In previous Simulation Columns focused on interprofessional education and teamwork, we have explored the use of standardized patients (SPs) as a way to add fidelity to simulation scenarios. We have discussed ways that SPs can provide live interaction with learners that simply cannot be replicated using a high-fidelity, computerized manikin. SPs often have a variety of skills sets, including the ability to portray a patient, family member, or clinician; the resilience to react to unexpected learner situations; and the compassion to provide relevant, targeted feedback to the learners that will hopefully help them improve their practice.
Starting with this column and continuing in upcoming issues, we will focus on the use of SPs in the practice setting and how nursing professional development (NPD) practitioners can maximize their educational offerings by capitalizing on this powerful simulation modality.
The use of SPs can be traced back to the 1960s when neurologist Howard Barrows discovered that non-healthcare providers could be trained to act as "patients" for medical students. By interacting with these "patients," the students could learn how to get a medical history and develop important communication skills. Since then, the use of SPs has expanded to schools of nursing and other health professions schools, as well as the practice setting. Currently, SPs can be useful for teaching students and experienced clinicians.
There are a variety of resources available to help NPD practitioners get started with using SPs. Pascucci, Weinstock, O'Connor, Fancy, and Meyer (2014) provide a comprehensive discussion on how to recruit SPs, train them, and appropriately use them to help learners develop communication, clinical, and professional skills. Bosek, Li, and Hicks (2007) also provide detailed information on how to implement an SP program. The Association of Standardized Patient Educators (http://www.aspeducators.org) provides information and resources on how to most effectively use this simulation modality, including a core curriculum, conferences, and webinars.
Many of these SP references offer specific guidance on all aspects of SP usage and management. For this initial column on SPs, the focus is on highlighting the perspective of an SP and what NPD practitioners can do to enhance this important relationship. I interviewed Greg Beauchaine, who started working as an SP 2 years ago at the advice of his son, a physician assistant (PA). As he describes, "My son went to school at Oregon Health Sciences University which he really liked. When I retired from teaching elementary school, he suggested that I should try being an SP. So, I applied at Duke University Clinical Skills Lab and have been an SP ever since." In addition to being a retired teacher, Beauchaine is also a 21-year Navy Veteran.
MEH: Greg, tell me what you enjoy most about being an SP.
GB: I really enjoy working with the PA and nurse practitioner students because they are so interested in doing a good job. They don't pretend like it's a make believe scenario, and they act things out well. They treat me like a real patient and always thank me for my work. It seems to me like a worthwhile endeavor. I imagine that going to see real patients without having experience with an SP could be nerve-wracking!
MEH: It sounds as if you appreciate working with learners who respect you and your role and, above all, take their learning seriously.
GB: That is correct. I have worked with some residents who did not take the scenarios seriously. They acted like they did not need to practice with an SP and just went through the motions. From my perspective, not fully engaging with the SP is a missed opportunity.
MEH: How has being an SP changed the way you look at health care, healthcare providers, and your own healthcare situation?
GB: I am more aware of how things should be done. For example, I look to see if healthcare providers wash their hands, whether they place a stethoscope next to my chest rather than listen over my shirt, and whether they explain to me what they are doing. I recently went to see a nurse practitioner, and she did everything correctly. When she found out that I am an SP, she said that explained why I was so interested in what she was doing! She told me she learned from SPs and that she always wanted to do things the right way.
MEH: How do you feel about having to go with the flow during a scenario? How do you handle issues that arise that are not scripted?
GB: My favorite example of this was a time that I was playing a patient that smoked two packs a day for the last 40 years. This patient ran a restaurant and enjoyed smoking with his workers as he was able to relax and get to know them better. The learners for this scenario were first-year medical students, and one of them was so nervous interviewing me that she had to stop and ask her preceptor what to do. I kept in character and suggested she have a smoke with me as it might help relax her! She laughed and became more comfortable. As an SP, you really have to ad lib sometimes.
MEH: That is a great story! Do you have any other humorous stories to share?
GB: I had one scenario where I played a patient with colon cancer who had a tumor taken out. I had an intravenous line (IV) and a foley catheter taped on me, as they do not ever put anything invasive into an SP. During the scenario, the floor nurse called the resident in because the patient had not been voiding. When the resident came in to check on me, he asked if the foley catheter was properly inserted. Before I had a chance to answer, he pulled down my pants and said that the catheter was not properly inserted. I immediately answered, "How much do you think they are paying me to do this?!"
MEH: I bet that was quite a surprise and something that required quick thinking on your part! Given your experience with different learners, what would you like NPD practitioners to know about SPs?
GB: I would like them to know that the SP program is worthwhile. We offer a good service to learners. Also, everyone needs to know that bedside manner is sometimes not taken as seriously as it should be. The learners need to have a demeanor that is sincere and that they want to help people. I can tell if they are going through the motions or if they really care.
MEH: Tell me about giving feedback to the learners.
GB: I never want to be negative so I always think about what I want to say to them. I put things as a suggestion, such as "You might want to try this, or that." I find that it is best not to just praise them, so if I offer them something that they can do differently, they appreciate it. If I feel I have a connection with them, I offer more suggestions.
MEH: What other thoughts do you have for NPD practitioners on how to train SPs for a role?
GB: Generally for every role I get an outline with symptoms. One thing that I find helpful is having a rehearsal or practice session with our SP coordinator. We are able to go through the scenario and figure out ways to make it better.
MEH: What are your greatest challenges in being an SP?
GB: Nothing! I love doing this!
One highly relevant takeaway from Greg's interview is that NPD practitioners need to make sure that learners are educated on the importance of SPs and how they must be respected for their insight and feedback. Because many SPs are motivated to help learners become better healthcare providers, it is essential for learners to show them appropriate respect and appreciation.
It is also important to ensure the comfort of the SP in carrying out their role. For example, depending on their background, some SPs might need to have more rehearsal time or might need more background information to help them portray a patient, family member, or clinician. By developing a supportive and collaborative relationship with SPs, NPD practitioners can help them optimize their role and ultimately perform better for the learners. In addition to ensuring the comfort level of SPs, NPD practitioners must ensure their physical safety as well and protect them from any potential physical harm.
As we continue with future columns focused on SPs, we will be interviewing other NPD practitioners who have worked with SPs on various educational projects. Do you have a project that you would like to share? Do you have specific questions that you would like answered about SPs and how to use them to their maximum potential? Have you experienced challenges with this simulation modality and would like to share your experiences with others? Please email me at mailto:[email protected].
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