Role-playing helps MDs learn empathy

Exactly one year after her father died, Terry Wanamaker found herself in a cold, white exam room experiencing a deja vu of sorts. She listened as a doctor gently told her that her dad had just died.

This time, though, it wasn't for real.

Wanamaker, 46, an East Williston resident, is what's called a standardized or simulated patient, or an SP. Although the public is often unaware of their existence, SPs work in most teaching hospitals and can be an important part of the learning process for doctors, nurses and other health care professionals. They're paid to pose as real patients or family members of patients with particular symptoms or problems. SPs often have formal acting or teaching backgrounds, or sometimes just life experience that makes them good candidates for the job.

Wanamaker, who's been doing this for five years, now helps train new SPs as well. "It is the perfect job for me. I love being in the room with the learner and helping them come to that 'aha' moment," she said.

"That happens when a doctor, for instance, has an epiphany and says something like, 'Oh my god, I didn't realize what I did or said made you feel that way,' " Wanamaker said. The doctor may have seemed distracted or cold when delivering bad news, or perhaps overly sympathetic or emotional, which also could be off-putting to some.

Difficult conversations

Doctors, medical students and other health care professionals going through the training aren't given grades, but they do receive feedback on their performance in hopes they'll learn from the experience with an SP and won't make the same mistake with real patients and their families.

Case scenarios, which generally are written by doctors, run the gamut of experiences: delivering bad news to parents of a sick child, telling patients that they have inoperable cancer and interviewing a rape victim. Case enactment is strictly dialogue, with no actual exams or touching.

Emily Sellinger, a medical student at Hofstra University in Hempstead, still recalls the trepidation she felt when she was given the task of telling an expectant mother that her baby had a high risk for Down syndrome.

The woman was not really a patient; she was an SP. Still, Sellinger said, the conversation taught her a lot about how she would and should handle a similar situation in real life.

"Working with standardized patients has been the most fun and interactive part of medical school so far," Sellinger said. "We learn things in the classroom about communication, such as breaking bad news, but it is one thing to role-play with a teacher or student who you know and another to do it with a standardized patient. It feels so real. You are wearing a white coat, and they are really good actors."

Trolling for acting talent

Jane Wickey, director of standardized patient education at the North Shore-LIJ Health System's Center for Learning and Innovation/Clinical Skills Center in Lake Success, runs something akin to a talent agency. "I have a number of semiretired nurses and some students," she said of her growing Rolodex. Wanamaker is one of her trainers.

"My folks come from all walks of life, and they are very diverse in age and race and body type," Wickey said. SPs earn about $25 an hour. The program is home to 14 exam rooms, allowing up to 14 simulations at a time.

"We make the encounters as real as possible," she said. The case scenarios given to the SPs are very detailed. "The more information that the standardized patient has, the better they are at fielding questions," Wickey said.

"The SPs live and breathe these patients," she said, "so when students come through, they are immersed in their role."

Catholic Health Services of Long Island also uses SPs in its training, according to Dr. Patrick O'Shaughnessy, senior vice president for medical affairs and chief medical officer for the health system. They use staff from the system's hospitals, nursing homes and home care and hospice agencies to serve as SPs to help improve patients' overall experience.

For instance, he said, "SPs may approach a care provider and ask for directions to radiology, and then he or she will give feedback on how the employee did," kind of like a secret shopper. He also uses SPs to teach his staff how to respond in medical emergencies.

In the future, O'Shaughnessy said, he plans to hire SPs.

With the technology available today, he said, "we can really simulate any scenario, and the human element takes it to a whole new level."

WANT TO BE A SIMULATED PATIENT?

Various health care systems on Long Island use standardized patients (SPs), but each facility has its own system for recruiting participants. For instance:

* People interested in the program for the North Shore-LIJ Health System need to complete an application on the system's website. Go to: nslijcareers.com.

* The Clinical Skills Center at Stony Brook University Medical Center uses a temp agency to hire SPs. For information, call 631-444-2098.

* Catholic Health Services of Long Island currently uses only staff members in its SP program, although it may seek outside help in the future.

For those interested in other health care facilities, check their websites or try calling their human resources offices to ask whether they have an SP program.