Rommel Pacson sits in a hospital, while a nurse tries to diagnose his condition. The young nurse asks him about his health history with detailed notes, looking for helpful clues. Pacson waits for any curveball questions the nurse could throw at him. But he feels ready. After all, he’s been coached on what to say, and he’s already spoken to three different nurses this week.
Pacson is what is called a standardized patient (SP), a performer who acts in clinical simulations for nursing and medical students. He and other SPs frequently work at the Clinical Simulation Center of Las Vegas (CSCLV), which is part of UNLV’s programs to train future healthcare leaders. Simulation staff put students in various controlled environments, evaluating their interpersonal and communication skills and critical thinking. SPs are coached by trainers to simulate a real patient, from their history and physical traits to their emotions based on specific situations, including counseling and physical examinations
Becoming a Standardized Patient
Standardized patient simulations were first developed by medical educator and innovator Dr. Howard Barrows at the University of Southern California in the 1960s. According to Gigi Guizado de Nathan, the standardized patient coordinator at CSCLV, the concept of SPs initially brought some ridicule over actors being introduced into the scientific environment of medical education.
“At USC, the visionary idea was met with enough resistance from neurologists and medical educators that Dr. Barrows left USC to find a more supportive academic climate in Canada,” she said. “Finding a welcoming home at McMaster University, he went on to pioneer problem-based learning. It took a long time to get where we are today, with SPs becoming the norm in medical education.”
Becoming an SP isn’t a straightforward path. Theatrical experience isn’t required, but it does help. Pacson is now in his fourth year as an SP, having been in performing arts since 1986. He first heard about SP work through a colleague and decided to try it out. As a massage therapist, he had an advantage in learning the role. He says, “I have a background in health with anatomy, physiology, certain conditions we had to learn, so I sort of brushed up on my medical knowledge as we went along.”
His preparation isn’t too different from what a regular actor does, specifically the focus on characterization. “[We] go through a background story,” he explains. “‘Where was I born? Why am I here? Why am I rich? Why am I poor? How do I feel about the character I'm acting’? So, in that sense, it's the same.” Pacson has played some cases multiple times, which not only increases his familiarity, but lets him relax more into the character.
Adriana Chavez, like Pacson, heard about SP work through word of mouth while performing in a play a few years ago. She contacted Guizado de Nathan for an audition, and her SP career started from there, including work at Touro University Nevada). Chavez says Guizado de Nathan helped seamlessly transition from regular acting performances to being an SP. “She has rehearsal days, and our SP trainers are also in the theater field”, she explains. “They know how to be with and manage other actors.”
That transition includes theater-style preparation, complete with camera staging and script rehearsals. Guizado de Nathan explains they practice both what to say and what not to say (to keep simulations from going off the rails), as well as analyzing the different performances an SP could play.
Performing with Intent
Where the comparisons with acting end is during the actual scenario, interacting with a student, their unknown performance partner. “[The staff] give you parameters of your character, but sometimes [the students] ask you a question that wasn't thought about,” Pacson says. “So, you have to think, ‘What would my character think about this situation? How would he react?’ You still have to portray this character with this condition that you're going to seek medical help for.”
Chavez credits her improvisation training to help guide her along while staying true to the scenario. “We have the script, the scenario, and character of the patient,” Chavez explains. “We have to follow that through line. But we pay attention to the student doctors. If I know my part, then I can maneuver or I can use whatever the doctor throws at me, as long as I know what my character needs to say.”
Paying Attention to the Little Details
Though an SP needs to convincingly act in front of students, Pacson says he prioritizes presenting the case by giving the students the signs they need to diagnose his condition, as opposed to worrying about delivering a tour de force performance. “It’s not necessarily a case that we play, but how we talk to them, how we interact.” He compares the scenario to a treasure hunt. “We give them little bits of information. They have to ask the right question in the right way for us to answer them. It can get really specific, which I think is also another fascinating challenge.”
Chavez adds the encounter hinges on both the SP and the student performance. “They have to take what I give them,” she says. “They’re going to lose out if they’re not listening and are too consumed with getting each question out without having the bedside manner. You really have to listen, and you take in what the person is giving you and respond authentically, not just getting the lines out.”
She cites great eye contact and presence as other factors that can improve a student’s performance.
In addition to giving the correct details, SPs also observe the students for debriefing after the simulation. SPs will fill out an intake form, giving their feedback on how the scene went. They will also play back the recorded simulation afterward with instructors and look for nuances that may influence how a patient responds.
Recalling one simulation, Pacson says, “When I said this word, [the student] sort of made a little smirk and that made me feel like she thinks my condition is funny. We tell them later when they smirk, the patient I was playing felt like you didn’t care or were belittling his condition.” He adds, “That’s what we’re here to do, to help you with your people skills, help prepare for the realities out there in the real world.”
More Than an Act
While some scenarios are more mundane, others require more emotional resonance and kinetic movements, which Chavez says has helped her grow as an actor. “We are allowed to be creative with the interpretation of the patient, with certain structures we need to meet,” she says. “It’s given me reassurance that I do have something to bring to the table.”
For Pacson, he’s proud to watch UNLV School of Nursing students absorb the lessons learned and apply them in subsequent semesters. “It’s incredible to see how [the students] have grown, the things we taught them in the first year that they’ve taken on,” he says. “The second year [student], they’re looking at my eye, being more personable — not a robot trying to really stick with the facts and [show] nothing emotional — because that’s a vulnerable time for patients. I can see what we do is helpful to them in that aspect.”