Naomi Grodin likes to imagine that she’s dying. What she enjoys more, though, is telling her pseudo-condition to strangers. Over the past decade, the South Hills resident has probably seen hundreds of doctors. Sometimes, she will tell them that she is terminally ill. Other times, she pretends that it is a family member with the condition.
Grodin’s diagnosis is not searchable on WebMD. She is a thespian.
For the last 16 years, Grodin has acted as both a standardized patient and a professional simulator. The roles yield differing benefits to trainees, explained Dr. Rachel Schuster, a pulmonary and critical care physician at UPMC.
“Standardized patients are more for assessment. Often, they’ll have an interesting physical finding,” said Schuster. The exchange largely bolsters medical students and other learners’ abilities to perform histories and physicals.
Conversely, professional simulators are utilized more for communicative strategies.
The characters have a decision tree and internal framework. Facilitators then “titrate” how the information is revealed — what the characters do with their emotional temperature, if they get mad, if they cry, if they reveal a whole slew of information — based on how the trainee interacts, explained Schuster, who spent a year-and-a half of her fellowship researching the subject.
“We are essentially doing roleplaying with doctors or doctors-to-be in an effort to teach them communication skills so that they can be become better communicators and better listeners,” said Shirley Tannenbaum, a retired professor of theater at Point Park University who started working as a professional simulator and standardized patient four years ago.
Part of what makes the exercise so effective is the setting and circumstances, Schuster explained.
As opposed to an unpredictable live conversation between parties, in this largely controlled pedagogic surrounding either the trainee or the facilitator can stop the exchange at any point.
What happens then is that the “simulator is just sitting there almost like a paused tape, as if it were a pause in the conversation, you can then rewind and start again,” said Schuster.
The lab-like environment allows trainees to “see what happens where the stakes are very low.”
For doctors, attempting new communicative approaches in this backdrop is safer than during real-life scenarios. And for actors, the experience is extremely rewarding.
“To me, it’s one of the most important things I could do as a human being, to help these doctors and other populations,” Grodin said.
“In a way, I feel that I am doing a service to the profession and to the patients as well,” added Tannenbaum.
Working with standardized patients can be “fun,” said Jacob Brent, a third-year medical student at the University of Pittsburgh Medical School.
“That was our first experience with human beings. It was an opportunity to learn the skills to interact with people about vulnerable topics and sensitive topics.”
Around 90 percent of the time, the situations are believable, claimed both Brent and Schuster.
Problems arise, however, when credibility comes into play.
“If you don’t buy into the story it becomes a little ridiculous or surreal,” he said.
“They can tell you that you weren’t empathic [or] didn’t seem invested in my pain, and [you’re] like, ‘I’m really tired and you’re not really sick.’”
For an optimal outcome all parties must agree to the conditions. Often, this leads the group to darker corners.
The sessions done at Children’s Hospital “are I think the most difficult,” said Tannenbaum. Those cases largely involve the death of children and require a physician or intern to deliver “the bad news.”
“It’s so emotional, and if you are going to portray it realistically, you have to go there every time.”
Logistically, this means that an actor must reprise the role “over and over again,” throughout the day with different groups of trainees.
Couple the repetitiveness with real-life triggers and the act easily intensifies.
“I had to play a case where my father was dying shortly after my own father was dying,” recalled Grodin.
“Every time, before I went into the room for the simulation, I looked at a picture of my dad who had just died in hospice two weeks earlier, and I would say, ‘This is for you Daddy.’”
Grodin kept the role for the next several years. It was only after she took over the simulation business that she had once worked for that she finally gave the part up.
These days, as owner of Grodin Professional Simulators, Grodin largely serves as a coordinator, however, times arise where a substitute is needed, like recently when one of her actors got the stomach flu.
“Sometimes real life happens,” she remarked.
As an actor, adopting these roles has been “worthwhile, interesting and challenging,” said Tannenbaum.
The enterprise is “strange, it’s not for everybody, but I think it’s fascinating,” Grodin added.
“It’s a serious acting genre,” agreed Schuster, “but I think the most important thing to me is the value it gives to medical education that people don’t get from anything else. People can get into really toxic patterns of communication that don’t work.”
Adam Reinherz can be reached at firstname.lastname@example.org.