- Published on Tuesday, 24 July 2012 15:01
By Laura L. Acosta
UTEP News Service
Fred Keyser is not a real patient, but he plays one for nurse practitioner and health sciences students at The University of Texas at El Paso.
Keyser is a standardized patient – an actor who is trained to perform the role of a patient or family member to allow students to practice their clinical and communication skills in a safe learning environment.
“You have to take on this character and present it effectively, but then you have to pay attention to what the student is saying and how the student is saying it because that is how they are graded,” said Keyser, an actor and past president of the El Paso Playhouse who is retired from the Department of Homeland Security.
Since 2010, the UTEP School of Nursing has been using standardized patients to teach students to obtain a medical history, perform a physical exam and develop their communication and critical skills.
Actors are trained to portray the same patient going through a medical situation, such as a stroke, asthma attack or a parent with a sick child. They are given scripts with a complete medical history to follow and medical complaints to act out. Even though the actors are different, students receive the same information and responses.
“This is more like improv where you learn a series of facts and you have a basic outline but you never know what the audience is going to ask for,” said Keyser, who has appeared in The Fantastics and Man of La Mancha and has reprised his role as a standardized patient four times. “You have pieces of information and based on the students’ questions, you have to be able to jump to that particular piece of information and present it back. But it’s acting. You have to have a character. You have to stick to that character and all your responses have to be as that character would respond.”
Standardized patients are recruited from the community and come from all walks of life. They include retired hotel and restaurant owners, teachers and UTEP students.
After Joe Palomo retired from his military and civil service career with the Department of Defense eight years ago, he was looking for something challenging to do in his spare time.
Palomo did not have any acting experience, but he joked that he has had all the major diseases, which qualified him to take part in the encounters.
“Some of the standardized patients don’t sleep the night before, but I get plenty of sleep,” Palomo said with a laugh. “It really weighs heavy on some of us. But we rely on the training that we were given and we give it our best.”
Thelma Garcia, a retired seventh- and eighth-grade math teacher, was part of the first group of standardized patients at UTEP and has been involved every semester since the start of the program.
She said that as a teacher she can see how valuable this experience is for students.
“I’ve had (students) ask me, ‘Do you really have this illness?’ and I say, ‘No.’ I have them believing that I’m really sick and that’s really nice to know that I’m doing my job,” Garcia said.
The actors and students are not allowed to mingle until the exercise has ended and students have received their evaluations. Encounters take place in the standardized patient area in the Center for Simulation, which includes four identical clinic-style rooms, two treatment areas for physical and occupational therapy, and a patient lounge.
“We try to maintain a distance between the student and the standardized patient,” said Debbie Sikes, an instructor in clinical nursing and the coordinator for the Objective Structured Clinical Examination (OSCE) and Standardized Patient (SP) program. “Even though that standardized patient is a real person, we still want them to stay in character because we don’t want to break the reality that the student was in the room with a patient.”
Details of the encounters also are confidential because cases are repeated each semester and students are evaluated on their performance.
“We don’t want the student who is coming in the next semester to know the specifics of the cases that we’re doing this semester, because when I give the standardized patients the script, they’ve got the test. And when I give them the checklist, I’ve given them the answers to the test.”
The rooms are wired with video equipment and the training is recorded. Standardized patients are given two checklists of questions that the students should ask – one to measure the student’s communication skills and the other to see how well the student conducts the health history. While one standardized patient is in with the student, another actor is in the control room looking at the scenario on the monitor and marking off the checklist.
After the performance, students are given feedback and allowed to look at the video to see what they did well and what areas need improvement.
“The first time I did this, a patient told me that I was very unorganized with my assessment and when I saw myself, I was,” said Karina Moser, a nurse practitioner student. “She was right. I was like ‘What do I do next?’ The next two times it was smooth.”
For Laura Marquez, the feedback she gets from patients will help her in her career as a nurse practitioner.
“In the real world, you don’t get patients that come back and tell you this is what you did wrong or this is what you did right,” Marquez said. “It helps looking at ourselves. You start seeing a lot of things - if you use a certain word a lot of times, or how you come across to the patient.”
In addition to working with nursing students, standardized patients also have worked with students from physical therapy, occupational therapy, pharmacy, social work and speech language pathology.
Sikes said one of the goals of the program is to promote interdisciplinary collaboration to allow students to see how they will work with different disciplines in a real health care setting.
“As an actor you have to present the same person to two totally different professionals,” Keyser said. “They ask different questions. The social worker is coming from a complete different angle – how does this person fit into society as opposed to what is physically wrong with this person? So the character has to be able to understand and respond to scrutiny from both directions.”
Ron Szatkowski, an actor at the El Paso Playhouse, said his role as a standardized patient has helped him become a better patient when he goes to the doctor.
“It makes me more aware of what I need to think about before I talk to my health care provider and to be more specific and more concrete,” Szatkowski said. “If you go in there in a complete fog, they’re not going to be able to help much. But the more accurate you are about where the pain is or what kind of a pain you’re having, also makes the encounter go faster.”
For Palomo, being a standardized patient is his way to give back to the community.
“It’s very gratifying because I feel that it’s a very good tool for the students,” Palomo said. “I think that they walk away with something that they probably couldn’t get through any other teaching method.”
For information on how to become a standardized patient, visit http://nursing.utep.edu/sp/