How do healthcare providers become proficient in the physical tasks they must conduct with patients?
Practice. On manikins, on peers.
How do they improve their skills to ask patients questions, empathize with patients, and educate patients about their health?
Practice with standardized patients.
“Standardized patients (SPs) are an intermediate step for nursing and medical students; they’re real flesh and blood, rather than high-tech humans, but they don’t actually suffer from the ailments they portray,” stated an article in the spring 2017 issue of “Virginia Nursing Legacy.” “But make no mistake: there is nothing pretend about interacting with an SP, who might add a phalanx of props (wheelchairs, moulage, and hospital gowns) to the litany of groans, moans, and exhortations as they convey their predicaments.”
SPs aren’t necessarily actors. Students of all majors and off campus “regular” people are hired by the Boise State University College of Health Sciences Simulation Center to be SPs in simulations. A high number of Boise State SPs are retired; several are former health care providers.
“One of the main reasons why I wanted to be a standardized patient was because I want to attend physician assistant school when I graduate from Boise State and I feel like working with the nursing students gives me a glimpse into my future,” said Shelby Gibbons. “I know that someday I will be in their shoes, so it makes it exciting for me. I feel like I can also relate with the nursing students on a lot of things because we all want to go into the field of health and we both have to work very hard in school to get there.”
The College of Health Sciences Simulation Center started using SPs in 2010. The SP program started with theatre student internships and grew to incorporate Service-Learning students in social work, psychology and other fields that found the SP experience valuable. The program now hires temporary classified non-benefitted off campus people, in addition to interested Boise State students, to expose health sciences students to a greater age range of SPs.
The Standardized Patient program offers an orientation and ongoing trainings for employees. These include face to face rehearsals, simulation scenario videos, and an annual training that covers acting and feedback techniques. All SPs receive an annual evaluation.
Manikins are used in scenarios that require invasive procedures or symptoms that can’t be mimicked with an SP. Also SPs are much more cost effective than a high fidelity manikin.
The students love working with SPs; they prefer SPs over a manikin. The Simulation Center uses task trainers – prosthetics that attach to the SP’s body – so students can insert IVs or hear customizable lung and heart sounds safely on an SP. SPs help students develop communication, interpersonal and prioritization skills.
“I role play scenarios and simulate certain health related conditions/behaviors as directed, in a controlled lab setting, said Joan Hardy, a Boise State SP. “My assignment is to help provide a consistent, positive learning experience for the student while maintaining a professional manner. I am given opportunity to rehearse as needed with support from staff. I believe every simulation has the potential to further the students experience in the field of nursing and promote self-awareness and expertise.”
SPs are given prep materials so that they can portray a patient accurately. Prep materials include the patient’s history, the condition and situation, what props the Simulation Center will use to make the SP look like the patient they are portraying. Props may include task trainers, wigs, makeup, hospital gowns and more.
The SPs may rehearse with the faculty, particularly in behavioral health scenarios. They may also practice with other SPs, where another SP pretends to be the student. This allows the faculty to observe and coach the SP in their portrayal of the patient.
Make up may include moulage, a combination of prosthetics and makeup to create the illusion of a wound, condition or symptom. The goal is to make the simulation scenarios as realistic as possible.
SPs offer great benefit to the students’ future of interacting with patients.
“It’s different for students to practice on a human,” said Becky Bunderson, director of operations for the Simulation Center. “It’s often the first time students lay hands on a live person. They feel better about practicing first on an SP, before going off campus to their clinicals.”
“Participating in simulation has boosted my confidence tremendously,” said nursing student Jen Luchini. “Before nursing school I had zero health care experience, which left me feeling daunted and racing to catch up to fellow students who have so much more experience in the field. I am so thankful I can practice and repeat skills in the simulation lab before beginning clinicals; it’s the closest learning opportunity to real life.”
“I have learned to better process my emotional response in different situations,” adds nursing alumnus Justin Eaton (‘17). “This field is surrounded by overwhelming and uncomfortable experiences. The ability to dissect a scenario, piece it back together, and then plug it into the big picture is crucial in providing an optimal patient experience.”
“I like being a standardized patient because I know that I am helping out the nursing students and the faculty,” said Gibbons. “As a college student, I am usually on the “other side,” meaning that I am used to being the one that is being taught. When I work as a standardized patient, I get to give feedback to students on things they could improve on and, in a way, help teach them, which is cool to do. It makes me feel happy that I am positively contributing to another student’s education.”
“Participating in simulations helped me work through some of the bumps and blunders that every new and uncoordinated student has to go through,” states Eaton. “Developing proper habits early on make staying up to date attainable and a better nurse in the long run.“
“I really appreciate the opportunity to practice skills in a safe and risk-free environment,” reflects Luchini. “Learning is guided by knowledgeable facilitators and the debriefing portion of simulation lab is invaluable. I can review and reflect on my performance and receive honest feedback from peers and instructors. It is truly authentic learning.”