Medical students spend years studying the intricacies connected to the world of medicine, but there are some lessons that can’t be found in the classroom or lab. That’s where a standardized patient comes in.
Standardized patients, often professional actors, are trained to replicate the symptoms and characteristics of an actual patient. They may depict cases based on authentic encounters that physicians experience with real patients.
They also provide feedback to students in skill areas ranging from interpersonal communication and history-taking to physical exams and patient counseling. The feedback not only assists with making students better physicians, it also may help them pass required professional exams.
A standardized patient's belly is palpated by
a medical student practicing his skills.
"Students won’t practice as physicians if they can’t pass a national high stakes standardized patient exam in their fourth year," explains
Mary Donovan, who heads the School of Medicine’s standardized patient program. The National Board of Medical Examiners runs the exam known as the Step 2CS, which measures clinical skills.
One of the most difficult skills to teach in medicine is how to communicate with patients and ask questions that disclose vital information, Donovan says. That communication must project confidence and professional competence, even when delivering devastating news.
Over the years, some students have gotten flustered in their attempts to explain an illness in nontechnical terms. Other times, they may find themselves shaking uncontrollably when trying to guide an otoscope into the ear.
"Then again, there are students who so completely forget the visit is 'fake,'" says Donovan, "that they’ll actually get tears in their eyes with an emotional SP." She also says the visit can reveal if a student takes too long to explain something or doesn’t sound sympathetic.
The Medical Center’s standardized patient program is geared toward first-, second- and third-year students, and the exercises progressively become complex and demanding with each year.
First-year students start off interviewing to learn the skill of creating patient histories. They begin demonstrating fundamental physical exam skills during the second year, while the third year consists of presenting patients with preliminary diagnoses and possible treatment plans. By the fourth year, medical students begin seeing actual patients in clinical rotations. Medical student usually take their Step 2CS exam by mid-year.
Mary Donovan, left, guides a medical student as
practicing clinical skills on actors.
Training actors to portray specific disorders is a collaborative effort between Donovan and the professors. She’ll give the standardized patients scenarios such as, "An older patient who has Parkinson’s, would he wobble with his eyes closed or would he just sway on the axis?" With the help of content experts such as
Dr. Shyrl Sistrunk, medical director for the Integrated Learning Center, Donovan is able to provide the fake patients with specific behaviors and responses.
In the last 10 or 15 years, cameras and microphones have provided insight to professors about how students interact and think during patient encounters. The revelations, Donovan notes, "are sometimes curriculum-changing." In the past, professors assumed students had learned examination basics such as how to palpate correctly, or ensure the stethoscope touched the skin.
"Now schools are taking harder looks at their curricula and revising when necessary to better prepare students before they begin dealing with real patients," she adds.
Where the actors portraying patients may not win an Emmy, they fill an important role in educating students.
"You can’t learn these skills from a book," Donovan says. "Students need to interact with real people, and they need a safe environment where they can learn from their mistakes before dealing with actual patients."
