It’s a Wednesday afternoon, and it’s almost showtime for 10 players, mostly veterans of various Richmond stages.
They’re backstage in comfy robes and slippers. They chat quietly, or stand alone. Some stretch, others bounce on tiptoes. Just a few minutes before the performances begin, they disrobe and place their lives in tiny piles; slouched heaps of slippers and shoes, robes, mini backpacks, to-go coffee cups of various brands, an iPod and a paper script here, and a metal mint container there.
Then an electronic bell sounds and as one, they each open a door leading to the site of today’s performances.
Now, each is wearing an exam gown, the little tie-in-the-back cotton things. And each today is playing the same character, someone with an orthopedic complaint, either a bad hip, knee or ankle.
It’s an intimate gig, an interactive performance with an audience of two in a cubicle that looks an awful lot like an exam room at most any doctor’s office. Each performance begins and ends at the same time, and follows the same script and format.
Uniformity is the point: This particular day job has them performing as standardized patients, part of the training at the VCU School of Medicine. Each presents the same case in the same way, according to specific parameters. Their medical students are rated on a standardized scale, and each of the actors also is trained to provide constructive feedback, according to Ellen Brock and Aaron Anderson.
Brock is the director of the state-of-the-art facility where the training is done, the Center for Human Simulation and Patient Safety. Anderson is an associate chair in the theater department and founding director of the standardized patient program.
The onstage skills translate easily to this venue, according to Anderson. Actors have to have that believability and authenticity, it just happens to have to be presented consistently.
“You learn by practicing on patients, but our patients are able to give specific feedback,” Anderson says.
'The best job for an actor in Richmond'
Terry Menefee Gau is familiar with the standardized patient role, a part she’s played for three years. Check out her resume and her expansive listing on IMDB, and you see she keeps busy outside of her VCU gig. She has appeared in films including “Evan Almighty” and “Killing Kennedy,” done regional advertising and a national commercial, and a plethora of stage work, too.
But for today, she’s an orthopedic patient. The students are doing their first physical exam, something simple. It’s just a workshop, not an exam in which they will be graded. Ortho is easy. Chest and lung and abdominal exams are more involved; there’s more to look for and listen to.
The students take the lead. There’s two of them, one serves as the principal, the other watches. They switch roles for the next session a half-hour later.
Observers and teachers can watch through one-way glass. The students are facing the glass, Gau has her back to the wall as she plays her part, but after a few minutes, the student has her stand as the physical portion of the exam begins.
Gau grimaces as she gets off the table. You can feel her pain.
At the five-minute warning, the standardized patients mostly are already imparting their observations to the students. A robotic voice saying “Please enter feedback now” extraneously ends the sessions. There’s a three-minute break before the next round.
Gau exits, says the session went well, and that the student was well prepared. The students were engaged, and their questions turned into a discussion.
Like many program participants, Gau learned of the gig through friends who act. She enjoys the work because it’s a great way to use acting skills in a way that helps others.
On a typical day, Gau says, the standardized patients spend the morning getting into character, learning who they are for the day, the medical condition to be depicted. It takes about 90 minutes to 2 1/2 hours to prepare.
Gau says actors make great standardized patients for students to work with in learning physical exam skills because they are comfortable with the sensation of touch, and like athletes, are comfortable with and know their bodies, how they move. That eases the discomfort the students feel when learning how to conduct the physical exams.
“They need to have a safe place to mess up,” she says.
For Gau, the more difficult part of the process is the assessment. Standardized patients want to be constructive and helpful, to provide honest, meaningful feedback and maintain a good relationship. Students generally are “over the moon” grateful for the feedback, she says. They want the critique so they can improve at what they do.
Richmond resident McLean Jesse has been a standardized patient for four years. She’s an artist, actress and designer, and today she’s filling in and helping to manage the back office, if you will. She never thought she would take a job out of theater or art, but this post spoke to her. “I love the program.”
This is the basic stuff, but there are harder roles to play. One critical skill they work on is how to break bad news to someone. In those sessions, the standardized patients have to play someone who’s facing a heartbreaking event, being told that they have cancer, or that their father has died.
Pamela Daniel has served as a standardized patient since August 2013. For her, the job is fun, like a stage production. It comes with its challenges and can be draining, though, as in the day she had to portray a patient in crisis during a psychology exam.
Gau says mental health cases are especially difficult to portray, a breakdown with lots of emotion and crying, as is the breaking of bad news. Do that six times in a day and it can be quite draining, she says.
Daniel says there is a downside in learning about numerous illnesses: “The hypochondriac comes out.”
