of the interaction— not just a case, not just a diagnosis.
Nguyen says SPs are“ standardized, simulated with specific quotes that they have to say or specific presentations, but … they’ re still also people with their own personalities. You can’ t treat the experience as if you were in the anatomy cadaver lab … [ it ] is not the same at all.”
In the partnership between medical students and standardized patients, this duality exists as well. The SPs offer their words, bodies, and minds for the education of the next generation of doctors. As students, many of us probably know very little about them outside of the roles they are assigned to play, only as much as they choose to disclose— much like real patients. Likewise, they are much more than components of medical education.
“ At the beginning, I was worried about seeing SPs as part of the assessment and grading process, or as a challenge that had to be solved,” medical student Paige Liebel says. She soon came to realize, however, that SPs“ are really partners in the room” and are“ helping us learn.”
Liebel says that the SPs help establish a“ safe space” where medical students can break the fourth wall and directly ask if they’ re performing an exam maneuver appropriately.“ I don’ t know how else I would learn [ the clinical skills ] other than possibly hurting a patient or not doing a good job,” she says.
Similar to how skilled actors outshine and outlive their characters and the props on a stage, the SPs’ parts as educators transcend their roles in exam rooms as they become acquainted with their medical student audience.
“ Sometimes you will have special interactions with SPs, where you’ ll remember them and they’ ll remember you [ or ] something about your [ medical ] interview, and it kind of just gets carried through throughout the years like an inside joke,” Nguyen says.
ACT IV: SETTING THE STAGE FOR BROWN’ S STANDARDIZED PATIENT PROGRAM In Brown’ s Doctoring program, which started in 2005, students work with faculty and standardized patients to learn clinical skills and how to apply medical knowledge to directly care for patients using a patient-centered approach, according to Rougas and Director of the Doctoring Program Dana Chofay, MD. Prior to this, students would work with their clinical mentors to identify real patients at the hospital for students to interview. While this is still a component of students’ training, many of their initial interactions now transpire in the Doctoring course.
“ The first time taking [ vital signs ], the first time putting a stethoscope on somebody’ s back, taking a pulse … the first time I touched someone in a medical sense” happened with the SPs, Liebel says.
The program offers professional, clinical experience where student doctors can err and navigate difficult situations before they become real, Rougas says. Skills practiced include interviewing, counseling on topics like interpersonal violence, nutrition, and depression, relaying clinical diagnoses, and examining patients.
As an early medical student,“ it’ s the only time where you actually have the chance to direct how the conversation is going to go,” Liebel adds.
Salguero Lizarraga built up her confidence by working with standardized patients before transitioning to her clinical rotations at the hospitals.“ SPs were so great at helping me really feel comfortable and find my workflow, so that way I can be present for my current patients now,” she says.
The standardized patient program has evolved throughout the years, alongside changes in how medical communication is taught to students. Handley highlights efforts to diversify those who are hired as SPs and the types of patients represented in clinical cases to reflect the patient community, including patients of various genders and patients with disabilities. She also worked to double the number of SPs from 30 to 60 since 2018.
Oakes says he has noticed a larger emphasis on trauma-informed care over the years, referring to the phrasing that students use when giving instructions during the physical exam or when asking patients questions about their medical history.
“ The fact that respect for others is instilled and is an important part of the curriculum makes me happy to go to work every day and really just warms my heart, knowing that I’ m working in a place where empathy matters, where other people’ s lives matter … and the spectrum of human life is respected,” Oakes says.
ACT V: A LOOK BEHIND THE STANDARDIZED PATIENT CHARACTERS When I join my interview calls with Oakes and Goldberg for this article, I greet familiar faces. Both were key figures in my medical education at Brown. As in our prior encounters, I have come prepared with a checklist of questions. This time, however, I am not asking about how their
PHOTOGRAPH: GETTY IMAGES / AZMANL
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