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Fake Patients Let Medical Students Practice on Underserved Populations

Patty Wight
Third-year medical student Allie Tetreault (left) and standardized patient Gabrielle Nuki.

Going to the doctor is not typically at the top of anyone's want-to-do-list, especially for teenagers, who are considered an underserved population in health care. But adolescence is considered a critical time for physicians to connect with young patients as they confront risky behaviors. To build stronger relationships with teens, medical students are increasingly training with simulated, or so-called "standardized patients" for practice.

Third-year medical student Allie Tetreault opens the door to an exam room at Maine Medical Center and greets her 16-year-old patient.

"Hey there Emma. How are you?" Tetreault says.

It looks and feels like a typical doctor's visit, from the exam table to Emma, the patient, wearing a johnny. But Emma is fictional. She's a character played by high-school junior Gabrielle Nuki, who has aspirations of becoming a doctor. She heard about this job from her advisor at school. Nuki says she has taken on a range of roles as a standardized patient.

"I've had one case where I was concerned about being pregnant," Nuki says. "That was kind of like the most harsh one, I guess."

Her character today, on the other hand, is just a shy teenager in for a routine health exam. Tetreault tries to break the ice. She asks Emma about family and school.

"What kinds of things do you like to do outside of school?" Tetreault asks Emma.

"I play soccer. Pre-season's coming up pretty soon," Emma replies.

The questions are innocuous, but there's a strategy at play here. First, Tetreault establishes rapport to get Emma to open up. Then, she asks questions that can ultimately lead to the information she needs as a doctor. Information about potentially risky behaviors.

"And how about your friends? Are they on the team too, or do they do other things?" Tetreault asks Emma.

"A lot of times, if you start asking teens about friends, you can ask what their friends are doing, and then you can ask them, 'Well, are you doing those things too?'" Tetreault says.

Like being sexually active or experimenting with drugs and alcohol. The director of pediatric training at Maine Med, Pat Patterson, says it's a physician's job to help patients limit these kinds of behaviors. But teens can be tough to crack.

"Teens are an underserved population group," she says. "One of the reasons teens have identified not seeking care is access. But another reason is some of them feel distinctly uncomfortable when they go into a physician's office."

Working with standardized patients gives medical students practice with broaching delicate issues. They also get frank feedback. Patterson says standardized patients tend to be more forthcoming than real patients.

"When you see a patient, especially a hospitalized patient, they're ill,"she says "They're not likely to give honest feedback to a caregiver about — 'that was uncomfortable,' or 'that made me feel really anxious,' or any of those kinds of feedback that we would like to have to better improve our delivery of care."

Back in the exam room, Emma takes deep breaths as her physical exam wraps up. Tetreault gives her a clean bill of health.

"All right — you look perfectly healthy to me," Tetreault says.

Now that the appointment is over, Nuki sheds her Emma role and gives feedback to Tetreault.

"I think you were really good about having a conversation and maintaining eye contact and having a good tone," Nuki says. "I also liked how gentle and comfortable the physical exam was. And I think maybe you could have had a couple more times where you could've asked me if I had any more questions, but other than that I think you did a good job."

Tetreault, who is 23, says she finds it much easier to talk to adult patients about sexual and drug activity. Working with teen standardized patients like Nuki helps her build confidence.

"Especially because I'm not that much older than a lot of the teens," Tetreault says. "So it feels like I should not be in this mentor role, almost, for these teens that are only a few years younger than me. So it's good to practice and get more comfortable with it."

As medical care shifts from a top-down approach where the doctor knows best to more of a partnership with patients, Patterson says standardized patients help doctors in training develop important communication skills. Skills that will strengthen relationships and lead to better outcomes.