The only way for a doctor-in-training to know how to give a physical exam is for them to practice. But most patients would prefer the doctors aren’t finding their feet in the hospital room.
In order into get the practice in and eliminate those first-time jitters, medical students at the Schulich School of Medicine & Dentistry participate in the Patient-Centred Clinical Methods course. That’s where they meet someone like Carol Robinson-Todd, who is helping first- and second-year students get a jump on their bedside manner.
“We are people who are not sick people, but are here to portray a sick person. We can give feedback to the student. You don’t often get to do that with your own physician,” Robinson-Todd says.
Since 1997, Robinson-Todd has role-played as a patient for young medical students in the program. An amateur actor from the London area, Robinson-Todd was intrigued by the opportunity to see physicians-in-training firsthand. “It’s fascinating seeing what they know and don’t know,” she says.
Through their interactions Robinson-Todd watches the students develop poise, confidence and a sense of who they are while wearing the white coat.
She is one of close to 400 simulated patients who are employed to ‘act out’ different conditions. They are given a script with a specified condition and instructed how to respond to different questions so the students get a sense of how a patient in such a condition might act or react.
“It’s a safe learning environment for them,” says Judy McCormick, manager of the Clinical Skills Facility and Clinical Skills Learning Program. “We can give them as much help as we can and make it as safe as we can for them to learn what they need to learn without them feeling like they are being examined or evaluated.
“It takes some of the pressure off and it allows them to learn these things in way that is conducive to their learning.”
But in order to broaden the pre-clinical experiences, the program needs diversity its simulated patients.
Currently, the program is looking to employ people of different ethnicities to participate in the program; students need to be trained on how to interact with people of different cultures and backgrounds.
Cultural beliefs, language and religion can play a role in a person’s medical treatment. As well, some medical conditions are more prevalent in certain populations, such as people of Aboriginal, Hispanic, Asian, south Asian or African descents are at higher risk for developing diabetes.
“It’s becoming more and more important for us to be able to provide these different backgrounds to the students so they have an understanding of the community they will be treating as they get into the clinical world,” McCormick says.
All of the simulated patients are informed in advance of the requirements of the script (with the option to decline participation) and not all role-playing involves a physical exam.
“We spend a couple of years with (students) giving them the opportunity to practice dealing with different types of patient situations, in terms of communications skills, physical exam skills … before they get off to a real, clinical setting where they have to start seeing real patients,” McCormick explains.
Working with a simulated patient before moving into the clinical setting helps students get over their first-time jitters, and builds trust in the student-doctor’s expertise.
“They need to develop the comfort level so that from the patient’s perspective, the patient feels the student-doctor is confident and knows what they are doing, and feels comfortable doing what they are doing,” says Jane Graham, clinical methods coordinator. “Patient interviews are not something that can be taught in a classroom, but interviewing a patient is a skill that clinicians develop over time.”
Physicians need to be sensitive to cultural needs so patients are not unintentionally mistreated, Graham notes.
If the program is able to expand its simulated patient demographics, co-ordinators will be able to develop medical cases specific to those ethnicities, which would further the teaching opportunities for students.
“Giving students every opportunity we can to deal with different patients of all different communities and all walks of life is going to be valuable to them,” McCormick adds.
For those interested in applying to be a simulated patient, contact Judy McCormick at 519-661-3748 or judy.mccormick@schulich.uwo.ca.
