Medical student Mariah Pate works with actor-patient Christine Murdock.
Let?s just get this out of the way up front. Christine Murdock isn?t channeling Cosmo Kramer and the medical students aren?t standing around playing ?guess the disease.? If they did, they would lose points with their instructors.
Murdock, an actor, is a standardized patient. She?s paid to help East Tennessee State University medical, pharmacy and nursing students learn how to talk to ? and more importantly ? listen to patients. She and 30-some other standardized patients help students garner the most (and most useful) information in the limited time they?ll have with actual patients. Standardized patients are the practice before the practice.
The concept of using actors to portray patients has been around since the early 1970s, but it didn?t gain traction in medical schools for another 10 years. It hit pop culture consciousness with a 1998 episode of ?Seinfeld? in which the aforementioned Kramer regaled med students with the tale of his encounter with the coquettish haberdasher and his resulting symptoms, prompting a med student to shout out the correct diagnosis.
That?s not likely to happen in the basement of the Carl a. Jones Building at the Veterans Affairs Medical Center, where a long, narrow space has been transformed into a row of eight exam rooms. before the program moved into the space last fall, the staff moved from vacant office to empty hallway setting up makeshift exam rooms for 20-some years.
Dr. Forrest Lang introduced standardized patients into the curriculum of the Quillen College of Medicine in 1987. The initial group of patients was recruited from The Road Company, a professional ensemble of actors and playwrights. they served as standardized patients in the classroom and as patients and doctors in a series of video clips used to provide interactive instruction in doctor-patient communication.
On a recent Friday afternoon, Murdock ? a Road Company alumnus ? changed into a hospital gown to become mrs. Ross, a character she knows inside and outside. It?s a good thing she does because there?s been a slight mix-up with the script. that might have thrown a rookie, but not Murdock.
She scrambles to find out what?s was wrong with mrs. Ross this time (it?s breathing difficulty and some shoulder pain) and where she?s seeing today?s doctors (in a hospital).
Murdock looks over the scenario and says, ?It?s OK, I think I remember enough to do it.? That?s because she?s been part of ETSU?s standardized patient program since its inception and has played mrs. Ross and mrs. Ross?s concerned daughter and just about every other female character many times over.
?When I play mrs. Ross, I sort of channel Gladys,? Murdock said of the actor who played the mother to her daughter over the years.
At least once a week, Murdock is interviewed or poked and prodded. This time it?s both. Third-year Quillen students will spend 10 minutes on an interview and 10 minutes on the physical exam with a debriefing and feedback after each part. Two faculty members observe the interactions and rate the students.
Not only does Murdock know the character, she knows exactly what the doctors-in-training are supposed to do and how they?re supposed to do it. And she makes them work for every bit of information they get from her. that way by the time they get to you, they may have had bad communication habits drummed out of them. Or most of them, anyway.
?There are some people you just can?t teach,? she concedes. ?But it?s amazing to watch the students? progress. If I weren?t already happy with my doctor, sure, I?d go to one of the students I?ve helped train. Absolutely.?
Johnson City native Rahul Lauhan can see the progress he?s made since he started working with standardized patients during his first year at Quillen. ?I was anxious to work with people who would be critiquing me, but I felt excited to begin learning physical exam skills,? he said. ?While my skills have evolved and I feel more confident when dealing with standardized patients, there is still a bit of anxiety and excitement before I begin an encounter with an SP.?
If mrs. Ross doesn?t feel comfortable talking to the doctor, she won?t volunteer information. If she?s asked a yes-or-no question, the doctor gets a ?yes? or a ?no? and that?s it, no added insight.
Lauhan avoids the shutout by sprinkling his interview with ?tell me a little about …? ?talk more about the symptoms? and ?could you describe…?
?What?s your impression about what?s going on?? He asks about her breathing problem and shoulder pain.
Mrs. Ross mentions pneumonia and osteoporosis. He asks: ?Is that something you?re worried about? what do you know about pneumonia and osteoporosis??
Questions like these help doctors ferret out fears and misconceptions that can interfere with diagnosis, treatment and recovery.
?Standardized patients have taught me that letting the patient talk and talk is very important,? said Elli Bonnett, who?s from Mooresburg in Hawkins County. ?There is often more going on with their health than their presenting complaint. I feel like standardized patients have made me more comfortable with the more intimate nature of history taking and physical exam.?
?One of the most important things about seeing patients is how you interact with them in an interview setting,? said Lauhan. ?Practicing with standardized patients is essential for medical students so that they can learn effective interview and interpersonal skills.?
Mariah Pate, a Florida native, agrees. ?The standardized patients have been a great resource … I feel much more comfortable with them now and my confidence in interviewing and exam skills has increased because of my experience with standardized patients,? she said.
A big part of doctor-patient communication is ensuring the patient knows what?s going on and is comfortable confiding in the doctor and asking questions. Jargon and judging are discouraged.
Murdock recalls a student talking to one of her characters during a follow-up for pancreatitis. ?He took my hand and said, ?There are people who just can?t drink as much as other people and I think you?re one of them.? there was no judgment and nothing threatening. It?s then that you just want to say, ?so, are you going to practice around here???
Not that there aren?t light moments. most of the time Murdock manages to stay in character and suppress her inner smart aleck, but sometimes it?s just too tempting.
?I was getting a head-to-toe physical once and the student was supposed to assess my senses,? Murdock said. ?So he asks: ?How do you smell?? I couldn?t let that one go.?