Medical students study for years and memorize volumes of facts and figures to get their certifications and degrees, but a special program being used across the state also can help them work on their bedside manner — before they ever set foot in a clinic or hospital.
Standardized Patient (SP) programs represent a pioneering, holistic approach to training future health care professionals, helping prepare them for the complexities of patient care in ways textbooks cannot match. These programs, designed to simulate real-world patient interactions by using real people portraying patients, play a crucial role in honing clinical skills, enhancing diagnostic abilities and ultimately improving patient care outcomes.
“I like to say that students — we call them ‘learners’ — come to simulation first so they can learn how to work with our ‘fake’ patients before they go and actually have to work with real patients,” says Miranda Powell, Standardized Patient lab coordinator at the University of South Alabama. “Make your mistakes with us and then build your confidence up here before you’re in the hospital with people that actually have these issues.”
Standardized Patient programs involve the use of trained individuals who portray patients with specific medical conditions or scenarios in a controlled setting. These SPs are integral to medical education as they allow students to practice clinical skills in a realistic yet risk-free environment. The scenarios are meticulously crafted to reflect a wide range of medical conditions, ensuring that students encounter diverse situations that they may face in their future careers.
Using Standardized Patients has been around since the 1960s, says Tara Edmonds, the director of assessment in the University of Alabama at Birmingham’s Office of Standardized Patient Education (OSPE) and a faculty instructor in the school’s Department of Medical Education. It has since become a cornerstone in medical education and is used in medical education programs across the country.
UAB started its SP-specific program in 2000, and it continues to expand. “In fiscal year 23, we had 7,449 learners with 9,872 learner hours,” says Edmonds, “and that was across 11,718 SP encounters, so that shows how much time these learners are spending in our center.”
Standardized Patient programs can be found across the state, from the Alabama College of Osteopathic Medicine (ACOM) in Dothan to the College of Nursing at the University of Alabama in Huntsville (UAH). Two of the largest programs are at UAB and USA.
“What is so valuable about this program is that it provides a standardized way to teach and assess your learners on these exam skills, whether they’re history-taking skills or physical exam skills,” says Edmonds. “So, if you think about when you’re trying to teach somebody how to do a pulmonary exam or a cardiac exam, if you want to ensure that they learn all of the components of that, and you have to test on all the components, you have to have a way for them to show you or demonstrate all of those components.”
To create a case for the program, the course instructors work with the SP program to determine what skills a student/learner should have learned and exactly what they need to do in a clinical or examination setting.
“Then, we make a case to include a patient’s name, their social history — basically everything that’s going on in their life that is relevant and could be asked during a real medical encounter,” she says.
“Then we take a group of people and we train them to the case. They all learn it,” continues Edmonds. “And what’s great is that they’re all standardized to each other, so every single patient has to be the same patient every single time. So, then each learner who comes into the room has the exact same opportunity. So, student A and student B, they’re going to see two different patients, but they’re going to get the same information. Hopefully, they’ll ask similar questions and get the same responses, and they’re going to perform the same physical exams, get the same results. And then make the same management decisions. So, what we’re doing is we’re standardizing their testing,”
The sessions are recorded, which gives an opportunity for learners to see what they did right and what they need to improve. “We can say, well, that was great, but you should have done this one thing, because now you’re not going to be able to get this diagnosis right,” she says.
The USA Standardized Patient program lab opened in 2013, but had been doing simulations a while before that, says Powell. “I actually started here as an SP in 2014 when I was a student and have worked my way up in the program.” USA currently has about 160 SPs, nearly four times the number they started with 11 years ago. The program started with the College of Nursing but has expanded to serve 10 medical disciplines at USA.
Each discipline coordinates the dates needed with the program. “They usually reach out to us about six months to a year before their scheduled event, so we have a lot of time to plan, make sure logistics and everything are set and make sure everything’s going to run smoothly, because we may need a few SPs or we may need 50 for an event,” says Powell.
The program tries to recruit a wide variety of SPs as far as age and gender, which helps learners practice on various real people, she says. Many are students and retirees who have the time and flexibility to commit to the program, but Powell says it can be more challenging to find working age men and women to serve as SPs.
“We go to career fairs, we go out into the community, to different community groups,” she says. “I’ve gone to the YMCA and Mother’s Day Out programs before because, you know, you have to start getting creative and think, so where can I find working-age men and women that don’t have full time jobs? A lot of people don’t even know about this program, but it’s a flexible, fun job and you can do it and make a little money.”
The pay scale varies from program to program, but hovers around $16 an hour — not bad for a flexible part-time job, say participants.
Bob Hanks, who has been an SP since 2017 when he was the director of Counseling and Testing Services at USA, says the interaction with the learners and the mental challenge are what keeps him coming back. “And, to be honest, I like the flexibility of it. As a retiree, I can work when I want and decline if I want to travel or whatever else.”
Eden Blackmon, an online student with Troy University, heard about the program through a friend, got involved about two years ago and loves it. “It gives me freedom to be a student, do what I want to do and then still make a little bit of money on the side.”
Blackmon says she also enjoys the diversity of the program, which gives learners a chance to interact with “warm bodies.”
“AI is becoming such a big thing and it’s taking over a lot of stuff and it’s wonderful in a lot of ways,” she says. “But the one thing it lacks is emotion — and that’s what SPs bring to the table.”
Jennifer G. Williams is a Hartselle-based freelance contributor to Business Alabama.
This article appears in the September 2024 issue of Business Alabama.
