'Actors' play important role in physician training

A standardarized patient participating in a role-playing exercise Dana Benson
713-798-8267
benson@bcm.edu

HOUSTON -- (April 1, 2009) -- A patient sits in a typical physician's office, complaining of bad back. But it's not really a doctor's office or even a real patient. Rather, the patient is essentially an actor pretending to be in pain for the purpose of training medical students.

This scenario and others like it play out at medical schools throughout the country. At Baylor College of Medicine, the Simulation Program for Clinical Performance Improvement began about 17 years ago and has recently expanded.

Hear a standardized patient discuss his experience.

Transcripts

New 'patients' needed for simulation program

Standardized patients are always needed for BCM's simulation program.

Applicants must have a flexible schedule and the ability to accurately portray a patient and recall aspects of a medical exam. The program generally pays $20 per hour for training and performances. SPs are considered consultants and are not eligible for BCM benefits. Minors may not apply as SPs.

To see if you quality, fill out an application and answer questions about your physical characteristics and medical history. For more information and to request an application, call 713-798-7952 or e-mail Eugenia Greenfield at eugeniag@bcm.edu.

Potential SPs must audition after submitting an application. The purpose is not only to see how they portray a patient, but how much they can recall about their interaction with the medical student or resident.

Once a person is accepted into the program, they are added to a database of patient roles. When a "casting call" comes in, that pool is searched for matches.

Interactions with students

The program trains qualified individuals to teach and evaluate medical students, explained Britta Thompson, Ph.D., director of the simulation program. The standardized patients, or SPs, go through a rigorous process that prepares them for "performances," or scripted interactions with the students.

"Standardized patients allow medical students to see patients as near to reality as possible," said Thompson. "Students can ask questions, they can take a history and conduct a physical exam. They can learn all those clinical skills before they ever even go out to practice those skills on a real patient."

Students interact with SPs throughout medical school and during residency. Some of the projects include:

Objective Structured Clinical Examinations – OSCEs are used for teaching and evaluating the clinical skills of medical students before they begin their clinical rotations. This examination is administered to first-year students in May/June and to second year students at the end of the preclinical curriculum.
Clinical Performance Examinations – CPXs are used for evaluating the clinical skills of medical students. The testing situation is much like the OSCE described above. However, this examination is a high stakes exam administered at the end of the third year to test clinical skills. It is also given monthly at the end of the Family and Community Medicine Core Clerkship.
Classroom Demonstrations – These use standardized patients to illustrate specific history-taking and physical examination techniques.
Practice Sessions – Practice sessions provide students with an opportunity to practice their history-taking skills or components of the physical exam on an SP before performing them on real patients in a clinical setting.

Program benefits

"I definitely think the SP program is a valuable component to my medical training," said Alyssa Randall, a fourth-year medical student. "I think it is critical for the learner to be evaluated in a controlled environment as in the SP program. This allows a fairer assessment of the student by faculty. It also allows the student to receive feedback from the SP of how they come across to the patient in terms of clarity, competence and empathy."

Just as students get a lot out of the program, so do the simulated patients. Many get involved initially for some extra money, but soon find it worthwhile in other ways, said Eugenia Greenfield, project coordinator for the program and a former SP.

"There's a camaraderie among the SPs. They interact with each other; they share thoughts and ideas on how to play a particular role. Once you get into it, it's one of those things that gets in your blood," said Greenfield, who started as a SP when she was a stay-at-home mom.

Contributing to medicine

There's also a feeling of satisfaction knowing you are contributing to medical education, said Larry Bararata, a current SP at BCM. He's been involved in the program for more than two years.

He describes Baylor College of Medicine students as intelligent and admires their eagerness to learn and improve.

"The humility they show, the willingness to learn, to better themselves, to be the best they can be in all areas of medicine – all those things are a big reason why this is so much fun for me," Bararata said. "The students are just invaluable."

Room to grow

The program at Baylor has grown recently, including getting its own lab, called the Claire Huckins Simulation Lab for Clinical Performance Improvement, which expanded last year to 14 rooms from only six. When the program started, BCM used facilities at UT Houston.

Each room looks like a real exam room. They are equipped with computers and wall-mounted exam equipment. There are also mounted video cameras, and a tape is made of each encounter for evaluation by faculty and quality assurance of the program.

Other elements of the SP program include the use of a "Harvey" mannequin, which is a simulator that helps train students to conduct a cardiology physical, as well as other simulators. Some SPs also help train students to conduct gynecologic exams, though these interactions do not include simulated scenarios.

Thompson and her colleagues would like to see the program expand even more, and for that they may need more simulated patients. To learn more about becoming a simulated patient at Baylor College of Medicine, call 713-798-7952 or e-mail Eugenia Greenfield at eugeniag@bcm.edu.