, Education
Lin Wang .................................... Associate Director, Finance
Kathryn Wilkinson ...................... Administrative Assistant

Associate Trainers:
Bonnie Anderson
Suzanne Bennett
Karen Delaney-Laupacis
Susan Greenfield
Sandy Gruenwald
Derek Keurvorst
Laura-Jayne Nelles
Rob Squire
Annabelle Torsein
Kerri Weir

Standardized Patient Program, University of Toronto Page 27

Standardized Patient Program

88 College Street
Toronto, ON M5G 1L4

Standardized Patient Program, University of Toronto Page 28

 The University of Toronto
St. George Campus

1 2 3 4 5

A A

B B

C C

D D

E E

F F

1 2 3 4 5

Standardized Patient Program, University of Toronto Page 29

Standardized Patient Program, University of Toronto Page 30
The “downtown” Hospitals

Michener
Institute

Standardized Patient Program, University of Toronto Page 31

The Toronto General Hospital

Elizabeth Street Parking:

$4.00 each 1/2 hour or less to a
maximum of $19.00 to 7:00 a.m. when
it starts again at $4.00 each 1/2 hour
or less.
After 6:00 p.m. to 7:00 a.m., Monday -
Friday -- FLAT RATE: $6.50
Sunday and Holidays -- $6.50 flat rate
all day
Please Note: The first two floors of the
Elizabeth Street parkade are reserved
for patients.

Clinical Services Building on Gerrard

Street:
$4.00 each 1/2 hour or less to a
maximum of $25.00 to 7:00 a.m. when
it starts again at $4.00 each 1/2 hour
or less.
After 6:00 p.m. to 7:00 a.m., Monday -
Friday – FLAT RATE: $6.50
Sunday and Holidays -- $6.50 flat rate
all day

Standardized Patient Program, University of Toronto Page 32

Princess Margaret Hospital

Murray Street (visitor parking at the Hydro lot):

$4.00 each half hour or less to a maximum of $16.00
$10.00 Early Bird (in before 9 a.m. and out before 8 p.m.)
$6.00 flat rate after 6 p.m.
$6.00 weekends (Saturdays, Sundays and Holidays)

Toronto Western Hospital

Leonard Street Parking:
$3.00 each 1/2 hour or less to a maximum of $11.00 to
7:00 a.m. when it starts again at $3.00 each 1/2 hour or
less
After 6:00 p.m. to 7:00 a.m., and Sundays and holidays
-- FLAT RATE: $5.00

Bathurst Underground Parking:

$3.50 each 1/2 hour or less to a maximum of $14.00 to
Dundas
7:00 a.m. when it starts again at $3.50 each 1/2 hour
or less
After 6:00 p.m. to 7:00 a.m., Monday - Friday -- FLAT
RATE: $6.50
Sunday and Holidays -- $6.50 flat rate all day

Nassau Street Parking:

$4.00 each 1/2 hour or less to a maximum of $16.00 to
7:00 a.m. when it starts again at $4.00 each 1/2 hour or
less
After 6:00 p.m. to 7:00 a.m., Monday - Friday -- FLAT
RATE: $6.50
*At the Nassau lot, no letters, transponders or staff
rates apply. No exceptions.
Sunday and Holidays -- $6.50 flat rate all day

Bathurst Street

750 Dundas St. W.

(Medwest Bldg)

Standardized Patient Program, University of Toronto Page 33

Mt. Sinai Hospital

Parking garages are located across from the hospital on

Murray Street.

The approximate cost for parking is $14 a day. If you arrive

before 9:00 a.m., many parking lots offer "early bird"
specials.

If you don't mind a short walk, you can find some lower
parking rates on St. Patrick Street. Also, limited meter
parking exists on the streets surrounding the Hospital.

Hospital for Sick Children

Sick Kids has two main parking lots:

An underground lot below the hospital
(enter from Elm Street, between University
Avenue and Elizabeth Street)
And outdoor oversized vehicle lot at the
corner of Bay Street and Elm Street.
These lots only accept cash!

Street Parking
Please read the street parking signs carefully if you are parking near the hospital. You are not allowed to
park on any street before 9:30 in the morning and between 3:30 in the afternoon and 6:30 at night.

Parking rates
Monday to Friday 7 a.m. to 7 a.m. - $3.50 per half hour to a maximum of $25
Saturday, Sunday and Holidays 7 a.m. to 7 a.m. - $2 per half hour to a maximum of $6
Monday to Sunday 6 p.m. to 7 a.m. - $2 per half hour to a maximum of $6

Standardized Patient Program, University of Toronto Page 34

St. Michael’s Hospital

There is indoor parking directly

across Queen Street and an
outdoor parking lot directly
across from the hospital on
Bond Street. These lots are not
operated or owned by St.
Michael's Hospital and require
payment for parking.

Women’s College Hospital

Parking is available in the hospital garage beside Women’s

College Hospital on Grenville Street.

Standardized Patient Program, University of Toronto Page 35

Sunnybrook Health Sciences Centre

Parking
The hourly rate is $3.50/half hour
Maximum daily rate is $18.00 per day

Standardized Patient Program, University of Toronto Page 36

Toronto East General Hospital

Sammon Avenue Visitor Lot

7am – 6pm, $2.00 / 20 minutes, maximum $12.00
6pm – 7am, $5.00, flat Rate

Medical Office Building Parking Lot

24 hours, $2.00 / 20 minutes, No Maximum
Pay parking is available on the street between
9am and
9pm.

St. Joseph’s Health

Science Centre

The parking garage is located at the corner of the

Queensway and Sunnyside Avenue – from the
Queensway, turn north on Sunnyside, and the
garage entrance is immediately on the left

Half-hourly Rate
Patients and visitors are charged $2.50 per half
hour with a daily maximum (6:00 a.m. until
midnight) of $15.

Day Pass - $15

Visitors have "in and out" privileges with the pass.
Pass expires at 6:00 a.m.

Standardized Patient Program, University of Toronto Page 37

The Scarborough Hospital
– General Campus

The Visitor's Parking Garage is located just West of the hospital.

There are two other lots that are available for metered parking.

North York General Hospital

Main Entrance Visitors' Parking Lot
$3.50 per half hour or less
$7.00 per hour or less
$10.50 per 1 1/2 hour or less
$14 day maximum (24 hours)
$14 day pass (includes in and out privileges)
for a 15-day pass

Emergency Lot (short-term parking)

The Emergency Lot has a pay and display
machine that takes coins and credit cards.
There is a change machine inside the
entrance to the right of the Charlotte & Lewis
Steinberg Emergency.
Nearby parking meters are the same rate:
$3.25 per half hour
$20 day maximum

Parking Lot at 4000 Leslie St. (across the

street from the hospital)
$2.50 per half hour or less
$12 day maximum

Standardized Patient Program, University of Toronto Page 38