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Simulated Patient Program Important Part of Medical Trainingby Dana Benson 
Classroom demonstrations use standardized patients to illustrate specific history-taking and physical examination techniques. Larry Bararata comes to Baylor College of Medicine frequently with a myriad of health problems. But he's not sick. In fact, there's not a single thing wrong with him. He is one of a cadre of "actors" who playt an important role at BCM. Bararata and the other actors are a component in the building blocks of a complete medical education, along with classroom instruction and clinical training. They are part of the Simulation Program for Clinical Performance Improvement that uses "actors" playing the role of patients as well as simulator devices to train and assess medical students and residents. Teach and evaluateThe program trains qualified individuals to teach and evaluate medical students, explained Dr. Britta Thompson, director of the simulation program. The standardized patients 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." Dr. Alyssa Randall, a May BCM graduate, said the program was a valuable component to her medical training. "I think it is critical for the learners to be evaluated in a controlled environment as in the standardized patient program. This allows a fairer assessment by faculty. It also allows the students to receive feedback from the standardized patient about how they come across in terms of clarity, competence and empathy." Simulation has different facetsThe simulation program is implemented in a number of different ways during medical school and residency:
The BCM Simulation Program began about 17 years ago, using facilities at The University of Texas Medical School at Houston. Now it operates out of BCM at the Claire Huckins Simulation Lab for Clinical Performance Improvement, which has 14 mock exam rooms. Normal-looking exam roomsEach room looks like a real exam room in a physician's office or clinic. They are equipped with computers and wall-mounted exam equipment. Unlike the typical examination room, they also have mounted video cameras. Members of the faculty use the tapes to evaluate students. They also provide a means of quality assurance of the program. Other elements of the program include simulators, such as the "Harvey" mannequin, which helps train students to conduct a cardiology physical exam. The use of simulators is important because they can mimic health conditions that standardized patients cannot, such as a heart murmur. They have recently acquired several additional simulators such as a device called a ventriloscope—essentially a programmable stethoscope that permits wireless transmissions of any sound, such as that of the heart or lungs, into what appears to be a normal stethoscope, noted Shewanna Manning, coordinator for the simulation program. It can be used to teach students how to detect normal heart and lung sounds as well as those that are abnormal. Improvements planned
Third-year medical student William Choi checks out the ear of "actor" Larry Bararata, who helps medical students understand patient care better. Dr. Elizabeth Nelson, senior associate dean for medical education, has been a proponent for increasing the use of simulation and standardized patients for teaching and testing, and she is among those credited by Thompson with stimulating the program's growth. She said she and those who support the program hope to acquire additional simulators, increase the use of standardized patients and simulation for teaching and testing, and eventually build a state-of-the-art simulation center complete with not only outpatient exam rooms, but also inpatient rooms, low fidelity simulation skills training rooms, a mock operating room/emergency room and debriefing rooms. Currently, there are about 75 standardized patients in the Baylor program. Bararata describes one of the roles he has played—that of a patient with back pain. "I have the facial expression of constant pain. I walk around holding my back, and I have difficulty getting to the exam table. I need help, but I don't want to ask for it. Depending on how well I connect with the student, I may allow him or her to help me or I may do it myself," he explained. "Students have to gain trust from me, and everyone does it a little bit different. Some students do it as a very serious encounter; some do it in a very friendly manner." Bararata, who's been involved in the program for more than two years, said he feels as though he is contributing to medical education. He describes Baylor College of Medicine students as intelligent and admires their eagerness to learn and improve. Willingness to learn"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. Many standardized patients get involved initially for some extra money, but soon find it worthwhile in other ways, said Eugenia Greenfield, project coordinator and standardized patient trainer for the program and a former standardized patient. "There's camaraderie among the standardized patients. 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 get in your blood," said Greenfield. For more information about the BCM simulation program, including how to become a standardized patient, visit http://www.bcm.edu/spprogram/. |
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Volume 5, Issue 1, Winter 2009 |
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| Last modified: December 7, 2009 |