Mark Attiah | Living gifts to medical education

In the summer between my sophomore and junior years of college, during a science enrichment program at Duke University School of Medicine, our group was asked to participate in a disaster-preparedness drill. The exercise was intended to simulate the evacuation of a hospital. We were to be the patients.

We were given cards that told us what ailment we had and, thus, how much blood and gore we were supposed to be covered in and how much groaning we were supposed to do. I was a psychiatric patient, so I had neither of those things; the card instructed me to act agitated.

The medical students at the simulation never knew what was coming.
They didn’t know quite what to do when they saw a clearly angry and very unrestrained person storm through the hallway, cursing at everyone within a five-foot radius. Everyone went silent as they tried to figure out if my banging on the vending machines and hurling insults at the doctors was part of the script. They called security. I received a standing ovation as I was handcuffed and carried away.

I had no idea that people did this kind of thing on a regular basis.

They’re called standardized patients. Although they may not be quite as ham-handed as I was in the story above, they are people who come from all walks of life to help educate medical students by acting like patients. Their symptoms and complaints range from the mundane to the serious, and their background stories are as diverse as they are.

The upshot of the program is that it allows medical students to practice correct history and physical exam skills before having to encounter the real patient from hell with no experience whatsoever.

“What I hope that they add to the education is that you’ll feel comfortable asking these questions before you interact with actual patients,” said Anita Lee, director of Penn’s “Introduction to Clinical Medicine” course, in which standardized patients are used.

The SP program affords a very valuable benefit to the overly anxious medical student — a margin of error. All too often, we hear of that one student who asked a heinous question and offended an old lady or missed a huge part of the history that would have given away the diagnosis.

With this program, I can take comfort in the fact that I can be _that _person with impunity and be able to go to sleep at night. SPs allow me to fail spectacularly — with balloons and confetti — and chalk it up to a learning experience.

Much like people who donate their bodies and organs to science and medical education, SPs are living gifts.

“They’re very all-purpose and can be used for a lot of different scenarios,” Lee said. Not just good historians, these brave souls also agree to have physical exams performed on them by bumbling medical students. (But this isn’t as much of a death wish as I make it sound.)

On top of being actors and historians, SPs are also great teachers and can tell medical students things like, “No, you want to find my carotid pulse, not choke me to death.” Most SPs have been through enough histories and physicals that they are likely to know how to perform them better than the medical students who are practicing on them.

What makes SPs valuable is that they are trained to give good feedback, pointing out a student’s strengths and weaknesses. If you had asked me to give feedback during the evacuation scenario, I would have said that it’s probably not a good idea to stand with your mouth open when a psych patient is on a rampage. You might swallow a fly.

The SP program — and simulation of live scenarios in general — benefit not just medical students but trained doctors as well. It seems to be taking a larger role in the education of future doctors, and they will be all the better for it.

Mark Attiah is a second-year medical student from Dallas, Texas. His email address is mattiah@mail.med.upenn.edu. Truth Be Told appears every other Thursday.

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