Jamie Fair spends about 40 hours a month at the doctor’s office complaining about her various ailments.
Fair isn’t a hypochondriac. She’s an employee of the University of Pittsburgh’s Standardized Patient Program. Coordinated through the Office of Medical Education since 2001, standardized patients, or SPs, help aspiring doctors, nurses, physical therapists, dentists and pharmacists become more compassionate communicators.
They are, essentially, actors who specialize in illness — “a living, breathing tool” that Pitt’s medical students practice with, says Sarah Carleton.
Carleton and Fair are among more than 150 SPs currently at Pitt. They are trained to portray folks battling everything from bad backs, high cholesterol and depression to memory loss, heart problems and even cancer.
The practice began in 1964 at the University of Southern California when neurologist Dr. Howard S. Barrows asked healthy people to feign illnesses so his students could get hands-on experience in a safe, controlled environment.
It caught on nationwide, because it fills a gap that even the best classroom instruction cannot.
“Often, this job is not about getting to an exact diagnosis. It focuses more on allowing the student to practice certain skills, like how to screen for substance use, or what types of questions to ask about family history in a setting where no one’s actual healthcare is involved,” says Fair, who picked up this part-time job in 2007.
Although she has a degree in voice training from Carnegie Mellon University, studied improv at The Second City in Chicago and at Pittsburgh Public Theater, and now teaches acting classes, she says theatrical experience isn’t necessary for the position. What matters is a willingness to listen and learn.
“SPs are trained in communication skills and know the expectations that our students need to meet on a given day,” Fair explains. “Our job is to respond to the words and actions of the student within those parameters. I need to simultaneously remember small details of our conversation and how it impacted me, for better or worse, and relay that back to the student so that they can keep using what they are doing well, and also shine a light on moments that may have been a little bumpy or uncomfortable, emotionally or physically.”
Valerie Fulmer, operations director of the program, says SPs go through 16 to 24 hours of training before getting an assignment. And the program’s curriculum is kept current on trending medical concerns.
“There are always new things to address,” says Fulmer, who worked as an SP before she began running Pitt’s program in 2002. “For instance, we have several activities that address opioid use.”
Ed Gerstenhaber says the most challenging patient he’s had to portray in his seven years as an SP is a widower with thoughts of suicide. The examining student had to establish a feeling of empathy before the 71-year-old retired engineer confided in him.
During mock physical exams, he says, med students are judged on whether or not they follow a 45-step checklist. In cases where they must give a diagnosis, they sometimes only get enough information to narrow it down to two or three possibilities.
Expert diagnosis, Gerstenhaber says, is “really a lot more complicated than just picking a disease.”
Although Pitt’s program is designed for students, the SPs also benefit. Seeing med students endure stressful testing situations has given Carleton even more respect for health care workers and a sense of pride in how she is helping support the next generation of caregivers.
“SPs serve as a mirror,” she says, “so students can see how what they’re doing is having an impact. You don’t always get that opportunity once you’re a practicing physician. I love it for what it teaches me. As they’re learning, I’m learning as well.”