Barbara Gamberini gets sick several times a year, and it’s always something different.
She’s had a cold, the flu, a stroke, a heart attack and even cancer. She’s had each condition on multiple occasions. But every time she goes in for an examination, she leaves perfectly healthy and feeling great.
Gamberini, 64, hasn’t really had those health problems. She’s a standardized patient, one of at least 50 people trained by the Wake Forest PA program to act out the symptoms so PA students in their preclinical year can practice history taking, physical examination and diagnosis.
The standardized patient program is critical to preparing students to apply their classroom learning to working with actual patients. “It replicates the human-to-human experience,” said Erich Grant (’05), MMS, PA-C, assistant professor and vice chair of education and curricular innovation. Grant leads the standardized patient training program.
At the end of each unit of the preclinical year, PA students evaluate standardized patients, or “SPs,” as they’re often called, as though the student and the SP were in a clinical environment. The SPs outwardly exhibit and complain of symptoms, and it’s up to the students to determine what’s bothering them.
It’s not always as simple as identifying symptoms that correlate to a disease. Often, the SPs display real human emotions of fear and anxiety, and their characters’ backgrounds may also come into play.
“Almost every case has a narrative thread behind it,” added Grant. If the students ask the right questions, the SPs reveal more about their backgrounds, which helps the students uncover the potential cause of the ailments. Afterwards, students are evaluated and given feedback on their performances.
Grant said this approach helps PA students practice dual processing, which involves listening to what patients are saying as well as evaluating symptoms. “It’s an important skill they have to develop,” he stressed. “The only way to do it is to work with real human beings.”
That’s why the PA program curriculum places so much emphasis on working with SPs. The five SP days during the first year are more than what other PA schools typically provide, according to Grant, and they represent a significant expense.
“We invest heavily in preparing our students for real-life situations,” he continued. “This experience helps them to learn to deal with the human as well as the disease.”
Gamberini said she essentially stumbled into the opportunity to become an SP more than 25 years ago and has been doing it ever since. A former high school teacher, she doesn’t have a background in theater or acting. “I’m just a fairly outgoing person,” she said.
As a former teacher, she’s comfortable being in front of students and helping them learn. She also just really enjoys being an SP. “From the beginning, I just loved it,” she said.
But to Gamberini, who also serves as an SP for the MD program, it’s more than just a fun side job. She sees it as a responsibility to help create better healthcare providers. “It’s not just medical knowledge,” she said. “It’s also shaping their communication, compassion and empathy.”
It’s a role Gamberini and her colleagues take very seriously. “I spend a lot of hours practicing and studying the script,” she said, stressing the importance of getting the symptoms right every time. “We have to stay standardized. There’s no improvising.”
Some of the roles she gets can be quite demanding, both physically and emotionally. “Sometimes I’ll have an emotional case, playing a patient that’s gone through something traumatic,” she recalled. SPs often reprise their patient roles as many as eight times in a day for different PA students. “That can be draining.”
But it’s all part of the job, Gamberini said. “I want to give these students the best possible experience.”
While the SP program represents a significant investment from the school, Grant says it’s paying off.
“The students have a love-hate relationship with the SP days,” he said, noting it can be difficult and nerve-wracking to know they’re being watched, and that they’ll have to watch video of their examinations afterwards.
“Just like the SPs are performing, the students are on stage, too,” added Grant. “Eventually, they’ll need to be able to play their role seamlessly in the real world.”
The level of training and practice PA students get from the SP exams is having a positive effect, according to Grant. “We hear from preceptors about how personable and comfortable with patients our students are during clinical rotations,” he said. “It’s clear the students gain a lot.”
Gamberini echoed that sentiment, saying she can see the students’ growth throughout the year. “It’s amazing to see how much they’re absorbing in such a short time.”
Occasionally, she will see former students as practicing PAs in the community, and even when she visits a clinic for a real exam. “It’s a real honor to see them reach their goals and see the people they become,” she smiled.
“I feel good that I was a small part of it.”