The EEC opened its doors in August 2003 and is considered to be one the most respected standardized patient programs in the nation. Within its walls, we educate and assess our own students for all the health programs, as well as residents from various hospitals. We also participate in community service programs, running SP projects for students from local grammar schools and high schools who are interested in entering the health professions.
The goal of the EEC Standardized Patient Program is to create a controlled and safe environment where our students may learn the fine art of patient care. During the course of their education, they will have multiple opportunities to practice this art with our standardized patients, receiving feedback on their clinical and communications skills from members of the faculty, their peers and the standardized patients themselves.
As a result, when the time comes for our students to begin seeing real patients in clinics and hospitals, they feel more prepared and confident.
The EEC Evaluation Suite has been designed to simulate an actual physician’s office. There are fourteen patient examination rooms each fully equipped with an examination table and the necessary medical equipment that you would see in any clinic examination room.
This state-of-the-art facility allows us digitally record all student encounters with the standardized patients. Each examination room has two pan/zoom/tilt cameras and one microphone. Recording all of the SP encounters allows students to later review and self-evaluate their clinical and communication skills with patients.
There is a computer in every exam room on which the SPs enter into our testing software system the case checklist written by the faculty.
Outside of each examination room is a laptop on which students complete a post-encounter exercise based on the patient case. Students may also be asked to order lab tests, view the results, read and interpret EKGs, MRIs, X-rays, examine different types of specimens and listen to specific heart and lung sounds all on computer.
There is an Observation Room which is utilized by members of the faculty as a way to observe the students’ performances live. We also do several exercises where we have students observe one another and then deliver peer feedback, allowing them to learn from one another.
What is a “standardized patient”?
“The Simulated/Standardized Patient (SP) is a person who has been carefully coached to simulate an actual patient so accurately that the simulation cannot be detected by a skilled clinician. In performing the simulation, the SP presents the gestalt of the patient being simulated; not just the history, but the body language, the physical findings and the emotional and personality characteristics as well.”
From Howard S. Barrows“Simulated (Standardized) Patients and Other Human Simulations”1987
Here at the EEC, we hire men and women of all ages to portray the patients that our students will examine. Our SPs are highly trained and have a great deal of experience. The majority of them work as SPs at all the medical schools in the Chicagoland area. They are true professionals.
What makes the patients “standardized”? We cast multiple SPs per patient case. Each SP is carefully trained to portray the case in the exact same manner as his/her counterpart and must do so many times per day. Therefore, the portrayals are “standardized.”
Why use SPs for assessing students’ clinical skills?
By using SP clinical encounters, we are able to reliably assess the students’ interviewing, physical examination and communication skills. Once all of the evaluation checklists are scored, we will be able to directly compare each student’s performance to his/her fellow classmates. Also, there is the matter equity in the SP assessment. Therefore, all students taking an examination in the EEC center will see the same exact “patients.” This is not possible in a real clinical setting, where the patients change daily. Using standardized patient examinations is also an excellent method with which to evaluate curriculum and promote faculty development.
Who writes the patient cases that the SPs portray?
Physicians and Health Professionals from within the university write and develop the patient cases. The case authors also participate in the training of the standardized patients, along with the EEC staff, to assure an accurate and realistic portrayal. We also share and exchange cases with other standardized patient programs throughout the nation.
How to become a Standardized Patient
Now that you have read all about what being a Standardized Patient entails, click on the SP Application link to download an application, fill it out completely and return to us along with a current work resume and photograph of yourself.
FREQUENTLY ASKED QUESTIONS ABOUT BEING A STANDARDIZED PATIENT
Is this like being a research subject?
No. Most people think of medical research subjects as people who participate in drug studies or dietary studies. This is very different. We are studying the medical students, not the patients. We use standardized patients to simulate for the students. A typical type of encounter would be the student meeting a patient for the first time in a clinic or emergency department, interviewing that patient about their complaint and performing a physical examination on the patient.
What types of physical examinations would be done?
They would be very common types of examinations – similar to the type you would have in a doctor’s office. For example, the student may take your blood pressure; listen to your heart and lungs with a stethoscope; press on your abdomen for tenderness or swelling; look into your eyes, ears and throat; check your reflexes, etc. In some cases, there may be a female breast examination. However, NO invasive procedures are ever performed and NO needles ever used.
How do I know what to say when the medical student interviews me?
When hired for an EEC project, you will be given a patient case/script. You will have to memorize all of the facts of this patient case, as well as portray the symptoms described in the case. For example, if the case is headache, you will have to act as if you have a headache. The cases are written by physicians and are based on real patients they have seen in practice. You will be trained in the facts of the case and symptoms portrayal by the EEC staff members, as well as a physician. This will assure the accuracy and standardization of your portrayal.
That sounds like acting. Do I have to be an actor?
No. Some standardized patients are trained and experienced actors, but many are not. You can be a very good standardized patient without ever having been on stage. There are similarities to what actors do, but there are many differences too. If you are appropriate for the patient case, we can train you to do the job properly regardless of your experience.
I am an actor. This should be easy for me and a good experience too.
Perhaps. But you may find it much more difficult than working from a script or within dramatic improvisational outlines, and you may find that very frustrating. This work has nothing to do with finding dramatic moments, finding your “motivation,” or playing to an audience. It has everything to do with disciplining yourself within in the needs of the case you are portraying and the exam, itself. It can be very repetitive, as exactly the same simulation must be done for every student who sees you. There can be absolutely no improvisation or veering from the case/script. Some actors find it difficult or annoying and we cannot use them. Remember, too, that the cases must remain confidential. You will not be permitted to use the material in any public or private performance.
