Standardized Patients - a standardized process

Some of my first year classmates at the Keck School of Medicine were recently interviewed for an article in the Los Angeles Times about the actors who play standardized patients for our clinical skills workshops.

Standardized patients (or SPs) are essentially “practice” patients who are used to demonstrate to learning medical students a variety of different situations that they will face in the future as doctors. Actors play these different characters off of a script that provides basic information about the patient and his/her background.

Mel Melcon / Los Angeles Times

So far, we have had SPs to practice basic interview skills, how to take a sexual history, how to deal with a dying patient and how to interact with a difficult patient.

The article deals mostly with our Dying Patient workshop (obviously the LA Times would choose the most emotionally charged situation for their story) and it was interesting to read about the SP experience from the actor’s point of view. (Being in LA, the actors are very good and always seem to go the extra mile to stay in character.)

 Of course there is no doubt that SPs are important for our education as medical students but honestly, they are one of my least favorite parts of our curriculum so far. During an SP workshop, the actors are the ones with the script but sometimes I feel like they are doing more improvising than the medical students. Before every session, we are briefed on the situation we will be practicing and then advised about how to deal with it.

Appropriate responses to different patient situations are turned it into a formula for us. And yes, formulas can be useful when we are terrified because we know nothing. But what happens when we start trying to apply the wrong formula to a situation? Or stop really listening to our patient because we are so robotically going through the required steps? 

Accuse me of having no imagination, but whenever I walk into that small and enclosed room where we conduct our SP interviews, I feel fake and I start to act fake. I slip into formula mode because I'm not there to listen to a patient, I'm there is accomplish the "workshop goal". It makes me even more appreciative that we are able to interview actual patients at LA County or Keck Hospital once a week.

Some of those stories are so crazy, there is no formula we can use on them. And that’s where I learn my most valuable interview skill as a medical student: how to improvise.

-Mansi