New Conn. Medical School Hires Patient Actors

Dec. 16--NORTH HAVEN -- Dave Howell of Madison has been an actor, a professor and a bank officer. Now he can add "fake patient" to his resume.

"My wife saw the ad on Craigslist, and said, 'You need to do something -- get out and do this,'" said Howell, 74.

Quinnipiac University has hired 24 "standardized patients," people to play the role of patients for medical students' training exercises. They are the first crop of simulated patients at the Frank H. Netter M.D. School of Medicine, which opened in September. The part-time employees assume specific maladies and meet with medical students in mock examinations.

The exercise gives the students practice in asking questions to suss out the right diagnosis, and in honing their interpersonal skills.

Dr. Aaron Bernard, program director, said he wishes he had this kind of training when he was in medical school. He considers himself to be a pretty personable guy, but the kind of interaction between doctor and patient "is a whole other communication skill," and one that's hard to prepare for on your own.

"When you're talking to a patient or their family about dying and disease, it's not a good thing if you're doing it for the first time," he said. It can leave the family upset and disillusioned about the health care system, and "some doctors will dwell about it for days."

The "patients" were given an hourlong introductory course Dec. 12 and then did a rehearsal with seven of the school's faculty members. Starting in January, they will perform simulated exams with the students. After each exam, the actors will fill out a form evaluating the student's performance.

For their practice run, students were assigned one of three maladies: unstable angina, bronchitis or migraine headache. All the actors get about 10 pages of backstory that they need to memorize, including their symptoms, family history and lifestyle choices such as exercising, sleeping, drugs and alcohol.

Joellen Pullman of Cheshire pulled the bronchitis card. Dr. Anthony "Bud" Ardolino, senior associate dean for academic affairs, took the role of her doctor. Ardolino asked Pullman if she smoked.

"No, I don't," she said. "Wait! Yes I do! Half a pack a day."

Pullman rolled her eyes. "You start to get in the role and then you start drawing from your own life," she said.

Ardolino said she nonetheless made a good bronchitis patient. Believability is important, he said. It's key to getting the students to take the exercise seriously, he said. For the most part, he said, getting students to go along isn't a problem.

"My long experience is that they leave their disbelief at the door," he said. "I've seen students who have cried when the story involves loved ones who have died. It's really amazing how they can get into the play acting."

So what happens if the students ask a question that isn't addressed in the script? Wing it, Ardolino said. "Make up an answer, but don't make up a really bad answer." For instance, he said, don't give an answer that leads the student down a whole other path of questions.

Pullman said she was happy for the work. It was a good way to make $18 an hour, she said, although she wished it were more steady.

"It won't be a definite amount of work," she said. "It won't be 20 hours every week."

At first, Bernard said, the standardized patients will be called maybe every other week, and work will become gradually steadier over the next year or two. Eventually, he said, many of the actors will be called in every day. They currently have enough people for the program, but Bernard said the university will likely be hiring more next year.

Yale, UConn Do It Too

Most of the actors are newbies in the field of standardized patients, but a couple have made the rounds at the two other medical schools in the state. Angelo Tarantello of Newington said he has been working as a professional patient at the medical schools at Yale and UConn since the 1990s.

"At first, I was very nervous," said Tarantello, 51. Since then, he said, acting sick is practically second nature. He also works at the emergency department of the Hospital of Central Connecticut, "so I know how people react to things."

The idea has been around since the 1960s, but it took a while for it to catch on. UConn was ahead of the curve when it started a simulated patient program in 1987. The program now has 60 professional patients. Because they give feedback to the students, Pfeiffer calls them "patient-instructors."

"A lot of it involves the principles of good interviewing," she said, "moving from broad questions and getting the general landscape and then asking more direct questions to get more details, and then focus on what the cause might be."

The program also focuses on subtler skills, like body language and expressing empathy. That's a little trickier to teach, she said, "but it is teachable." Some students take to it more naturally than others, she said.

In one of the more advanced classes, students tell the actor-patients that they have cancer. It's a difficult lesson, Pfeiffer said, but not nearly as difficult as having to do it in real life without any preparation.

"This is their flight simulator," she said. "They can crash, but they won't burn."

Yale started its standardized program in 1994, hiring a troupe of eight actors from a theater in Clinton. Dr. Frederick Haeseler, associate director of the teaching and learning center at the Yale School of Medicine, said the exercises give future doctors the skills "to help patients talk about themselves and tell the story of their illness, and to get patients to talk freely about their feelings and emotions centered around their illnesses."

It wasn't until 2004 when the field exploded, as the national board medical licensing exam first included standardized patient cases. Since then, medical schools have established their own standardized patient programs or send their students to universities that have them.

Most of the simulations don't require Juilliard-trained thespians. But occasionally, Bernard said, simulations can call for patients who are for angry, frustrated or depressed. And ailments that cause physical pain provide some opportunity for the actors to ham it up with grimaces and groans.

Luckily, the pool of 24 standardized patients includes a handful of people with acting background. One of the patients has several TV appearances among his credits. Concerned that this most recent gig might detract from his IMDB page, though, he did not want to be identified.

During the introductory class, Lisa Evarts asked how invasive the exams can get. Bernard told her that it's usually nothing more a tongue depressor or a look inside the patient's ear.

"No catheters, then? Then we're OK," she said. Evarts, of Northford, said she has no acting in her background, just her own experiences with doctors. When she heard that she could "help these brilliant minds," she jumped at the chance to be a professional patient, an occupation she had never heard of before.

"I didn't even know it existed," she said, "but I think it's brilliant."

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