Creating realistic 'patients' a matter of listening, reacting

By Paul Mayne
September 26, 2012

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Clinical skillsPaul Mayne, Western News
Justin Quesnelle, new manger of the Clinical Skills Learning Program at the Schulich School of Medicine & Dentistry, said while playing a role, being a standardized patient is more about listening and reacting than it is acting.


There are days when Justin Quesnelle deals with cardiac arrest, a hip replacement and appendicitis. He may even follow that up with a mild case of the flu or even a battle with diabetes.

And no, he’s not the unluckiest person in the world.

Quesnelle is the new manger of the Clinical Skills Learning Program at the Schulich School of Medicine & Dentistry. There, he helps train more than 400 ‘standardized patients’ (or SPs for short). These ‘patients’ are actually healthy individuals who offer their time playing the role of a sick patients to hone the bedside manner of soon-to-be doctors.

“This is a great facility and program,” said Quesnelle, who worked at Western for five years as a full-time trainer and exam coordinator, and is two months into his new role.

As founder and artistic director of the London-based Passionfool Theatre, Quesnelle is starting his sixth season with the company. While he’ll be directing The Crucible this November at the Arts Project, his day job also finds him directing in a whole new way.

While there are scripts for the SPs, only 10 per cent of participants have acting experience. The rest are everyday folks, from high school students to seniors, who are hired on by Quesnelle to fill an important need.

“In essence, it is like casting a role,” said Quesnelle, who earned his degree in English Language/Literature at Western in 2003.

Each patient’s case can involve up to three pages of a background description. Quesnelle said he might go over the ‘script’ with the SP for an hour or so before the student training begins.

“What we try to do is in the training session is really discuss who this person is, what makes them tick, what are they worried about and why are they here. What happens with the student is we try to simulate, as closely as possible, what this experience would be like if this were a real patient,” he said.

It’s less acting and more directing and discussing the background of the scripts, trying to find the link between who the SPs really are and who they’re supposed to be.

“That’s what’s important, finding a way for them to understand who this person is. The students are suspending their disbelief and we try to get the patients to know the background and know the history, and then forget that they know it,” he said. “The interaction isn’t scripted in any way, the standardized patient just has a lot of background and is taught to listen and react. The interview goes wherever it goes. Acting would be more scripted. … It’s really more an exercise in active listening and reacting.”

Afterward, the SPs offer feedback to the students, which a real patient doesn’t always have the opportunity to do.

In addition to practice, up to 200 SPs work on the Objective Standard Clinical Examinations as students run through a circuit of rooms, each with a different discipline of medicine, from cardiatric to pediatrics.

Quesnelle says feedback from the students, faculty and standardized patients play a big role in what sort of cases are presented each time.

“If students are struggling in residency in a specific area, we may need to go back to adjust our cases for first- and second-year students,” he said.

In the end, it’s all about giving the students a judgment-free area where it’s safe to make mistakes.

“Here, they have the opportunity to, frankly, fail and for that to be okay,” Quesnelle said. “If they don’t learn where they can improve, then there’s no sense in doing it. If everyone is going to be flawless at it, then why are we here?

“It’s about listening, communicating and improving those skills.”

Always on the lookout for new standardized patients, Clinical Skills Learning Program manager Justin Quesnelle encourages anyone interested in playing the role of a lifetime to find out more at the program's website.


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