They're actors, but they don't perform on stage or in front of cameras. And they don't do drama or comedy. Rather, they specialize in injuries and illnesses.
"I've had every disease you can imagine," said Donna Sparks, a retired teacher who, along with her husband, Jeff, has been acting sick for 10 years at Wake Forest School of Medicine.
Donna and Jeff Sparks are among the role-players known as standardized patients. They are people who have been trained to accurately and consistently portray the physical signs or symptoms of medical conditions and the emotional characteristics and everyday concerns of actual patients in simulated clinical sessions with medical students, physician assistant students and others who are pursuing health care professions.
The purpose of these encounters is both simple and important: to give prospective providers the opportunity to develop both clinical skills and "bedside manner" before they begin to practice medicine for real.
"It's definitely valuable," said Lauren West-Livingston, a third-year student at Wake Forest School of Medicine. "We get to practice with these patients in a controlled environment so that when we go on to see real patients in the hospital or in clinic we have some experience, and some confidence."
Standardized patients – also referred to as simulated patients or patient actors – are employed at most medical schools and teaching hospitals in the United States. The concept was introduced at the University of Southern California in 1963, more fully developed at the University of Arizona in the 1970s and widely adopted by medical schools – including Wake Forest School of Medicine – in the 1980s.
"Standardized patients are vital in helping us prepare our students for their future careers in health care," said Mary Claire O'Brien, M.D., the Wake Forest medical school's senior associate dean for health care education. "Our students are able not only to practice their clinical work but also to learn the importance of building relationships with their patients, empathizing with them and doing what's best for them physically, emotionally and financially."
Wake Forest medical students have clinical sessions with standardized patients – SPs for short – during all four of their years at the school. To give the students the most realistic experience possible, the sessions are held in specially equipped examination rooms at the Bowman Gray Center for Medical Education and cover a wide variety of medical scenarios – such as conducting a routine physical examination, diagnosing a minor ailment or delivering a negative prognosis about a life-threatening disease – with all types of people.
Wake Forest School of Medicine currently has a roster of 85 patient actors, said Kendall Freeman, manager of the Standardized Patient Program, which is part of the school's Center for Experiential and Applied Learning. These men and women range in age from 20 to 75, have body types spanning the spectrum from athletic to obese, are members of different racial and ethnic groups and come from diverse socioeconomic, educational and occupational backgrounds.
"Right now we have pretty much everybody," Freeman said.
To maintain that mix, hiring is done on the basis of demographic need, Freeman said. Otherwise, there are no requirements for becoming a standardized patient, and acting experience is definitely not necessary. That's because SPs are obliged to strictly stick to the script in the clinical sessions, for which the medical aspects are standardized to allow for direct comparison and consistent evaluation of the students' clinical skills.
At Wake Forest School of Medicine, newly hired standardized patients undergo a full day of training. To prepare for sessions with students, all SPs receive, usually one or two weeks in advance, detailed instructions and, if needed, additional training for the particular medical scenario.
And while emoting and improvisation are taboo, the SPs are, in addition to presenting a specific medical condition, sometimes called on to portray patients with assorted attitudes, behaviors or issues related to or independent of their health status.
"There are patients who intentionally make it difficult for us to get the information we need," said West-Livingston, who is pursuing a Ph.D. along with her medical degree. "The sessions also can include what are called opportunities for empathy, where they'll say 'I'm worried about my job' or 'My insurance doesn't cover that' and we have to take a break from the diagnostic side and focus on the human aspect."
Faculty members evaluate the students' performances in the simulations but the SPs also have input, submitting a written evaluation sheet after each session.
"One thing we evaluate the students on is how comfortable we feel with them," Donna Sparks said. "Do they listen to us? Do they show empathy and concern? Do they use layman's terms instead of medical jargon?"
Being a standardized patient is not, it must be said, a regular part-time job. The hours are not steady, the need for SPs varies throughout the year and each actor is by nature ineligible to participate in more than half of the simulated clinical sessions. ("I don't qualify for ectopic pregnancy," Jeff Sparks noted.) But the position does have its rewards beyond the pay, which at Wake Forest is $20 an hour.
"It's very gratifying to see how the students progress from their first year to their fourth year," Jeff Sparks said. "It's quite a change."
"For me, this is another way that I can continue teaching and keep myself busy during retirement," Donna Sparks said. "The students are so appreciative of what we do, and we really enjoy working with them."
That feeling extends both ways. The sessions with the standardized patients, West-Livingston said, "are most people's favorite part of the curriculum."