Maryland's medical schools use "standardized patients" in training

Daily Record, The (Baltimore), Mar 20, 2003 by Patrice Dickens

Neva Krauss has a very unusual job. She cries for a living.

"I go to [Johns] Hopkins. I cry for four hours and I make $40 an hour," said Krauss, an actor since age 10.

Now the 37-year-old Hamden resident isn't your typical actor. She doesn't star in big blockbuster movies or major Broadway productions. Nor is she a famous celebrity.

But she is a star in her own unique way.

Her fans are doctors and nurses, surgeons and medical students. Her stage is the Clinical Education and Evaluation Lab at the University of Maryland and a similar facility -- the Clinical Education Center -- at the Johns Hopkins University where she is a standardized patient.

"This is one-on-one acting, so this is really unique," said Krauss "It's intimate, but you know the camera is always there."

Simulating medicine

A standardized patient is someone who has been trained to portray actual patients, simulating their physical findings and psychosocial characteristics.

Created about two years ago, the Clinical Education and Evaluation Lab is a joint venture between the University of Maryland School of Nursing and the School of Medicine.

"You think of an ailment and we have someone playing that case," said Kathy Schaivone, manager of Maryland's lab.

The facility has more than 100 standardized patients in its database so no medical student will encounter the same standardized patient twice. They range from age 4 to 80, Schaivone said.

The facility uses standardized patients to evaluate, assess and teach doctor-patient relationships.

Students learn and practice skills such as diagnosing certain ailments, and interviewing and counseling in 30-minute long meetings that take place in one of the six examination rooms, outfitted with all the equipment one would find in an examination room at a doctor's office, as well as a rolling video camera.

The first 20 minutes are devoted to a simulated doctor's visit, the remaining 10 to critiques by the standardized patients, Schaivone said.

At the University of Maryland facility, Krauss usually plays "Karla Green," a 30-year-old mother of a young child earning $15 per hour. In her role, Krauss and her real-life daughter, 7-year-old Chauna, give the medical students just enough hints for them to figure out that Chauna is suffering from stress induced headaches, because the father has started traveling a lot. Over at Hopkins, Krauss is a standardized patient in the institution's "End of Life," program, an initiative aimed at making Hopkins' medical staff -- doctors, nurses, surgeons, and chaplains -- more cohesive in delivering the news about the death of a loved one to family members. "We are trying to change the culture in hospitals, to approaching the family as a team as opposed to individuals," Krauss said. At Hopkins, Krauss has played the role of losing a mother, a child and a sister. But despite the difficulty of dealing with emotions surrounding death, the initiative has had measurable results. Since the start of the program five years ago, organ donation has gone up 15 percent, said Dr. Michael A. Williams, assistant professor of neurology at Johns Hopkins Hospital. "If the family is treated well and the family feels like they were communicated well to, they are more apt to have their loved one's organs donated," Krauss said. Good communication between the medical staff and the family of the deceased also "diffuses a lot of lawsuits," because the family feels like the doctor did everything in their power to save the deceased, Krauss said. With a twist But the fictional characters are not always straightforward. Some have a politically correct punch to them. For example, there is the fictional "Charlie Adams," played by 35- year-old Jabari Simba, a Hyattsville resident. Simba's character is a minister who is a closet drunk. However, there are at least two other Charlie Adamses -- one a truck driver who is on his third or fourth marriage, the other a gay man, Simba said. "We try to expose the students to a lot of cultural issues that come up," Schaivone said. And apparently, culture is defined in a very broad sense, from disabilities to religion to socio-economics. For example, there is a Karla Green character that is a Jehovah's Witness and a "Lynette Perkins" character that has multiple sclerosis. Simba, an actor by profession, said he enjoys being a standardized patient. "It gives me a way to keep my skills sharp, and it allows the students to gain more experience than they would in a classroom setting, interacting with just each other," Simba said. Joya Maye, a 27-year-old standardized patient at the University of Maryland facility, said the medical students "really appreciate what we are doing for them." Maye, who also has worked at Hopkins, plays one of the fictional Lynette Perkinses, an anxious woman who thinks she might be pregnant. The medical students, she said, are often shy and scared, and often expect her to get out of character when they are messing up on their routine. But Maye said the highest compliment is when a student says, "You were so real, I totally forgot you are an actor." "Most of the time, they are so nervous," said Krauss, reflecting on an encounter with a male medical student. The student was supposed to examine Krauss by lifting up her gown and touching her stomach. However, he was so nervous, he forgot to drape a blanket over her after he lifted her gown, and he was so uncomfortable about touching her stomach that he poked her quickly with only one finger, Krauss said. Krauss said she has to allow the student to make a mistake before she calls the student's attention to it. "I am really cold, could you please find something to drape me," Krauss said she would say to the student. But don't mistake what standardized patients like Krauss, Maye and Simba are doing for entertainment. "It's more than entertainment. It's making a difference ... in communicating with family members," Krauss said.