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A Medical Role-Reversal: Patients As Teachers

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Standardized Patient Instructor Ray Alcala (right) helps first-year medical student Alicia White give a mock physical exam to fellow first-year student Jessica Rodriguez  (left) at GW’s School of Medicine and Health Sciences.
Rebecca Sheir
Standardized Patient Instructor Ray Alcala (right) helps first-year medical student Alicia White give a mock physical exam to fellow first-year student Jessica Rodriguez (left) at GW’s School of Medicine and Health Sciences.

Standardized patients, individuals who are trained to simulate real patients, are commonly used in medical education. They enable medical students to practice and improve their clinical and conversation skills for patient interaction. A program at The George Washington University School of Medicine and Health Sciences goes a step further with their standardized patients.

When the patient becomes the teacher
It's called the Standardized Patient Instructor (SPI) program, and graduates of the program go on to instruct first- and second-year medical students on physical exam systems. D.C. resident Ray Alcala started out as a standardized patient, and later decided to become a standardized patient instructor.

"I just found that fascinating to learn what it was that all these students were performing on me all these years, and be able to give them feedback on what they were doing," says Alcala.

The SPI program is in its second year. Jennifer Owens, a program instructor, trains SPIs like Alcala on GW's physical diagnosis checklist.
"Basically, what we feel needs to be incorporated in to a head-to-toe physical exam," she says.

The focus is on technique, she adds. So when first-year students are learning how to do a physical, a fourth-year student will be present to help with the more nitty-gritty medical details, such as a where a specific lymph node is located. Or if a student wants to know something related to technique, such as how to use an octoscope - the instrument for examining one's ears - an SPI will be on hand to demonstrate.

The SPI is there for something else, too: to bring in a patient's perspective, Alcala says.

"A lot of times students as doctors don't really realize the different issues they have to deal with," Alcala says. "We were just covering visual fields [in a recent teaching session], checking peripheral vision. And I've had really tall students checking visual fields, but they're thinking of where the fields would be for them. Then they'll do the maneuver and they're not getting the results that they're expecting. And I can say, 'Oh, and by the way, when you noticed the results were a little off, consider the fact that, ya know, we have a height differential.' And I think that they appreciate that perspective."

Making a difference for tomorrow's doctors
While Alcala has turned his standardized patient and SPI work in to a full-time gig, for many it's part-time work. Josh Drumwright, whose day job has him doing background investigations for a federal agency, says he enjoys the flexibility of being an SPI. He especially relishes the opportunity to teach medical students.

"You feel like you have a hands-on, interactive, important role in medical school," he says. "And it's a growing part of medical school; more and more medical schools are doing programs like this. It's fairly new for GW to have just regular people have such a large influence on the teaching process."

And while Alcala agrees this involvement of "regular people" is a positive thing, he says it's not without its challenges - such as gaining the students' trust.

"I think a lot of students will look at 'Oh! Well, he's not a doctor. He's not a fourth-year medical student. Why should I believe what he has to say?,' Alcala says. "But I think that if you demonstrate that you're confident, and that you speak the language, so to speak, all of a sudden, they open up to you."

He says it works the other way, too: being an SPI helps him look at these budding physicians in a whole other way.

"We know how many years and how much training they go through, but when you work with the students [the] way that we get to work with the students, you know that they're real people," he says. "And they're great people. And I just have such great appreciation for what they do and what they have to go through to be able to care for all of us."

Photos: Medical Role-Reversal


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