Is it safe?
Yes. There is no reason for anyone to do anything to you that might be harmful. You are not really sick, just simulating someone who is sick. The examinations are very basic and do not cause harm to a patient. At most, there may be some discomfort portraying the symptoms of the case several times a day. All encounters are digitally recorded and may be observed by faculty and EEC staff as they happen. This is, in part, for the safety of the standardized patient.
Do the medical students know that we aren’t real patients?
Yes. We aren’t trying to deceive anyone. Students know they are going to be seeing standardized patients in simulations of clinical encounters. They are told be treat the standardized patients as they would real patients in a real health care setting.
Do I have to decide whether or not the medical student passes the test?
No. It would not be fair to expect someone with no medical training to assess the clinical skills of medical students, and, it would not be fair to the medical students either. Part of the standardized patient’s job is to record the events of the encounters on a checklist specifically designed for the case for the purpose of scoring the students. You would also be trained to evaluate the students in their communication and interpersonal skills.
How often would I work?
The academic year runs from July 1 through June 30. Standardized patients (SP’s) are hired on a project-by-project basis – similar to temp work. Some projects only run one or two days while other projects may run for several weeks or months. Some projects also occur on Saturdays.
The hours of a project also vary. Some projects run only in the mornings from 8:00 am – 12:00 noon or only in the afternoons from 12:00 – 6:00 pm. There are also projects that run 8:00 am – 6:00 pm.
A SP is hired for a case based on the patient case requirements (similar to casting roles in a play). For example – a case may require an
overweight female between the ages of 40 – 50 with no surgical scars. If you match that description, you may be hired for that case/project.
Standardized patients who demonstrate strong skills are given the opportunity to work more often, depending on the need.
I’ve had a couple of health problems in the past. Can I still be used as a Standardized Patient?
Probably. Everyone has had some sort of medical history. Sometimes it doesn’t matter if the standardized patient has a medical problem that the patient in the case they are portraying has not had. But, sometimes it does matter. For example, if you have surgical scars on, for instance, your chest or abdomen, then we could not use you for a chest pain or abdominal pain case. Also, it is important to note that this work can be very tiring. If, because of your medical condition, you tire easily, then this work may not be suitable for you.
Why to you need Standardized Patients? I thought medical students learned on real patients?
Some things are better done using standardized patients. For example, a standardized patient may be seen by a large number of students and is expected to portray the case in a precise and consistent manner up to ten times a day. Every student sees that case portrayed in the exact same way. That is why we use the term “standardized” patient. This is a fair way to assess the students’ skills. A real patient often varies in the telling of their history. And, as I said above, a real patient would not have the stamina to be seen by ten students a day for 10 or 20 days in a row.
Will I need to know a lot about medicine?
No. We will teach you what you need to know about your case. We actually prefer people who have not had medical training because it can confuse the situation. Most standardized patients find they learn quite a lot from doing this work and they enjoy it very much.
Will I need to take my clothes off?
At times, yes. If the case requires the students to perform a physical examination, then the standardized patient is asked to wear a hospital gown with varying amounts of undergarments. In some cases which require no physical examination, standardized patients were their own street clothing. You have the option of telling us if you would prefer not to portray cases which involve physical exams.
How do you choose who will be hired?
We send people who are interested in SP work our application. If they fill it out and return it to us, we then contact them and bring them in for an interview and tour of the center and determine if they are suitable. We need people who understand well the unusual requirements of this program. You should be able to take an interest in the work beyond it simply being a “job.” You should be comfortable with your health and in your dealings with health professionals. Good reading and verbal communication skills are very important. It will be essential that anyone hired as a standardized patient not have any biases against any person based on their gender, race, religion, national origin, physical characteristics, sexual orientation, etc. Reliability and punctuality are very important, as well. There is also something else that is important to us: CONFIDENTIALITY. While working as a standardized patient for the EEC, nothing about the test in which you are participating must be revealed to anyone outside of the program. You will be required to sign a confidentiality agreement to that effect. Finally, references will be checked before you are hired to work for the program.
How much does it pay?
The pay scale for a standardized patient is as follows:
· History/Interview only or History with a focused physical exam = $16.00 per hour
· Head to Toe Practical Instruction (by invitation only) = $20.00 per hour
I think I could do this job; it sounds easy enough.
Think again. This job is NOT easy and is NOT for everybody. It requires intense communication, on your part, while being interviewed and examined by the students. You must be able to respond to the student’s questions in exactly the same way in every encounter. You must be able to maintain not only the patient’s character but also simulate their physical condition during a fifteen or twenty minute encounter (up to 10 encounters a day). After the encounter is over, you must be able to remember exactly what the student asked and what physical exam maneuvers the student performed and record these on your patient checklist. This job takes energy, memorization, discipline, concentration, excellent communication skills and a high level of comfort with your health and dealing with the medical profession. Being a standardized patient is hard work!!
I’m still interested. What do I do next?
Download the SP_Application.doc, fill it out completely and include a recent photo of yourself as well as a current work resume. You may either mail it to us or
send us an email attaching all the documents and photo.
Thank you for your interest in the Education and Evaluation Center.
Adapted from: Educational Commission for Foreign Medical Graduates and Tulane’s Teaching and Assessment of Professionals Skills (TAPS) Program