Acting the part: How simulated patients contribute to medical education

By: Kristine Roggentien

Date: Tuesday, May 8, 2018

Matthew Traxler entered the room to find J.C. Luxton doubled over, hands gripping the exam table, unable to straighten up due to back pain.

Luxton is a frequent visitor to the clinic, where he assumes the role of a simulated patient, acting as if he has an ailment so medical students like Traxler learn how to interact with patients and take the appropriate steps to treat them.

Working with simulated patients

Over four years, the average medical student will have about 65 encounters with a simulated patient. As the Carver College of Medicine prepares this week to graduate another class, it’s worth noting the valuable role of simulated patients.

“Simulated patients are there for us every step of the way—from the first months of med school through the last semester,” says Traxler, a graduating medical student from Minneapolis. “They allow us to make mistakes in the comfort of a classroom and figure out how to move forward.”

Simulated patients (SPs) act out clinical scenarios with students—either one-on-one or in small group settings—to work on two major concepts: medical interviewing and physical exams. For each encounter, the SPs have a scripted condition to act out—such as depression, the common cold, or an appendix about to burst—and then subsequently give feedback and evaluate the students on specific skills.

“Students love the chance to practice prior to being graded,” says Ellen Franklin, director of the Simulated Patient Program. She joined the program in 2002, and since that time, the program has grown and expanded how SPs are used.

Progressive training experience

Early in their training, students work with SPs to practice patient-centered communication skills. As they progress, they take on more advanced interviewing skills, which include:

Taking a sexual history
Having difficult conversations (delivering bad news)
Discussing geriatric concerns
Doing suicide assessments
Engaging in shared decision making
Having motivational conversations (e.g., to help patients improve their diet, stop tobacco use, etc.)

Students by then are participating in primary care experiences in psychiatry, pediatrics, surgery, obstetrics and gynecology, and inpatient care.

Educational benefit

“The SP program is invaluable. The opportunity to work with real people instead of just theory in the classroom has made my education much better for it. Until you actually do it, you never know how it’s going to turn out,” says Traxler.

In fact, Carver College of Medicine students have scored higher than the national average nearly every year on the USMLE Step 2 Clinical Skills exam. This exam includes encounters with simulated patients, which students must pass to get their medical license.

Being a simulated patient

Simulated patients often include local actors, retired teachers, health professionals, and even attorneys, and they’ve played a role in medical education at the UI since the 1960s—the Carver College of Medicine is recognized as a pioneer in their use.

“It’s really rewarding and really fun to see them improve,” says SP Elise Mozena. “It’s not just making a difference for the med students, it’s making a difference for the patients they’ll have years down the line.”

The SPs go through eight to 10 hours of training before they work with their first student. Experienced SPs may train to become physical exam teaching associates (PETAs), who—in addition to portraying scenarios—help introduce physical exam skills such as using a stethoscope, doing a cardiac exam, etc., before the students receive further training on those skills.

Clinical experience

While visiting his own doctors, Luxton, a longtime SP, says, “My checklist of communication skills from evaluating students is very active when I have my own doctor appointments—I can’t turn it off. Sometimes you’re with a doctor who hasn’t had training like this, and the difference is so stark.”

Working on communication skills is especially valuable. Students learn how to establish a relationship, express empathy, understand nonverbal cues, and ask questions in a nonjudgmental way.