Eight private exam rooms, each with a large, one-way mirror, line a curving corridor. On the other side of the mirror is a room where instructors watch what is happening in the exam room while listening through headphones. In the exam room is a patient dressed in a gown awaiting the entrance of a medical provider. The patients are actually actors role-playing as patients for the purpose of providing simulated experiences for medical students in the SIU School of Medicine Standardized Patient Program.
The standardized patients are called SPs and are trained in how to portray a character according to the case details they are to assume – age, physical or mental ailments and various symptoms to present such as a cough or a broken leg, for example. The SPs are coached to make the simulation as real as possible. There is even a chewing gum that can be used to give the SP's breath a certain odor that could be a symptom of a particular condition. Each case helps medical students, residents, nurses and other providers hone their skills, get assessed by faculty and learn the best techniques for when they interact with actual patients.
Mary Aiello served as director of the Standardized Patient Program for 23 years. Although she retired in 2023, she still works part-time assisting with the program.
Dr. Amelia Frank is the current director of the Standardized Patient Program and a physician and associate professor of Family and Community Medicine at SIU. She has come full circle as both her parents were doctors and teachers at SIU and says knew she wanted to pursue medicine and someday work at SIU.
The Standardized Patient Program began in the 1970s, and SIU was the first medical school in the nation to have a formalized program. In the 1980s, SIU was credited with having the first comprehensive performance-based program, and Dr. Howard Barrows was instrumental in making this a reality.
Barrows came to SIU from McMaster University Medical School in Canada where he was a pioneer in training actors to become simulated patients. Barrows later became the associate dean for educational affairs and chair of medical education at SIU. His work helped the school build a strong program that "is used by an overwhelming majority of medical schools across the country," Frank said. "Our program allows students to get hands-on skills learning. Students can try approaches and possibly fail, but that is part of the learning. With SPs, medical students won't actually hurt anyone if they make a mistake. They are observed in an unobtrusive way and given feedback from the faculty who watch them as well as the SPs."
Aiello adds, "I feel blessed to have worked with Barrows in the SP program. At first students were skeptical, but over time that changed to their appreciation for the simulations. Issues such as how to give bad news to a patient or deal with an abuse case can be practiced before encountering a real case."
Wen Fritsch, a fairly new SP, said, "We are given a case with specific details and spend a couple of weeks practicing. We are given instructions on what to say or not to say, what symptoms we are to present and what to watch for from the students. This training is so important. I love doing this, and have been impressed with the medical people I have met. The cases are all over the board. One time I had to act like a drunk who suffered a broken leg from jumping off a bridge in a small, rural town. The medical team who came in to see me had to come up with a solution about what they would do in a real situation."
Those being evaluated might be medical students (72 are enrolled at SIU), residents, nurses or visiting doctors. The simulation cases could be as minor as a sore throat and cough or as serious as a sexual assault. Frank said, "We work with other groups on external cases, such as training in social work or with the police in certain types of situations."
A beginning medical school student learns basic physical exam skills through simulation experiences. In subsequent years, assessment and skill development increase with a larger number of cases using SPs. In senior year, a student must complete SP cases along with a clinical reasoning exam to determine readiness for residency. By the time a student graduates they will have seen more than 50 SPs.
The program is always seeking new SPs. Pay is given to the participants. Currently, there are around 125 SPs, and more are welcomed. Information and an application can be found at https://www.siumed.edu/oec/sp.
Cinda Ackerman Klickna is a frequent contributor to Illinois Times and Springfield Business Journal.
