In 1963, Patty Dugger, a paraplegic woman with multiple sclerosis, visited the University of Southern California (USC) in Los Angeles for an examination with the school's third-year neurology clerkship — or at least that’s what the USC medical students were asked to believe. In reality, Patty’s name was Rose McWilliams. She was also a perfectly healthy artist's model from USC's art department.
"Patty" had been enlisted by neurologist and educator Howard S. Barrows, MD, who sought a better way of teaching and evaluating clinical skills using a controlled patient experience. Barrows coached Patty to present with several symptoms, such as sensory loss, as well as the questions and concerns of a real patient. Through that experience, Patty became the first standardized patient (SP) — an independent specialist trained to portray patient scenarios for the instruction and assessment of the clinical skills of medical students.
Barrows' idea caught on, and standardized patient programs have been implemented across the globe. This collaborative teaching methodology trains individuals to take on the roles of patients and family members in order to provide students and clinicians with an opportunity to practice their clinical and interpersonal skills.
The Penn Medicine Standardized Patient Program
Launched in 1997, Penn Medicine's Standardized Patient Program aims to provide safe, measurable, authentic learning and testing experiences for all trainees. Today, thousands of learners across multiple disciplines at Penn benefit from the program's highly-skilled SPs.
"The applications for SPs are limitless," said Denise LaMarra, MS, CHSE, director of Penn Medicine's Standardized Patient Program. "Real patients are not always accessible when they are being treated in a clinical setting or they may not be keen on having trainees practice on them. Through SP training, we are able to simulate things in a scalable way."
SPs undergo a rigorous training curriculum that prepares them to enact and maintain highly realistic patient portrayals. The SPs are also prepared to provide extensive feedback to trainees on communication and interpersonal skills.
"Our SPs are taught how to identify observable behaviors on the part of the trainee and tie that observation to a feeling," LaMarra explained. "Rather than saying, 'You seemed nervous,' an SP might say to a trainee, 'You were tapping your pen a lot.' Then, they unpack that behavior."
Beyond helping trainees learn history-taking and physical examinations, SPs help students, employees, and clinicians hone a range of skills from disclosing unexpected medical events to navigating difficult conversations with challenging colleagues.
"The SP experience provides learners with a safe way to practice before they are in a situation with real patients and families," LaMarra said.
Casting Call: Who is Eligible?
"We want to represent the real patient population, so hiring SPs that represent a wide demographic range is crucial," LaMarra said.
To that end, the Penn Medicine SP Program is committed to recruiting SPs who differ in terms of ethnicity, age, gender, sexual orientation, gender identity, body type, and physical ability.
"We want trainees to have exposure to a variety of encounters, so we try to hire for priority populations with a focus on diversity," LaMarra explained. "As an example, exposing a trainee to a patient who doesn’t speak English as their first language is a critical learning opportunity. Similarly, a patient with obesity can provide powerful insight into stigma and bias. All of these experiences prepare trainees for real-world applications."
And, SPs do not need to be skilled actors to take part in the program. "It helps to have people who are good at improvisation because we can't anticipate everything a trainee may do or say," LaMarra said. "All of our SPs are trained thoroughly, provided with a story, and instructed on how to role play and answer questions."
The Show Must Go On: Standardized Patients and COVID-19
Although the pandemic forced the SP Program team to adjust to a new, virtual format, the program has maintained momentum.
"Throughout the pandemic, we have continued to grow and thrive, despite our small staff of four full-time employees," LaMarra said. "We employ more than 200 SPs and, in the past year, we have conducted 10,000 remote encounters with medical students, 800 encounters with residents, fellows, and other health system providers, and more than 1,000 encounters with external clients outside of Penn Medicine."
In fact, Penn Medicine's SP Program continuously expands to accommodate learning needs across a variety of disciplines, including medical education, veterinary medicine, social work, genetic counseling, human resources, and customer service. Current clients include Penn Nursing, Penn Vet, the Penn Center for Community Health Workers, Children’s Hospital of Philadelphia, and Arcadia University.
For her efforts, LaMarra received an Outstanding Educator of the Year award from the Association of Standardized Patient Educators (ASPE) in 2021.
"Receiving the award was definitely an honor," LaMarra said. "The entire SP community is so wonderful and supportive. To be recognized by peers who understand this work was especially meaningful."
Since being introduced by Barrows nearly 60 years ago, the impact of SPs has continued to evolve and transform the learning experience. "We are standing on the shoulders of giants and learning from those who came before us," LaMarra said. "This work is truly a passion of mine, and I look forward to continuing to play a role."