Passage II

SOCIAL SCIENCE: This passage is adapted from the article "Medical Students Get Taste of Real-life Doctoring" by Perry Garfinkel (@2001 by The New York Times).

The scene is the emergency room of the Mount Sinai Hospital in Manhattan. The patient, a 22-year-old man named Marcus Holter, is lying on the bed, convincingly writhing in pain. The doctor is Tomer Begaz, a 26-year-old fourth-year medical student.

Marcus is a character played by an actor, Koyna Hood. But Begaz is a real medical student. Hood, trained to simulate disease symptoms, follows a script, ad-libbing when needed. Although Begaz knows that to his "patient " is really an actor, the only other information he has are vital signs and symptoms, read off a chart.

Alternately grabbing his stomach and his left knee. Marcus groans: "I have sickle cell. Please get me some Demerol.”

Reviewing the fort and says he the chart, Begaz offers words of comfort and says he will order the painkiller.

The performance, recorded on videotape, was being shown live in a nearby screening room, where seven monitors simultaneously broadcast other doctor-patient encounters being played out in mock examination rooms here at the Morchand Center for Clinical Competence at Mount Sinai School of Medicine.

These encounters are taking place at medical schools throughout the country. Using "standardized patients" ——actors and others trained to portray sick people——has now become standard procedure. The goals are to teach future doctors to diagnose diseases better and to communicate with patients.

The latest figures compiled by the Association of American Medical Colleges show that all 125 medical schools in the United States use standardized patients. In 1990 only 62 used them. The approach is also being considered for use on national licensing exams.

Dr. Mark H. Swartz. director of the Morchand Center, where 1, 400 students from six New York City medical schools are taught and evaluated every year, said the center uses actor-patients "because we have an intense gut feeling we're helping develop better doctors."

Interacting can be harder to teach than how to diagnose and then treat a patient's illness, said Dr Richard E. Hawkins, director of the simulation center at the Uniformed Services University.

"Our students are graduating into an increasingly complex health care environment," Dr. Hawkins said. "Physicians practicing today have to have a lot of skills, a lot of knowledge. But to be truly effective they need to practice patient advocacy: to talk to patients, to listen, to be compassionate."

The "audition" for participants, who earn about $25 an hour, is an interview. "I look for people with good improvisational skills, who are directable, who can think on their feet." said Elizabeth O'Gara, who oversees standardized patients at the UCLA School of Medicine.

The parts are based on real cases that faculty members have treated. The standardized patients are given scripts and background information that include complete personal and medical histories. But the patients often ad-lib.

"By the time they get to performance they know the patient so intimately they can answer any question," O'Gara said. "The biggest job for the trainer is anticipating any contingency the patient may encounter."

In the feedback sessions after the "exam," patients either fill out a form or give an assessment directly to the student.

Dr. Swartz said feedback was often missing when medical students practiced with real patients on hospital rounds. In addition, rounds are less instructive than they were in the past because many more people are treated as outpatients, so students may not see a wide variety of diseases.

The idea of using standardized patients was developed in 1963 by Dr. Howard S Barrows, who was then a neurologist at the University of Southern California.

"When I first introduced it, everyone thought it was the craziest thing they'd ever heard of in their lives," said Dr. Barrows, 73, a professor emeritus at Southern Illinois University Medical School, who continues to consult and write from his home in Hamilton Ontario. He came up with the idea after noticing the criteria faculty used to evaluate medical students' clinical skills were unscientific at best.

Recalling an experience from his last year of residency, in which a disgruntled patient fooled a doctor by faking symptoms, he realized that he could train people to simulate various physical signs and symptoms. But most doctors, trained in the tradition of teaching students on rounds, objected to pretend patients.

Because of the "resistance to it from the start," Dr. Barrows said, "I never envisioned that it would become so generally used around the world."