At the University of Pittsburgh School of Medicine (UPSOM) students are getting a real-life taste of what it’s really like to be a doctor. Through a program called the Standardized Patient Program, the UPSOM prepares its students for what’s to come when dealing with the public as doctors.
According to the Association of Standardized Patient Educators, the concept of Standardized Patients, or SPs, in the United States goes back to 1963, when a neurologist from the University of Southern California began teaching his third-yea students techniques on talking with their patients – a process known as “interviewing” in the medical community. Fast forward to today and you’ll find SPs being used by the UPSOM and many other institutions to teach and evaluate students.
A SP is someone who has been trained to portray, in a consistent, standardized manner, a patient in a medical situation. These actors are trained to realistically portray people with conditions ranging from broken ankles to alcoholism. And in addition to acting sick, SPs are also trained to provide in-depth feedback aimed at building better doctors. When the busiest time of the school year rolls around – September to March – UPSOM might average three to five “events” a week involving SPs which might run all day or only for just a few hours. Before an event, SPs are given a portfolio of basic information that they cannot change, including symptoms and certain medication habits. They are also given names and occupations, although sometimes the persona can be tweaked with permission.
Events are based on cases which are based on real patient scenarios. A typical encounter with a SP may involve interviewing, counseling, or examining the patient in the same manner as would occur during a regular clinic encounter. Students have the chance to practice interviewing skills they’ve learned to gather information needed to help diagnose the problem. In addition, they’ll have the opportunity to practice effective interpersonal skills that will help them later to connect with real patients. They’ll also be able to practice techniques and approaches for physical examination and to counsel patients on a variety of issues, some very challenging such as breaking bad news.
Researchers say encounters “staged” through the SP program have certain advantages that cannot be duplicated by the use of paper problems, role playing, questionnaires, or even real patients. The advantages include: working in a controlled, reproducible clinical situation; the clinical problem is present at any time or any place; it provides a unique opportunity to practice various skills; and most importantly, the SP can provide you with objective and unbiased feedback.
From their very first semester at the UPSOM, students take courses in both medical interviewing and basic anatomy, and begin their first encounters with SPs. During their four years of training at the UPSOM, students will have close to 100 encounters with SPs. “Working with SPs helps, especially in difficult situations,” said Erin Predis, a third-year student at the UPSOM. “It’s a safe environment. Sometimes you have someone yelling and screaming at you and you’re glad they’re not ‘real'”.
According to a survey conducted by the Association of American Medical Colleges, communication is what patients care about most when it comes to their doctors. So helping students to develop good communication skills is a huge goal of the SP program. “The [SP Program] is a ‘safe event’ for students,” said Karen Reyonds, RN, president of the Association of Standardized Patient Educators. “We can also examine students and have an opportunity to speak to their safety and competence before we set them loose on the public.” And in addition to SP feedback, course instructors and other students also provide their input.
“It’s not your job to teach the students about [medical examining],” said Valerie Fulmer, director of the UPSOM’s SP program. “You are there to provide an opportunity for them to learn through interviewing.