What is a “standardized patient?"
A standardized patient is someone who has been trained to simulate, in a consistent, standardized manner, a patient in a medical situation. Standardized patients are used by the Virginia Tech Carilion School of Medicine, and by many other medical institutions, to train and evaluate students. Standardized patients learn a case, based on a real patient other than themselves. They are then interviewed and examined by students as though they were that person in the doctor’s office or clinic. They will give that patient’s history, and simulate their physical signs, such as pain or difficulty walking. As a standardized patient, you will provide these students with an opportunity to interact with and learn more about patients with the condition that you portray.
I’ve seen advertisements for research subjects. Is being a standardized patient like that?
No. Most people think of medical research subjects as people who take medications or are on certain diets, and then have their reactions to them studied. This is very different. We use standardized patients to simulate situations for the students, such as meeting a new patient for the first time in a clinic, and interviewing them about their problems, examining them, and counseling the patient. As with real patients, good interviewing and communication techniques will result in a more productive physician-patient relationship.
What types of physical examination would be involved?
They will examine you as if you are one of their patients during a routine doctor visit. For example, they may: listen to your heart and lungs with a stethoscope; press on your abdomen looking for tenderness or swelling; look into your eyes, ears, and throat; take your blood pressure; assess your muscle strength; check your reflexes; check your pulses etc. None of the examinations involve taking any blood or other samples; no needles are used.
How do I know what to say and do when the student interviews and examines me?
You will be trained to portray a patient. We create a complete history for you to learn. It includes the patient’s complaint for which she or he comes to see the doctor, her/his past medical history, and details about her/his life such as their job, her/his family and activities. We also describe the emotional state she/he is in when she/he sees the doctor. By learning that history you can learn to simulate that person, and speak to the doctor just as they would. We would also show you how to move like that patient, and how to react to the physical examination. For example, you may be portraying someone with a bad back. We would show you where it hurts and what the patient could or could not do because of the back problem. If you are supposed to portray someone with a pain in the abdomen you would be shown how to react when it is pressed in certain places.
That sounds like acting. Do I have to be an actor?
No. Some standardized patients are trained and experienced actors but most are not. You can be a very good standardized patient without ever having been on stage or in a movie. There are some similarities to what actors do, but there are differences too. For most cases, if you are the right person we can train you to do the job regardless of your experience.
I am an actor. This should be easy for me and good experience too.
Perhaps. But you may find it much more difficult than working from a script or within dramatic improvisational outlines, and you may find it very frustrating. This work has nothing to do with finding dramatic moments or playing to an audience. It has everything to do with disciplining yourself within the needs of the case and the teaching of the students. It can be very repetitive, as exactly the same patient must be presented for every student. An actor can however, use their skills to present patients that are difficult for non-actors to simulate. This work is confidential, and you will not be permitted to use the material in any public or private performance.
Is it safe?
Yes. The examinations are very basic and do not cause any harm to the standardized patient.
Do the students know we are not real patients?
Yes. We aren’t trying to deceive anyone. Students are told they will be working with standardized patients, and are told to behave just as they are being trained to do with real patients.
I’ve had a couple of health problems in the past. Can I still be a standardized patient?
Probably, if you are suitable in every other way. If your personal health problems prevent you from participating in a particular case, then we will explore other cases. Remember this work is not about your health.
Why do you need standardized patients? I thought medical students learned with real patients.
Some things are better done with standardized patients. For example, we can have one standardized patient be seen by a number of students and behave each time as though it were the first time they have come to see a doctor for their problem. This is not intended to replace the experience they will need with real patients, but rather to add to their training. Using standardized patients allows students to practice before they work with the real patients, in a controlled, risk-free environment. It allows the medical students to learn from their mistakes without doing anything to a real patient that might be upsetting or harmful.
What types of people do you need?
Just as there are all kinds of real patients we would like to have a corps of standardized patients representing men and women of all ages and physical types. You must be 18 or older to be a standardized patient.
Do I need to know a lot about medicine?
No. We will teach you what you need to know.
How often would I work, and when?
That is very difficult to say right now. This is a developing program at the Virginia Tech Carilion School of Medicine, and while it may expand in the future, there will always be a limited amount of work; this can should not be considered steady work for standardized patients. We maintain a roster of people we can draw upon as needed. We would match you as closely as possible with the patient you are going to simulate, and then match schedule needs to standardized patient availability. Initially you might work only a very few hours over the course of months, or not work at all for some time.
Please note that once you agree to work on a particular day it is absolutely essential that you meet that work commitment, just as you would with any job. Training sessions for standardized patients are more flexible. We will try to accommodate your schedule for training. Please note that training is mandatory; you cannot work unless you attend training.
What is a typical work day or work week?
There is no standard; it depends on the nature of the particular session. Some sessions consist of a few hours for a few afternoons within a single week. Others will involve more afternoons; still others may involve full days, 4 or 5 days a week for one week or several. Student sessions with standardized patients usually take place during weekdays, most often in the afternoons, so you would have to be available at those times, but there are also full day sessions.
How much does the job pay?
We are now paying $15 per hour for both the training and the student sessions. You are not an employee of the Virginia Tech Carilion School of Medicine, but rather an independent contractor. You are responsible for paying your own taxes on this income. No benefits are paid.
I’ve been a standardized patient for other organizations. Would I be able to work for the Virginia Tech Carilion School of Medicine?
If you are continuing to work as an standardized patient elsewhere you are certainly welcome to work for the Virginia Tech Carilion School of Medicine.
I’m still interested. What do I do next?
Please contact Heidi Lane by email or by phone at (540) 526-2505.
As part of the clinical sciences and skills value domain, Virginia Tech Carilion School of Medicine students get early practice in a clinical setting with standardized patients as well as other volunteers from the community. Check out some pictures from a class session as students practiced checking heart rates, blood pressure and breathing.