Fake patients test Vermont medical students

June 8, 2008 10:07:53 PM PDT
The patient talked a mile a minute, hopped off the exam table, paced around and poked through the cupboards when the medical students entered the exam room.

The "patient" had spent hours training how to fake it ? in the interest of science. It was "Mania Day" at the University of Vermont's medical school.

One part drama, two parts science as doctors-in-training test their diagnostic skills and bedside manner by assessing the ailments of patients played by real people in a program that's growing in popularity at U.S. medical schools.

"This environment allows them to practice and make mistakes in an environment conducive to learning before they go to the patient," said Tamara Owens, president of the Association of Standardized Patient Educators.

Most health care institutions now have some sort of standardized patient program or simulation center, practicing everything performing exams to suturing mannequins. Medical students now also are required to take a national exam involving standardized patients.

But the training does much more than prepare them for the test.

"The idea is that if we want every student to handle or work with a patient with a migraine, schizophrenia, bipolar, knee pain, back pain, we can't assume or hope that patients with those problems are going to present in the hospital or in the office," said Nicholas.

"So what we can do here is to create any kind of scenario that our clinical faculty want to teach."

Dr. Howard Barrows came up with the idea in the 1960s at the University of California at San Diego.

UVM, which Owens said considers to be one of the pioneers in the methodology, along with San Diego and University of Texas Medical Branch at Galveston, started doing it the 1970s to teach doctors how to perform pelvic exams in women. The school expanded the practice to other areas in the mid-1990s as it considered changing its curriculum and became clearer about the skills that students needed, said Cate Nicholas, director of the program.

"We really needed to spend more time on some real, basic clinical exam skills, professionalism ? how do you present yourself to a patient ? communication-interpersonal skills, history taking skills, physical exam skills, clinical reasoning," she said.

That's when the concept of practicing on fake patients was introduced.

The "patients" at UVM come from all backgrounds ? nurses, dancers, actors, teachers, a boat maker ? and need to have some level of acting ability to be effective.

They meet with doctors to learn how to act out their symptoms the same way others do, so that students get the same experience and can be assessed uniformly.

"It might take up to 8 to 12 hours of training to prepare them for a project," Owens said. "So it requires them to have the ability to recall at a 90 percent or better rate in order to be included in the project."

For $20 an hour, they not only act, they also instruct students and offer feedback.

"You can see them grow," said Jim Conan, a retired state trooper and sometime actor.

At first, Ben Higgins, 24, of Mount Desert, Maine, had a hard time interrupting his manic patient ? Morris ? with questions.

Played by Conan, Morris talked rapidly about a home office he was building, his inability to install the dropped ceiling, and asked Higgins to help. He repeated himself, lost focus and changed the subject. He mentioned that his girlfriend was going to kick him out and urged the doctor to call and reassure her he was fine.

Midway through the half-hour session, Higgins and fellow student Elizabeth Cipolla, of New York City, took time out to discuss his case. They decided to ask Morris about medication and sleep. A doctor who stepped into the room to observe advised them to ask about his work, his level of functioning, to determine his concentration level.

The students learned Morris had been taking Zoloft and had felt euphoric ever since, sleeping only several hours a night.

The students then presented a list of findings ? from the patient's neat appearance to his rapid speech, energy level, euphoric mood, and warped sense of reality ? to the doctor.

"When they're in role like that, it feels very real," Higgins said. "It's fun to have real situations like that, so you can practice and know how to try and work on skills to interact with someone who might be in a manic state or a really depressed state."


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