Playing role of reality for future docs

Actors: Medical schools pay people to put their skills to work as standardized patients to train students what to expect.

Medicine & Science

December 15, 2003|By Dennis O'Brien | Dennis O'Brien,SUN STAFF

Carole Schaefer is not a patient, but she plays one in medical school. She has feigned headaches, fretted over her blood pressure and denied her alcoholism. When she learned her husband had cancer, she got so angry at his doctors that she threw her purse against a wall.

"I enjoy the kind of roles where you really get to act, where you have to bring out the Kleenex, so to speak," said Schaefer, 54, of Roland Park, who in real life has never been an alcoholic and enjoys good health, along with her husband.

But whatever the role, Schaefer is always playing to the same audience - future doctors.

Medical schools across the country pay people like Schaefer to fake illnesses, hide invented drug and alcohol problems and receive fabricated bad news. They're known as "standardized patients," and are used by future doctors to get accustomed to making diagnoses and discussing the sensitive issues that arise in medical treatment.

"We ask a lot of our doctors," said John Shatzer, director of medical education at the Johns Hopkins School of Medicine and supervisor of its standardized- patient program. "They're asking women they've just met about their sexual histories and dealing with families that are making life-ending decisions."

Actor-patients have been employed since the 1960s and are now staples at almost every medical school. But they will assume an added significance next fall, when all U.S. medical school graduates will be required to demonstrate their ability to evaluate 10 standardized patients before they are licensed by the National Board of Medical Examiners. Foreign medical school graduates have had the requirement for five years.

As part of their training, medical students are routinely grilled about illnesses and therapies when they make "rounds" with doctors in teaching hospitals. But it is only the standardized patient that they evaluate themselves.

"It's like acting, but you have fewer parameters because you don't have exact lines," said Hilda V. Peacock, a standardized patient and theater student at Towson University who will appear in an Arena Players production of Julius Caesar next month.

Peacock helped train a group of first-year medical students last month at the University of Maryland School of Medicine by playing Dolores Darling, a divorced, 25-year smoker. Her stage, like those at many schools, was a standardized-patient lab, designed to look like a treatment room in a doctor's office. The one exception is a video camera that feeds a bank of monitors in a nearby room.

In back-to-back, 15-minute sessions, Peacock met with six future doctors taking a course known as Introduction to Clinical Practice. Playing her role, she told each one that she was seeking treatment because she recently learned that she had high blood pressure and was worried about a stroke.

Each student asked her questions, left the room to write a note with a diagnosis and returned for a face-to-face evaluation of their performance by Peacock. Each session was videotaped for the students to study later.

Many stumbled through their initial examinations. Others were more confident, but left Peacock without making a diagnosis or telling her what treatment might be in store.

"She was actually much more complimentary than I probably deserved," said Abigal Lenhart, a first-year medical student who confessed to making insufficient eye contact during the exam.

The players' roles and symptoms reflect what the students are learning in class, said Kathy Schaivone, director of the program at the University of Maryland School of Nursing. The school also trains paramedics and nurse practitioners.

Standardized patients come from all walks of life, but about half have a background in community or professional theater.

Many hook up with medical schools through word of mouth or Web sites that advertise acting jobs. Some work only at one medical school, while others shuttle among all five in Baltimore and Washington.

Most are paid about $15 an hour and work from a few hours a month to 30 hours a week. They often repeat a role several times over the course of a semester or school year.

The trick, they say, is having enough free time to show up early in the morning or in the middle of the afternoon for a few hours of work. They also must be able to recall long and complicated medical histories for each fictional patient they play.

"You have to remember a lot of details," said patient Arnold Sampson, a real estate broker and member of the Screen Actors Guild who has also worked as an extra on the Homicide television series and had a brief speaking role in HBO's series, The Wire.

Like many innovations, standardized patients were not always widely accepted. "There was a lot of resistance to them at first," said Dr. Howard Barrows, a retired neurologist who pioneered the concept in the 1960s at the University of Southern California Medical Center. "Doctors thought they were wasting their time on training with anything other than real patients."

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