Jesse notes that the work is a great supplement for the actors. They get a call a couple weeks in advance to see who’s available. Of course, there’s nothing going on during holiday breaks, though summer is not as dead as it once was since most of these students are in school year-round.
It’s the best job for an actor in Richmond, says Ray Bullock, a standup comedian resplendent backstage in Stewie slippers and a Batman robe. He’s been working here for two years, and since he’s a standup, this is a perfect day job, since he has “lots of day to fill.”
He’s enjoyed the experience; you learn something new each day, it helps to sharpen acting chops, furthers your education and sharpens your stage skills. It’s a win for the arts, the students and their future patients.
“I can actually have my art,” he says.
Richmond resident Cheryl Fare is the backstage manager today, the keeper of the clock and the bringer of candy to boost energy between sessions.
The standardized patient gig has been hers for more than four years now. She likes how it allows her to combine her professional training and experiences acting and as a stage manager, and also her experiences as a caregiver and as a medical patient, too.
“It’s meaningful work,” she says. “It brings the two together in a nice way.”
A place for leaning and training
The center is on two levels in the McGlothlin Medical Education Center. The facility has in-patient and out-patient settings, including four acute care simulator rooms and a full operating room. The center allows students to apply their knowledge at a higher level before working with actual patients, Brock says.
It’s a realistic environment. Alarms sound, equipment beeps, and the students learn to listen and watch for cues around them, to discern what’s normal and what’s not say, in the pitch of a monitor.
“It’s about thinking like a doctor, Brock says.
Standardized patients are just part of the package. There’s a surgical model that blinks, breathes and even bleeds, and there’s a laparoscopy practice gadget where students learn to manipulate items in a 3D space on a 2D screen. Those skills are taken to the next level with a more complex gadget that gives a virtual reality simulation of laparoscopy. Students learn which tools are needed and the best strategy for a particular procedure.
The technology extends to the standardized patients, too. Jesse cites the time she donned a robot uterus and “screamed and screamed” as she delivered a robot baby. Mercifully, there’s also some supplementation involved when serving as a patient for students learning surgical skills, a prosthesis called a cut suit.
The standardized patients are an important part of the training process, instrumental in teaching students how to talk to patients, how to take a history and to perform physical exams, says Brock.
The upper floor of the center has 16 exam rooms as you’d find in a doctor’s office. Students enter through a front corridor. A corridor behind the exam rooms is where the standardized patients gather. There’s also a control room with monitors to see and record what’s going on.
The center in December earned accreditation as a Comprehensive Education Institute.
Program participants are recruited once a year. There’s a phone interview, followed with a round robin of acting exercises, Anderson says.
That’s followed with a boot camp, two or three days of paid training where newbies are run through a number of scenarios that they have to pass before they move on to more advanced exercises. After successful completion, a candidate is a probationary hire. Each has to complete an event in which they are run through the stations and learn what is expected, says Anderson.
“It’s actually quite rigorous,” he says.
The program has been active since 2011, and can accommodate most any need. You need 10 people over age 60 for a gerontology training? No problem, says Anderson. Six pregnant women for a family medicine session? Standardized patients will be found.
There are no specialists here. Whatever is needed, the standardized patients can accommodate, from portraying pancreatitis to psychosis. If you actually have a medical condition such as a bad knee or heart murmur, all the better: You have something that the doctors in training can actually detect and work with.
“It’s like 'Hamlet,' you don’t learn that role and only play that role,” says Anderson. “You play what’s needed.”
Jesse notes that the patients have multiple audiences. In addition to med students, they work with residents and doctors out in the world, too. They also have worked with dentists, and the service could be used by EMTs and firefighters, too.
The standardized patients are trained according to the particular event as though they’ve never done it before, says Anderson. Each case, they are trained fresh each time.
An unwritten goal of the program is to provide employment opportunities for Richmond’s acting community. There are about 65 on the roll, and only a few have been removed over the years. The more active they are, the more likely they are to be chosen for an event, says Anderson.
It’s fun, but also rewarding. The settings in which they work are intimate, but the impact is immense, helping doctors to learn to be better at their job in technique and in their interactions with patients from that point on through their career, says Anderson.
“There’s no higher calling in art than that,” he says. “Every single day, you make people better who make people better. How cool is that?”
The actors note that the personal growth curve for them is dramatic. They hone acting skills but they also gain knowledge of medical issues and health concerns as well.
“I never thought I’d go to med school, but sometimes I feel I’m in med school,” says Jesse.