Illustration by Marley Allen-Ash
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I recently spent an afternoon having my breasts fondled by strangers. Sixteen young, med students in fact. I was helping them prepare for their second-year final exams.
I’ve had a checkered career with a wide range of interesting jobs, but this may well be the strangest. I’m a fake patient, or in medical education circles, what’s known as a Standardized Patient or SP. Med students spend huge amounts of time learning facts and science with hard core book learning. In the case of my breasts, these students had yet to practice their knowledge of lymph node examinations on a real person. So, for $27.50 an hour, I find my motivation and go to work.
I sit in a gown on an examining table in a windowless beige room. A facilitator/physician gives a brief lecture and quizzes four students. The instructor demonstrates the procedure, and each student takes a turn. Armpits first. All good. Next, a little lower and each student follows the steps demonstrated by the instructor. Brief discussion, review, questions.
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The bell rings, the first group exits and another four students enter. And so goes the afternoon.
I am one of many Standardized Patients providing a body, an improvised response or a detailed script of ailments, for students to practice situational learning, or pass a test. The work varies and it absolutely makes for the best stories when I tell people about being a fake patient.
Some of these gigs are practice scenarios; others are exams with high stakes. These involve foreign trained doctors hoping for one of a handful of residency spots that will allow them to practice in Canada. If they fail, they must retake the exam within a year. If they fail twice, there are no more chances. Futures, careers and life plans are riding on these exams.
That’s why the “standard” part of being a Standardized Patient is crucial. Just like a written test, every question or scenario must be identical, so all candidates get the same chance. I have a script. I cannot deviate. The time frame is tight – eight to 10 minutes for a diagnosis, before a bell ends the session. Fake patients have questions or lines that we absolutely must deliver within that window. I’ve watched candidates sweat as they work to beat the clock.
I’ve played patients with sore knees, sore shoulders, dry eyes, a homeless, drug-addicted sex worker and a politician hoping to hide a Parkinson’s diagnosis.
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One of the most interesting scenarios aims to teach students how to deliver bad news. And one time, the tables turned. That day I played an unassuming patient looking for test results that might indicate a grim cancer diagnosis. It’s an improvisational role performed before a group with the student sitting close to deliver the news. Most got it right by saying more tests were needed and we shouldn’t jump to conclusions. But one answered my questions a little too breezily, with an “about that…” tone I recognized from my teenage daughter. I left time for her to fill the space with words of hope and empathy about the uncertainties. I asked about tying up loose ends and making funeral arrangements but the pauses were too long on her end of the conversation.
When her time was up, I was asked to provide feedback. My internal monologue suggested I be tactful, but I unleashed. I identified all the places she sounded unprofessional and suggested ways she might reframe her approach. I spoke to the group and when I turned to her, she was weeping uncontrollably.
I thought I was providing helpful feedback, but my gut told me this young person has never failed at anything. I backtracked and said I didn’t have the smarts to make it to where she’s sitting, but I do know about communication. More importantly, it’s a learnable skill.
Like in life, laughter can release the pressure of a tense assessment. During another scenario, I sit on an examining table while students get ready to examine my knee. They come close, they touch my knees, arms, look into my eyes. Whatever was required. They examine me closely, hyper-focused on the task, before asking questions. It was like being under a microscope.
One student is given my “symptoms” by the doctor/facilitator, including the line, “She has no pain.”
The student nodded her head, repeating the facts, going down a mental checklist as each bit of information was delivered. The facilitator had an accent so the last detail was heard as: “She has no brain.” The student nodded, check, and repeats, “She has no brain,” then looks at me, startled, as what she said sunk in. The three of us laughed hysterically. Then she got to work.
I get to watch the highest level of learning happen in real-time. I see the wheels turn as these incredibly hard-working young people think, process and make sense of what they know. It’s quite something. Awe inspiring, actually. I’m happy to be a part of it.
Pat Barford lives in Edmonton.
