Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, March 15, 1994 TAG: 9403150098
SECTION: VIRGINIA PAGE: C-3 EDITION: NEW RIVER VALLEY
SOURCE: MARK ST. JOHN ERICKSON NEWPORT NEWS DAILY PRESS
DATELINE: NORFOLK (AP) LENGTH: Long
Her right leg was drawn up as if to protect her aching stomach. Her right hand made a white-knuckled fist around the fold of her hospital gown. She spoke in short, painful, wrenching sentences, sniffling bravely as she answered questions about her symptoms.
Nausea. Fever. Burning urine. A sharp, horrible pain that shot right through her abdomen.
That's why she clenched her teeth as Tim Schremmer, a third-year student at Eastern Virginia Medical School, carefully worked his way through a nerve-wracking series of taps across her stomach.
"I think what we're going to end up doing here is admitting you to the hospital," he said. "I think you've got appendicitis."
Ten minutes later, Schremmer returned to find his patient sitting up and smiling.
"Hi, I'm Valerie Lint, and I'm all better. I think you did rather well back there," she said.
Such miraculous turnarounds may be the stuff of fantasy in most hospital situations. But at Eastern Virginia's new Clinical Skills Laboratory, instant cures and immediate feedback are an integral part of the course.
Lint works as one of more than 60 standardized patients who have been trained to simulate various medical conditions in practice exams with students. After each session, they walk the future doctors through a detailed assessment of both their clinical performance and their bedside manner.
Video cameras let other trainers watch the interview, giving the students another source of advice about how to improve their diagnostic talents. Some, like determined athletes, take the tapes home as they leave, using them to hone their body language and facial expressions as well as their examination skills.
All that make-believe experience can provide crucial guidance when the fledgling physicians begin working with real patients.
"Even after years of medical training, some new doctors are unprepared for what they will encounter in the examining room," said lab director Gayle Gliva-McConvey.
"This gives them a chance to get their feet wet in a controlled situation."
In decades past, such elaborate simulations were unheard of in medical schools. Most students, like generations of doctors before them, began their clinical training by examining each other.
Traditionally, they didn't work on real patients until their third year - and then only under the attending physician's supervision. Even then, Gliva-McConvey said, it was often a case of sink or swim until the students gained experience.
That hands-off approach frequently led to bad habits, if not outright mistakes, in conducting examinations.
Gliva-McConvey can recall many cases, in fact, where the students simply didn't know how to organize their questions or use basic instruments such as a stethoscope.
In addition to those fundamental learning problems, educators also faced considerable difficulties when it came to assessing the clinical skills of their charges.
"Sometimes patients will praise students they like, even if they don't do that well," Gliva-McConvey said. "Most are not qualified to evaluate how anyone does in the examining room. They're just not trained to know."
Standardized patients, in contrast, undergo hours of training regarding their make-believe ailments. In addition to learning how to simulate a wide range of physical symptoms with remarkable fidelity, they also know how to mimic the psychological and emotional effects a disease or injury can cause.
They're taught to recognize the correct exam procedures, too, beginning with such basic elements as washing the hands and including, in many cases, the proper use of various instruments and tests.
The training even incorporates such subtle but revealing clues about a patient's condition as body language, facial expression and the way the hands are held.
"My idea is that if we send a standardized patient into a doctor's office - and we have done that successfully in the past - they wouldn't know the difference," Gliva-McConvey said.
At McMasters University in Canada, where Gliva-McConvey helped create a pioneering standardized patient program, the staff at the clinical skills laboratory was capable of simulating about 400 different medical profiles.
At Eastern Virginia, where she and coordinator Hilarie Haley began work this past fall, the internationally known consultant hopes to double that number within a few years.
Her first class of simulators includes Karl Karnes, a 38-year-old Newport News firefighter who works at the laboratory during his time off. He portrays an anxious painting contractor troubled by both mounting debts and an abdominal condition known as irritable bowel syndrome.
In this case, learning to express the patient's impatient, uncooperative behavior is just as important as mimicking the physical symptoms, Karnes said.
"Once you know the material, you just let yourself go, blending things from the case with things from your own experience," he said. "After a few times, you actually become the person and forget everything else."
by CNB