Actors Training Doctors
Medical students probably don’t expect actors to take part in evaluating the students’ diagnostic and examination skills. But that’s what’s happening at Einstein and other medical schools throughout the nation. New York offers a huge pool of acting talent to draw from, and working as a “patient” for medical students has become a popular “between engagements” gig. Medical students encounter these actors, known as standardized patients (SPs), throughout their four-year education, applying what they’ve learned in class to their encounters with real people in exam rooms.
Didi Charney, a professional actor, plays female SPs age 40 through 65. Her non-SP acting career has included roles on TV’s As the World Turns and Another World and in a number of plays. Her SP repertoire spans 25 different roles. One, whom we will call “Janet Jones,” is her favorite.
Janet fainted while on the toilet. She chalked it up to not having eaten breakfast but sought treatment at her husband’s urging. The diagnosis: vasovagal syncope, a harmless fainting spell usually triggered by emotional distress. Didi knows Janet well. Einstein’s SPs play their characters up to 16 times a day, as one student after another interviews them about the health problem they’re depicting.
Ms. Charney learned about standardized patients 10 years ago via a newspaper article, and took to the idea right away. She liked the extra income and the opportunity to help future doctors learn how to communicate with their patients.
A BRIGHT IDEA
Dr. Howard Barrows at the University of Southern California started using actors as a way to test medical students’ skills. Today, SPs are a staple of medical education in this country and internationally. “It’s a way to determine that students have needed clinical skills, which include communication, history taking and physical exams,” explains Felise Milan, M.D., professor of clinical medicine and director of the Ruth L. Gottesman Clinical Skills Center and the Introduction to Clinical Medicine Program at Einstein, and an internist at Montefiore.
“The folks we work with are not just actors; they’re medical educators as well,” says Dr. Milan. “They need to be the character they’re playing, get the story right and keep track of what questions the student has asked and whether an exam was thorough. As soon as the encounter ends, they have to get on the computer and record what the student did and didn’t do.”
The actors help create a realistic environment in which students can practice their skills—but it is still a safe environment, where students can make mistakes.
Abigail Bergman, a second-year medical student, was nervous before her first SP interview even though she knew she would be dealing with an actor, not a real patient. Here, her patient had been instructed to resist questioning and to insist that she wanted to see a “real” doctor, not a student. “You have to learn how to calm patients down,” Ms. Bergman says. The difference between interviewing a standardized patient and a real one is that “if you forget what to ask an SP next, you can stop and say so—something you can’t do with a real patient.”
For each new role, Ms. Charney receives information about her character and the medical problem she’ll be enacting. Beyond that, she explains, “You need to develop a backstory to flesh out who the patient is, so that he or she is not just a cipher with a bunch of symptoms.”
Once, when playing a patient who owned a flower shop, Ms. Charney devised a backstory with numerous details, down to her character’s favorite flower. She makes notes of each backstory for future reference, since she may play the same role every few months for new crops of students.
But there’s no way to anticipate all the questions students will ask, so improvisational skills are vital. While Ms. Charney was playing the mother of a sick infant, a student asked how soon after birth her baby had his first bowel movement. Although a mother herself, she was momentarily stumped. Should I say I need to check my records or that I can’t remember, she wondered, finally settling on, “I’m sorry, I don’t remember.” Anna Lank, who recruits SPs for Einstein and other New York City–area medical schools, maintains a database of 1,600 people of varying ages, genders, sizes and ethnicities. She likens her job choosing the right person for the desired SP to that of a casting director. “We take great care to find exactly the right SP for each encounter,” she says.
Not all SPs are actors—“I have a writer, a retired nurse, students, a graphic designer,” says Ms. Lank—but actors do have an edge. “To become an SP you have to listen and observe well, and those are skills actors are trained in,” she notes. “You also need to be comfortable in imaginary circumstances and have the discipline to recreate your role over and over.”
Just like on stage.