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October 12, 2006

Performing as patients: Acting talents helpful in Standardized Patient Program

By Claire Dietz
News & Community Relations


Several medical schools had been using standardized patients in various programs for years, but it was in the mid-1990s that the movement really began to catch fire. And Jennie Struijk, who had just taken a part-time job at the UW organizing a program using them, became part of that movement.


Looking for support in her new position, she organized an e-mail listserv to trade information with program organizers at other universities. The participants came from a special interest group organized within the Association of American Medical Colleges. Interest increased when the National Board of Medical Examiners began using standardized patients for some exams. In time, the special interest group became the Association for Standardized Patient Educators (ASPE) and Struijk is now its president-elect. She will become president for a two-year term in January 2008.

Standardized patients are people who are hired to play the roles of patients with certain medical conditions and are used both for training and testing health professions students. At the UW, about 35 people work consistently in the program, with others recruited for some specific needs.

“At some schools, the pool of people is much larger and then they work only occasionally,” Struijk noted. “Here, I’ve tried to make the work more professional. We ask for more of a commitment from our standardized patients and we are more committed to them.”

The work requires a flexible schedule, so someone can be available on days when trainings or exams are scheduled. Standardized patients at the UW make about $4,000 to $5,000 a year if they work regularly. Having a regular group improves the accuracy of the roles portrayed and also improves the feedback students receive, Struijk believes.

For some people, the supplemental income is a good fit with their other pursuits. Some members of the group are retired, some are actors and some are freelance writers. Because students come and go, Struijk has found it easier to specifically recruit people that age for a certain role, rather than try to keep them in the ongoing pool.

Interestingly, actors don’t always like the work, at least in part because it requires repeating a limited role again and again.

Ken Anderson, a retired teacher, has been one of the actors for several yeras and enjoys the patient role. He sees repeating the same scenario as a challenge, particularly when students are being evaluated. “It’s important to give them the same stuff each time. I like the acting involved,” he said, “but I also really like the teaching aspect and the interaction with the students.”

Angela O’Donoghue, a three-year veteran, was actually one of the first standardized patients at McMaster University in Hamilton, Ontario, when the program there began in the 1970s. “I was younger then, so I sometimes got to play a ‘seductive patient’ role, which was fun,” she said. “Now I tend to be cast with one of the conditions that show up in middle age.”

O’Donoghue, who has never acted outside of the standardized patient roles, also points to the teaching aspect of the work as rewarding. “Sometimes a student will say at the end of the training that I really helped them, and that’s very satisfying. In the program at McMaster, we were just role-playing and not giving students any feedback. Here, I think the interaction with the students and helping them with their skills is the most rewarding.”

For any training or exam, the standardized patients work from a script that sets out the symptoms they will report and the other details of the “patient’s” life, such as age, family and occupation. The standardized patient also is given information to answer questions from the student. Some of that information is about habits, such as drinking or smoking, and some is about general health history. They’re also told whether they should seem anxious or indifferent about their symptoms, or something in between.

Additional information is sometimes given to them with the proviso that they don’t tell the student unless they are specifically asked. “You can train them to either divulge certain information on general questioning or only to divulge in response to a very specific question,” Struijk said. They are also trained to notice if a student fails to ask one of the standard questions in an exam.

Along with coordinating and organizing, much of Struijk’s work involves working with faculty to develop scripts and then training the standardized patients to portray the roles consistently.

Struijk’s title at the UW is clinical skills and assessment manager and she works as part of the Health Sciences Academic Services & Facilities unit. The program also works with students in the physician assistant, nurse practitioner and pharmacy programs, and in social work training.

Struijk earned a bachelor’s degree in biochemistry and then found that she liked teaching more than lab work, so she went back to school to earn a master’s degree in education. She began working at the UW in 1993.

When she tells people what she does for a living, many remember an episode of the TV show “Seinfeld” in which the character Kramer takes a job as a standardized patient portraying a man with gonorrhea.

In the show, the point of having a standardized patient is for the students to get the right diagnosis. In reality, Struijk says, the diagnosis isn’t so important; it’s the interaction with the patients and learning to ask the right questions. “With standardized patients, it’s really all about the journey.”

For more on the UW program, see http://depts.washington.edu/hsasf/clinical/index.html.

The ASPE site is http://www.aspeducators.org/index.htm.