Standardized Patient Program at Washington University School of Medicine
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Welcome to the Washington University St. Louis Immersive Learning Center page! In this safe practice environment, medical students hone their clinical skills.
Committed to helping medical students become better doctors, nearly 70 local professional actors work as standardized patients (SPs) at Washington University School of Medicine. They portray real patients, and repeatedly subject themselves to physical exam by inexperienced hands. Through this immersive program that builds in complexity over four years, students undergo a stunning transformation. H
ere, they learn to get comfortable touching and examining patients, taking histories, asking personal questions and writing notes. By the program’s conclusion, the students will have practiced delivering a terminal diagnosis. As the process unfolds, students learn more about who they are as individuals and how they can better connect with their future patients. In a benefit not afforded in the real world, SPs are trained to critique the students’ techniques — breaking character after a simulation and telling them exactly what it felt like to be their patient. Program organizers say, in the real world, most people “vote with their feet”: If displeased with a doctor’s lack of attentiveness or communication, they simply won’t come back or won’t follow health recommendations.“Patients today tell us, ‘I want you to be a good diagnostician and practice evidence-based medicine, but that’s not sufficient. I also want you to be able to talk to me,’” said Dehra A. Glueck, MD, assistant professor of psychiatry and medical director of the Standardized Patient Program. Glueck also served on a communications skills task force for the National Board of Medical Examiners. The initial, one-on-one standardized patient encounter happens early in the first year. The student must suspend disbelief, read the door note, knock and enter. A standardized patient, already in character, awaits. The challenge: ask the right questions, keep the patient on topic, gather information, respond to concerns and be empathic.
“This is about being fully present in the moment,” said Jamie Pitt, Standardized Patient Program coordinator. As with real practitioners, these doctors-to-be must put personal difficulties aside. Regardless of whether students are having a bad day, or if someone cut them off in the parking lot, it all becomes secondary to patients’ needs. “This changed my idea of what it means to learn to be a doctor,” said first-year student Giuseppe D’Amelio. “When we practice on each other, we’re just going through the motions. It’s very different when you don’t know what they (the patients) are going to say.”
Lack of confidence is a common problem, as is talking about highly personal subjects. As first-year student Jared Goodman explains: “Unlike any other conversation you’ve had in your life, you realize that every sensitive detail comes out in the first five minutes.”
From bowel movements to sexual behavior, all topics are open for discussion. “Up until now, social conditioning taught students not to talk about these things,” Glueck said. “They’re not always sure what words to use. That’s where we come in.”
Through video playback, students critically assess themselves, quickly realizing how often they say “um,” fidget, click their pens or look down at the floor. With input from faculty mentors, students go right back in, adjust the approach and try it again. Individualized attention is the program’s hallmark. In a word, most students describe those early experiences as “terrifying”; many walk into the simulated exam room, nervous and trembling, not exactly sure what to do. Clipboards are dropped. Hand sanitizer squirts across the room. Just a month before, these students were college kids. Now, they must face a patient — albeit, pretend — and appear “doctorly.”
The SPs are ready: They’ve memorized symptoms, medication dosages, family medical history and work-life balance. Together, Glueck, who enjoys screenwriting, and Pitt, who acts with local and national theater companies, have found their calling. The pair researches and develops a wide range of realistic scripts, complete with backstories, costume and props. Actors are carefully coached and scripts are rehearsed extensively. Despite thoughtful scriptwriting, the actors never know exactly what a student will ask. The job requires intense concentration. At times, SPs are interviewed by up to 10 students in succession.
“It’s not about an Oscar-award-winning performance,” Pitt said. “It’s about a consistent, reliable portrayal of symptoms. In our auditions, we look for people who have experience providing honest, constructive feedback without any medical biases.”
“You had a good demeanor,” a veteran SP told one student. “I think our rapport derailed a bit when I asked you a question and you didn’t know the answer. It’s always fair to say, ‘I don’t know. Let me research that and get back to you.’ I would have been floundering a bit, had I left the office without a solid understanding of the next steps I should take with my child.”
In one small-group session, a student decided his peers were “dancing around the subject too much.” He went into the exam room and flatly told the SP, “You’ve got cancer.” The SP burst into tears.
