Patients as teachers help develop future physicians
“”I think I’m having a stroke,”” says the patient, shortly after the doctor enters the emergency room.
The doctor pulls up a chair and sits besides the elderly woman, making sure to be on her level, greeting her and asking her to describe her symptoms. She says when she woke up six hours ago, she noticed the right side of her face was sagging downward and she was unable to stop herself from drooling. She mentions she had been having pain behind her right ear for the past few days, which has been interfering with sleeping and working.
The performance is convincing, but the patient’s symptoms are not real. This scene is acted out like a theater production, with producers, actors and an audience working together to help the “”doctor,”” a WesternU student, hone the skills needed to become a physician.
“”I like to think what we do here develops their skills as doctors,”” said Beth Mendoza, who has worked as a coach and standardized patient almost since the inception of the WesternU Standardized Patient Program more than 20 years ago.
Mendoza understands various systems of the body because University doctors have certified her. “”Since we are tools, we are as effective as the students make us.””
Standardized Patients study the case of a sick person for weeks, when they are e-mailed a complete list of scenarios, a checklist of symptoms, and the key points required to grade the student doctor. They also study the history of the patient – including their social life, where they live, their marital status and their work situation — and adopt the physicality of the symptoms. “”As a SP, we are trained well to inhabit the personas we are asked to portray,”” said John Lynd, a standardized patient since 1989.
Their training is enough to convince students that these encounters are real.
“”The second I open the door and enter the room, I almost always forget that this is a fake patient, and I really embrace the situation,”” said Daniel Park, DO ’12. “”In general, I still get a little nervous and anxious before each encounter because I take the encounter seriously.””
Park was impressed with Mendoza’s acting ability in this encounter about Bell’s palsy, a neurological condition. He was immediately drawn into the situation because she started off so scared and worried, he said. Afterward, he made sure she knew it by saying, “”That was the best acting so far.””
Park prepares for an SP encounter or exam by reviewing the objectives for that week based on previous lectures and notes. For this encounter during the neurological test, he struggled a bit, but finished in time to conduct the close of the interaction.
“”For me the closing is the most difficult, partly because I usually run out of time before I get to that part, so I haven’t been able to practice it much, but also because it makes me feel like the whole SP encounter is real,”” he said.
Standardized patients go through a checklist to determine how a student performed. They are evaluated on the student’s ability to ask about the patient’s history, the physical exam, and their global communication skills.
Some recent case examples include abdominal issues, neurology, HEENT (head, ears, eyes, nose and throat), delivering bad news, and veterinary medicine students interviewing a prospective client.
The College of Osteopathic Medicine of the Pacific (COMP), Office of Medical Education (OME) organizes the Standardized Patient Program, which is coordinated by co-directors Sandra Garner, MEd, and Toni Lynd.
COMP’s graduating class of 2008 ranked No. 1 in the nation on a licensing test measuring clinical skills, the COMLEX Level 2-PE/Clinical Skills Exam, which is the performance evaluation component conducted with standardized patients.
“”Consistent with the osteopathic philosophy and academic teaching model, our students are oriented and meet standardized patients within the first weeks of their freshman year in our program of instruction,”” said Dr. Clinton Adams, dean of the College of Osteopathic Medicine of the Pacific. “”They deal with psychosocial issues early on to acquaint them with their role and responsibility as active listeners, in preparation for the day they will be responsible for a treatment plan.””
Lynd started out as a standardized patient in 1989, when the patient was more of a model for the student doctor. When Garner started about four years ago, the standardized patient evolved, and was allowed to talk, respond and interact with the student doctor.
“”This program starts with the first-year students and grows with them,”” Lynd said. “”It sets up their foundation of learning and provides them with patient-centered care, doing a physical exam on things they learn in the classroom. It continues in advanced learning as the expectations for them grow in the future years. All the while, they have a ‘patient’ giving them feedback on how they felt during the encounter.
“”Because there is an emphasis on communication, it brings one of Western University’s core competencies to the forefront,”” she continued. “”They can practice their rapport, empathy, and partnering skills on every encounter, all the while receiving feedback from the ‘patient.’ In most cases, the students see the reality, not an acting job.
“”Sandra and I have worked hard to implement even more encounters, and now do three times the encounters per student we originally did four years ago,”” Lynd said, referring to her co-director. “”We know it works, and with ‘Difficult Patients,’ ‘Taking a Sexual History,’ and other advanced communication encounters, we are giving the students practice skills they usually don’t see until rotations.””
Students are given more than 30 minutes to complete a history during their first encounter. By the time students graduate, they will have had more than 40 encounters, and are required to finish one in 14 minutes. In addition, third-year students, while on rotation at a hospital, return to campus for their testing assessment on whatever the rotations they have had.
In addition, first and second year Residents come back from five Osteopathic Postdoctoral Training Institute (OPTI) hospitals to be assessed on their communications to meet core competency evaluations.
“”Once they get to the board exams, it’s like d
