Medical students study hard to become doctors, and some things you just can't learn from books. That's why, in recent years, medical schools have begun hiring standardized patients, or SPs. These healthy pretend-patients don't just give future MDs a warm body on which to hone their clinical skills; they take on the role of an afflicted person, with all the accompanying affect.
The SP program at the University of Vermont Medical College began in the 1970s, when a group of women volunteered to help teach pelvic exam techniques. UVM began using SPs in other parts of its program in the 1990s, and today employs about 70 of them part-time, at an average of $20 an hour. They work with medical students, as well as nurse practitioners, physical therapy students, and medical residents.
Vivian Jordan of Hinesburg was an SP in New Jersey for four years before she moved to Vermont in 2002 to be closer to her son and his family. This is her fourth year at UVM.
Like many SPs, the 59-year-old grandmother has a background in theater. She holds a Bachelor's degree in drama and literature from the College of New Jersey, and has performed in off-Broadway productions. Most recently she appeared in The Bad Seed with the Essex Community Players.
Jordan spoke with Seven Days at the SP HQ - UVM's Professional Learning and Assessment Center. It boasts a dozen exam rooms, each equipped with a hospital bed and two video cameras linked to a bank of monitors in the hallway, where instructors can observe and record SP encounters.
SEVEN DAYS: Can you walk me through an exam?
VIVIAN JORDAN: This room is a doctor's office, or it could be the ER, depending on the case. I'm lying here in a hospital johnny and a sheet over, and pretending to be in pain. The student comes in, asks me questions, then does an exam. Unfortunately, I had six pelvic exams today.
VJ: Yeah. Today, I couldn't move because of an intense abdominal pain. I really act the role for it, like, "Oh, ow, it really hurts." We have scripts that we work from. We tell students when the pain started, what type of pain it is, where it is, if we've tried to treat it with anything, that sort of thing. Everyone who does that case should do it the same way. The students should ask certain questions, and we have the standardized answers to them.
SD: What happens afterwards?
VJ: After they leave, we fill out a checksheet as to what they did or didn't do. Most of the time we bring them back in and talk about how they can improve their performance. We try really hard to give them a positive experience with the feedback. Rather than "That was terrible," it's more like, "That wasn't bad, but next time you do it, you might want to try so and so."
SD: Doctors can be intimidating. It's so rare that you have an opportunity to give them feedback. That must be empowering.
VJ: Yes. We're hoping that eventually, thanks to programs like this, in another decade or so you'll see better personal interaction between doctors and patients. We try to catch students early in their first year, and really work with them. Because some people are just born with those interpersonal skills, and others are not. We try to get the ones who are not, and at least give them little tricks they can use to make their patients more comfortable.
SD: What kind of tricks?
VJ: For instance, one of the cases I play, I have a sister who died of breast cancer. So when that comes up, it's just a matter of saying, "Gee, I'm sorry to hear that." Or it might be a little touch if somebody's in excruciating pain.
SD: You work with the same students over a period of time. Do they improve?
VJ: Absolutely. They come in, first-year students, they don't even know what to do with a stethoscope. They're trying to listen for a heart sound, and they don't even have the little thing on the end turned in the right direction, so they're not hearing anything, and they're wondering why. They're afraid to touch people.
We get them right at the beginning in a course called Doctoring Skills. Generally, it's just wonderful what we see, from first-year med school to fourth-year, how they progress. We watch them over the years and we get to know them. It's probably the best part of the job. There's some of them, I hope they stay around here, because I want them to be my doctor.
SD: Any exams that stand out in your mind?
VJ: I was doing a domestic-violence case. As the standardized patient, I'm supposed to be pretty defensive. I'm not thinking that I'm abused, and I don't want to know about it. I'm here because I get headaches.
But I had a student who just said the right things at the right time. I don't remember how he got to the fact that I was being physically abused . . . I had been rationalizing about it beforehand. You know, "It was my fault because my husband works hard and he deserves to have a good meal on the table. And if he's going to get mad about it, then I can't blame him."
And the student just stopped me and quietly said something like, "Nobody deserves to be hurt," and I was like, whoa. He was very calm. When I called him back in for feedback, we both just looked at each other and said, "Oh, my God." It was just amazing, for both of us.
SD: You can't teach a response like that.
VJ: No, you can't. You can teach what not to say. You can teach people not to go in and say, as soon as you suspect abuse, "Your partner hits you, doesn't he or she?" But what to do is sometimes either there or not. Or sometimes they develop it as they go along. I've seen that happen, too.
SD: Portraying that scenario sounds intense.
VJ: Speaking of intense, I did death and dying last year. One day, you come in, you get a diagnosis of terminal cancer, and then the next session, you only have a very short time left. You can barely walk. You sit in a chair and you're kind of drooly. We wear clothes that are too big, so that it looks like we've lost weight. It took me about two weeks to really recover from it. That's unusual for me. With all my acting experience, I can usually just drop it, but this was really an issue for me.
SD: Has this job changed the way you behave as a real patient?
VJ: Absolutely. I can sometimes direct the doctor a little bit more. And I'm much more critical. I had a head-to-toe physical not long ago that was one of the worst things I've ever seen in my life. I will never go back to her. I'm certainly much more comfortable in a doctor's office, because I don't feel that awe. He or she is just another person like me.