If you are a physician, how do you approach a patient about his drinking problem? Break the news to a parent that her 9-year-old has cancer? Or tell a patient that he is slowly losing his memory?
Instead of studying textbook examples, students at the KU School of Medicine-Wichita practice diagnosing actors pretending to be ill while professors watch on monitors to critique their abilities.
Before students receive a medical degree they must pass the clinical skills portion of the United States Medical Licensing Examination — a test that measures the student’s ability to communicate with patients, take down an accurate health history and diagnose an ailment in a specified amount of time.
Students from KU score above average on the clinical skills test.Before last fall, KU-Wichita served only third- and fourth-year medical students. And until last year, these students used rooms in the hospital’s clinic to learn about bedside manners.
Now KU-Wichita has a first-year class of medical students and a renovated wing with 12 simulated hospital rooms for them to train in.
KU-Wichita, along with KU-Kansas City, uses actors and simulated hospital rooms to help future doctors examine patients. In Wichita, these 12 recently renovated rooms at 1001 N. Minneapolis, feature forest green examining tables, relaxing pictures and lots of hand sanitizing solution.
This hospital-like setting is where students can work on their bedside manner and diagnostic ability. When medical students encounter a patient — an actor pretending to be ill — they must figure out what is wrong and what to say. They put a stethoscope to the “patient’s” heart and listen as the “patient” speaks of their pounding headache.
“Part of having a relationship with a patient is meeting them where they are,” said Gretchen Dickson, a KU faculty member. “It’s who they are as a person. How are you going to relate to them?”
The eight first-year students range from traditional pre-med graduates to a former chef and a mechanical engineer. Although most are from the Wichita area, one student grew up in Minnesota.
Stephanie Shields, who grew up in Andover, said that although she is nervous when she first enters the room, she assumes an air of confidence — and her timidity disappears.
“I like to get the feel of the patient,” Shields said. Even though her encounters with the patient are taped by two cameras, Shields forgets that she is pretending. “I just really like talking to patients. I get caught up in the moment and play the role.”
That’s what faculty members hope for.
Before students go into the examination rooms, Anne Walling, the director of the Standardized Patient Program tells them to be selective in their questions yet get plenty of detail. Her calm, Scottish-accented voice tends to quiet the nervous students.
Down the hall from the examination rooms is a control room where six faculty members oversee each medical student’s bedside practices on six monitors. Each student is given the same scenario; each “patient” has memorized an identical script. The students enter the rooms simultaneously. They have 15 minutes to complete their task.
Recently, the first-year students encountered a patient who was both friendly and forthcoming, so forthcoming that she admitted having at least three martinis each evening. While examining this middle-age woman, called Ellen Bumphrey, Shields kept her expression free of judgment. Her manner was confident, yet friendly.
As the students enter their second and third year, the patient encounters grow more complex and the patients become less cooperative.
“We want the students to feel free to make mistakes,” Dickson said. “We can help them.”
Although the encounters are simulated, they are important — students must do well; their grade depends on it.
“I was really nervous the first time, but the more I work with real patients and the more times we’ve done this, the more confident I am,” said Jordan Groskurth, a student from Derby.
Kyle Rowe, another first-year student, said it’s like taking baby steps. “I focus on eye contact,” he said. Rowe, who holds chemistry and psychology undergraduate degrees, said that he always remembers to thank the patient, but sometimes he forgets to summarize their symptoms and concerns back to them.
After the would-be doctors have met with the patient-actor, they must log their findings. This process can be almost as intimidating as the patient visit. These notes, like the visit with the patient, will be examined and deconstructed by the student and their instructors.
After viewing her previous tapes, Whitney Weixelman, a student from Wichita, noticed that she was always ready to nod and give an empathetic “OK,” but she saw she might have done this gesture a little too often.
Last year, more than 50 third-year medical students in Wichita saw 31 specialized cases. This year, with the admittance of a first-year program, and the increased use of this interactive teaching unit, the Wichita campus plans to double the amount of mock patient examinations.
The interactive teaching not only helps the students be more comfortable with future patient interactions, it helps to cement scientific and anatomical knowledge.
“They learn the science better this way,” Walling said. “It will stick better in their memory.”
Layers of information, such as lab results, are incorporated into each patient study. Many of the 171 faculty members not only coach each student on doctor etiquette in these “hospital visits,” but on biochemistry and anatomy as well.
What is unique about this center is that the university owns it and can use it on an as-needed basis. More and more medical teaching facilities are using these types of services.
“This kind of teaching is a lot more like playing jazz than playing classical music,” said Jon Schrage, chairman of the Department of Internal Medicine. “Sometimes you need to improvise.”