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Practice Makes Perfect – Standardized Patients Help Shape Tomorrow’s Doctors

Practice Makes Perfect – Standardized Patients Help Shape Tomorrow’s Doctors
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BY KATHLEEN HEINS

It begins with a knock on an examination room door. In comes a medical student pretending to be a doctor. Sitting on the exam table is a woman with a fake, yet realistic, chronic cough pretending to be a patient. The setting is not a theatre stage but a medical school.

The ai???patientai??? in this scenario is actually a contract employee of the medical school known as a standardized patient or SP. An SP, is a trained layperson who portrays a patient in a staged medical setting to help educate, evaluate and test medical students. In some cases, other health care workers may also learn or update skills through the assistance of an SP. The term ai???standardizedai??? is used because the ai???patientai??? is required to repeat his or her story in the same manner to a number of students, typically at the rate of three to four an hour. The use of SPs began in the early 1960s.

Denise LaMarra, director of the Standardized Patient Program at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, says her SPs include artists, teachers, and writers as well as a former flight attendant and a corrections counselor. About 45 percent of her SPs are 50 plus. ai???The combination of life experience ai??i?? personal, professional and as a patient ai??i?? give older SPs a rich resource to draw from for both their performance and for the personalized feedback they give students,ai??? she states. While a slight majority of her SPs are working actors, many have no formal training.

What Makes a Good Standardized Patient?

To succeed as a SP, you must be able to keep in character throughout the medical studentai??i??s exam. Typical qualities looked for in potential standardized patients:

  • High school diploma or GRE
  • Basic computer skills
  • Flexible schedule
  • Interest in students and learning
  • Excellent listening and communication skills
  • Ability to focus on the educational goals of an event and portray a scenario in a designated and consistent manner
  • A willingness to be videotaped for educational purposes
  • Ability to commit facts and dialogue to memory and remain in character
  • To apply to become an SP, check the web pages of your nearest medical school. The process often begins by filling out an online.

Once youai??i??ve applied to become a standardized patient you can expect an extensive interview process. If youai??i??re selected, you will also undergo a lengthy training period.

If you are selected, you will need to complete a background check, a drug and TB test, and show that youai??i??re up to date on immunizations. The pay varies, but is typically significantly more than minimum wage. The hours vary depending on the medical schoolai??i??s needs. Donai??i??t expect to make a living as an SP. You may work several times a month or just be called sporadically throughout the year.

Setting the Stage

Once youai??i??re onboard, scenarios vary. SPs may, for example, be asked to play a 50-year-old man or woman struggling with drug addiction and diabetes. They may be told to act defensive and angry when asked about drug use. At times, they might also be scripted as uneducated and confused by medical jargon.

In other scenarios an SP may be instructed to be depressed, impatient, fatigued, cold, in pain, etc. In some cases, stage makeup might be used. In others, women might be asked to arrive with no makeup to portray someone who is not sleeping well or in chronic pain. An SP may be asked to be the recipient of bad news or angry about having spent too much time in the waiting room.

If a physical exam is required, youai??i??ll know what to expect beforehand. Invasive physical exams are not a part of being an SP nor will you have to give blood or other samples. The medical student may, however, perform some routine tasks such as listening to your heart and checking your blood pressure. They may also conduct other non-invasive tasks such as pressing on your abdomen to identify swelling or tenderness, or feeling your thyroid; the butterfly-shaped gland found in front of the neck.

Setting the Scene

Overhead cameras capture the ai???appointmentai??? and, at times, instructors may also be watching through a one-way window. Studentsai??i?? skills are accessed by their instructors and may also include SP input either verbally or by a computerized assessment done at the end of the scenario.

Part of the challenge for the medical students is to ask the right questions they need to determine a diagnosis. In some scenarios a mention of a test theyai??i??d like to run (such as an A1C used to check average blood sugar level for the past two to three months), prompts the SP to deliver the staged results of this test. He or she may, for example, say: ai???The result of my A1C is in the drawer near the sink.ai???

Some other events that an SP might participate in include:

  • Delivering bad news
  • Explaining how medications work
  • Conducting a routine medical history
  • Performing physicals
  • Working with a difficult patient
  • Counseling a patient on making lifestyle changes

A Note about Memorization

Donai??i??t be put off by the need to memorize information. The more you do it, the better you will become. Some standardized patients make flashcards. Partners and friends can also serve as testers. If you keep your notes by your bedside to read before nodding off, your brain will actually process the information while you sleep. Recalling the information while trying to get to sleep ai??i?? or back to sleep in the middle of the night ai??i?? is also helpful and a good sleep aid besides!

Your script often includes not only information about your character but how to respond to questions asked by medical students. Typically you are provided with an opening line thatai??i??s given in response to the question ai???What brings you here today?ai??? Some responses might include: ai???I feel as if I am dragging through my daysai??? or ai???Lately I notice that my heart is racing.ai??? Your response to each question that follows is scripted.

Often an invitation is sent out to SPs who fit the bill of a patient that needs to be portrayed with the option to accept or decline the assignment. Events usually include a training session (in which scripts are given out and discussed) followed by the actual event at another date.

Making a Difference

Most SPs find the job especially satisfying because of the opportunity to contribute to shaping future doctors. ai???I was interested in helping to train medical students to become the best physicians they could be, in particular, to help them build interpersonal skills with patients — to listen carefully to patients, to show empathy, to be respectful and sensitive,ai??? says Patty Quinn, 64, of Philadelphia, an SP employed by LaMarra.

Many medical students report that advancing from mannequin to flesh and blood person, albeit not official patient, makes the transition from book learning to actual patients go more smoothly. It also helps them learn compassion, and the ability to work with a wide variety of people when it comes to age, ethnicity, race, sexual orientation, socioeconomic background and even personality.

They also get an opportunity to practice asking some fairly awkward questions,ai??? adds LaMarra. ai???When medical students learn about sexual history-taking, they get to interview at least one older SP,ai??? she states. ai???Itai??i??s an interesting challenge to ask someone who looks like they could be oneai??i??s grandmother or grandfather if they have sexual relations with men, women, or both.ai???

SPs are also used to practice proper draping techniques while examining a patient and how to address a patientai??i??s fears. If depression is suspected, students are able to learn how to pose questions regarding suicide risk and how to help patients get help.

LaMarra says that overall SPs are well-received by students who site the convincing acting of the SPs, the opportunity to practice patient care skills, and the problems that SPs point out as among benefits. Adds LaMarra: ai???In some cases the SPai??i??s portrayal is so realistic that the student forgets that theyai??i??re not working with an actual patient.ai???

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