| In other cases a patient
who has gangrene has to be told his foot must be amputated, and a woman is informed
that her mammogram is abnormal. That role is currently being played by an SP who
did have breast cancer years ago. "She very graciously volunteered to play
that part," explains Smith. "And because she actually went through it,
she is very, very good.“ The cases are diverse so as to challenge the students'
ability to remain non-judgmental and sensitive, regardless of the patient‘s
gender, race, intellect or sexual orientation. An example is the case of a man
who recently married and wants to know his HIV status. He had several homosexual
encounters a few years before and is worried. His test result is positive. The
student must be the bearer of bad news. KIDS PLAY ROLES TOO NJMS gives OSCEs in family medicine, internal medicine, obstetrics and gynecology, and pediatrics. Susan Mautone, MD, director of pediatric education at NJMS, says children as young as 3 and as old as 17 are standardized patients. Kids under 5 are given well-baby and developmental assessments, and are only "patients" for five minutes at a time. The students are evaluated on their ability to do the physical exam and on their interaction with the child's caretaker by a physician who sits in the room. Kids 7 and up learn scripts, and according to Mautone are very believable. “It‘s amazing what you can teach kids to do. Some can be so dramatic, and all of them get a kick out of doing it.“ The child-actors get a script about a week in advance and go through about three hours of practice to assure consistency in the simulations. Sore throats, meningitis, and appendicitis are among the disorders they feign. Most of the pediatric SPs are children of UMDNJ physicians and staff members, and don't get paid. Others get $50 for the day. Mautone‘s three children, now teenagers, have been SPs since they were six. "They love doing it because they get a day off from school, and I take them to Burger King for lunch," she says. Fourth-year student Ryan Jander has taken all the OSCEs. He says some are more realistic and/or comprehensive than others, but they are nevertheless a great tool for testing students' knowledge and interpersonal skills. "It's important that we show what we‘ve learned and communicate that to the patients," he says. Jander explains that the obstetrics and gynecology OSCE is an actual breast and pelvic exam on an SP. Early in the first year of medical school, students learn to do physical exams on a group of willing women. Those same women are then SPs for the OSCE, and give feedback as the student does the exam. "I think that‘s great," Jander says, emphatically. "I don‘t know how many other schools offer this kind of education, but I'm glad we get it here." He adds that learning gynecology early on is also good, since it demystifies the female anatomy, especially for men. Jander says he's generally "pretty nervous" during an OSCE. "It's like stage fright," he says. "Some of the rooms have cameras, so you feel like you're performing. And then you have the time constraint, and you're wracking your brain to try to remember if you covered all the bases. By the time I get to the last few patients, I've calmed down." SPs IN DENTISTRY UMDNJ-New Jersey Dental School (NJDS), along with the universities of Connecticut and Illinois, are the only dental schools in the country that use simulated patients as a teaching method. The program was developed and implemented four years ago by Hillary Broder, PhD, associate professor in the Department of General and Hospital Dentistry. "The actors don‘t get their teeth cleaned or drilled or pulled," she explains. "Nothing invasive is done to them." The simulated patients in the dental program are known as patient instructors. They are so named because, unlike most SPs, they give direct feedback to each student. On test days, four students each see one patient for 15 minutes. When they're through, the patient instructors do the evaluation and discuss it with the student. The students then switch charts, each sees another patient, and so on. "By getting immediate feedback, from the patient instructors, the students improve their data gathering and interpersonal interviewing skills," Broder says. "We really see significant improvement as the day goes on." Dental students go through four scenarios, out of six that are prepared, in both their junior and senior years. The cases focus on medical and dental problems as well as social and cultural issues. One patient, who believes in voodoo, has bleeding gums. She thinks that may be happening because the spirits are angry at her. Another woman has been abused by her husband and now has jaw pain and several loose teeth. "These cases teach the students to be sensitive to people who may see things differently and to realize there are many types of health beliefs and values," Broder says. Like the medical students, the dental students are evaluated with a content checklist, but their interviewing skills are rated by a detailed measure, known as the Arizona Clinical Interviewing Rating Scale. It ranks the students' performance on a scale of one to five, five being the highest. "It's a complex assessment tool that takes time for the patient instructors to master," says Broder. Senior Jennifer Reyes says the program is very valuable and introduces students to situations "you don‘t see every day." "I once had to tell a patient instructor very bad news," she says. "I've never had to do that before in my life. It was an eye-opener." And she's come across real-life cases like some she's had in the program. "I knew where to begin. It was great," she says.
SPs ENJOY THE JOB Marty Geltman and his wife Zella are both SPs for NJMS and for the simulated patient program run by NJMS-National Tuberculosis Center. Zella is also a patient instructor at NJDS. Both are retired teachers who are totally committed to the programs. "This is what it‘s all about," says Zella, who taught English at Montclair State. "Learning the human side of medicine and integrating it into the technical side is very important. It's like the icing on the cake." Marty says he and Zella would participate in the programs even if they didn't get paid. "We're helping students enhance their skills and maximize their potential," he says. "It's the little things, like giving a handshake and direct eye contact, that make all the difference. The medical students become aware of what more they could do to put patients at ease. It‘s very rewarding, and it's fun, too." NJMS's program has been recognized as one of the best in the country. In 1998, the school was invited to be a test site for the National Board of Medical Examiners, and has been selected as one of 36 sites in the country that will administer the OSCE on the licensing exam. New quarters are being readied for the program, and will include a bank of monitors so every student can be videotaped. In addition to the programs on the Newark campus, there is also one for residents in physical medicine and rehabilitation at Kessler Institute. Robert Wood Johnson Medical School administers OSCE-like assessment tests to residents in medicine, to all third-year students and to some second- and fourth-year students. And at UMDNJ-School of Osteopathic Medicine, second-year students participate in a simulated patient program developed by the Department of Family Medicine. While the tried-and-true method of reading and writing is still as valuable as ever, students and professors agree there's nothing like the real thing. Or, in this case, the almost real thing. |
