Actors perform on the stages of Long Wharf, the Shubert, Yale Cab, Yale Drama and Yale Rep. Also, in the classrooms of the Yale School of Medicine.
They’re called “standardized patients,” and it’s their job to play the role of patients for medical students learning to refine their bedside manner. On January 11, the topic at hand was shared decision-making—helping patients come to a decision about their health care by asking the right kinds of questions and being attentive to their concerns and desires.
On classroom doors in the Anlyan Center on Congress Avenue, the names of medical and physician’s assistant students were posted, four to a room, along with the names of five fictional patients they’d be interviewing. Part of a women’s and children’s health rotation, the morning’s scenarios involved birth control, pregnancy, menopause and uterine cancer. In the hallway, the five actresses who would be presenting those scenarios shed their winter coats, studied their lists of character facts and chatted with one another. There was some cheerful grousing: Oh, you got the pregnant daughter today? I got stuck with menopause!
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But once inside the classroom, their demeanors changed.
Cheri Brooks, playing a woman named Eve Perez, sat across from medical student Kenneth Gunasekera and spoke of her character’s dilemma in a soft and halting voice, sometimes near tears: the mother of a one-year-old, she wanted to “get her tubes tied.” Money was tight, and she felt she couldn’t take birth control because of migraines. Her husband didn’t know she was at the appointment.
“He’s always wanted to be a firefighter, and his dream finally came true three years ago,” said Brooks as Perez. “Since budget cuts in Milford, he’s going to lose his job. That’s all he’s wanted to do is be a firefighter. And he’s always wanted a big family. So…” Her voice trailed off.
Gunasekera was attentive. “Okay. So, tell me what you know about getting your tubes tied,” he said, using the same layman’s terms she’d used. The conversation continued, with Gunasekera bringing the patient some other options. He wandered into facts and statistics, then asked for a time out. “I think I’m monologuing a lot right now,” he said to his three fellow students and instructor Jim Van Rhee. “I’m starting to get into this thing about infection, and the procedure. I think there’s a better approach to what I’m doing right now.” While he requested help and Van Rhee responded, Brooks bowed her head and waited, holding her character until it was time to pick up the exchange again.
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In another scenario, actress Jackie Sidle, playing patient Jean Burgess, took on a more straightforward persona. “I’m miserable,” she told student Emmanuella Asabor. “I want to jump in front of a bus.” Later, when Asabor was coming to “the last big option” for treatment of hot flashes and menopausal symptoms, “basically the same medication that we give to treat depression,” Sidle broke in with “sauvignon blanc.” She smiled wryly, and the comment elicited a laugh from Asabor and everyone in the room.
Students discussed both of these comments later after Sidle/Burgess had left. Was she potentially suicidal? Was she drinking too much? Or was she just expressing her anxiety through the use of humor? “You can chuckle at her alcohol comment,” Van Rhee suggested. “You can then dive into that and say, ‘So, have you been drinking more wine to get through these symptoms, and is that a concern?’”
The program director for Yale’s Physician Assistant Online Program, Van Rhee has enlisted standardized patients in his teaching for 20 years and says nearly every medical school in the country now uses them. At some schools, the job goes beyond talking to actually undergoing physical exams, with standardized patients assessing and grading the students after the encounter. “It’s one thing to practice how to take a
Sidle, a professional actress, has been working as a standardized patient for 13 years. The most difficult cases to portray, she says, are the psychological scenarios. One of her roles is a patient with borderline personality disorder, which she plays for nursing students. “That was very hard to tap into at first,” she says. “Now I feel like I can kind of dial it in and portray it without going all sad.” Feeling an emotional response to the scenarios is a challenge for students as well. “Sometimes it taps into stuff in their life,” Sidle says, “and they’ve left very upset.”
Having multiple EKGs, blood pressure readings and even gynecological exams—as standardized patients do at other schools—may not be everyone’s idea of a great job. But Sidle says everyone she knows who does it, whether a professional actor or not, “loves their job and takes so much pride in it. They feel like they’re part of a team.” As standardized patients, they’re helping to educate tomorrow’s medical professionals. “You see the students in their first year, and then you’ll see them again in their third or fourth year,” Sidle says, “and you see how much they’ve progressed from being really terrified to really being able to ask sensitive questions and get to the emotion of the patient.”
Inside the classroom that day, Van Rhee’s second-year medical students were well on their way, offering one another supportive comments and suggestions as they did a post-mortem on each scenario. The challenge, as student Emmanuella Asabor saw it after her scenario, was “giving
That put her practice patient one step closer to making a shared decision. And it put her one step closer to becoming a better doctor.
Written and photographed by Kathy Leonard Czepiel.