“The actors respond exactly to what’s in front of them,” Glueck said. “And this dramatically changes what a student can learn. In the student’s second attempt, he gave the diagnosis and met the patient where she was, rather than thinking he knew how it should be done.”
St. Louis’ large professional acting community offers expertise and versatility. “It’s an absolute dream to play someone else and see if it’s believable,” said one SP, a professional actor, director and producer who also trained at Second City. “I have to step outside of myself, remain neutral and think about how this other person would respond. Certainly, it’s less random than improv, but it still requires spontaneity. It’s where art and science meet.” Program facilitators design simulated cases that reflect the region’s actual patient population, deriving input from clinical faculty, and building in elements of religious, ethnic and economic diversity. They strive to promote the use of appropriate, inclusive language and create scenarios that may be outside of the students’ comfort zone, such as a same-sex couple seeking treatment for an adopted child. The students are given a host of increasingly difficult scenarios each year. In their second year, students simulate an evolving physician-patient relationship by visiting the same SP multiple times. Third-year students participate in specialized SP encounters during rotating clerkships.
“The idea is that the more robust you make the practice environment, the more powerful and richer the insights,” Glueck said.
“Students bring innate abilities of varying degrees,” added Alan I. Glass, MD, assistant vice chancellor and director of Habif Health & Wellness Center. As a clinical skills section leader for first- and second-year students, Glass works closely with the SP program.
“For some students, it’s very easy,” Glass said. “For others — like in any subject — it takes more effort. We can teach them skills to be more effective.”
Glueck cautions, however, it’s not about making students all the same. It’s about helping students discover their individual styles so they can communicate in a way that feels natural and genuine.
“Over the course of time, we have a record of multiple patient encounters, and footage of them interacting with different people,” Glueck said. “We use this to see where students are struggling and translate this into actionable steps we can work on together so they can become the kind of doctor they want to be.”
Having gone through the entire SP program, fourth-year student Phillip McGuiness feels he is ready to face the real thing. “Much of the mental acrobatics, the awkwardness, is gone. The standardized patients just take it all in stride. These professionals have played a big part in making me a more efficient, compassionate doctor.”
“Some will say SPs don’t make up for real patients, which is true. Our students still round on hospital patients, but this gives them a focused, observed opportunity to practice. Self-assessment is critical to lifelong learning.”— Alison Whelan, MD, senior associate dean for education at the medical school. For many medical school alumni, fellow classmates were the first “standardized patients.” “We learned physical exam skills on each other,” said Whelan. “There was no instruction on communication. Over time, the medical community has realized that body language does matter — how you sit, how you look at a patient, how you acknowledge what they are saying.”
Nationally, medical schools are paying more attention to so-called “soft” skills and adding standardized patient programs into their curriculums. In 2004, the National Board of Medical Examiners added the Step 2 Clinical Skills component, a pass/fail test that is one of three steps students must complete before applying for a medical license. In Step 2, fourth-year medical students travel to a testing center and assess 12 standardized patients over eight hours, with 15 minutes for each encounter and 10 minutes to record each patient note. Prior to taking Step 2, Washington University requires students to complete an in-house Clinical Competency Exam — in which they must evaluate six standardized patients in a day. Not all medical schools offer this preparatory advantage for Step 2, the results of which factor into the residency match.
“The Washington University directors have developed novel approaches that serve as a fantastic model for those of us around the country teaching communication skills to our students,” said Lisa Bernstein, MD, FACP, associate professor of medicine and director of Becoming a Doctor curriculum at Emory University School of Medicine. Bernstein also served on an NBME communication skills task force.
08/02/2023
It is my great pleasure to introduce you to Jan Bruns-Mantovani, our SP Spotlight for this week!
Jan has been a stellar member of the SP Program at Washington University School of Medicine for the past two years. She looks forward to the interactions with her fellow SPs and the faculty and especially enjoys working with the amazing students in Wash U's School of Med. Jan's favorite part of an encounter is when she has the opportunity for face-to-face feedback with a student. She says that it's incredibly rewarding when she feels that the student has walked away with information they may find helpful for a lifetime. After spending more than 20 years on-stage in local theatre, and working for 25 years in children’s healthcare, Jan relishes the opportunity to bring her acting skills and healthcare experience together in this way. Her hope is that her interactions with the students will assist them in learning to communicate more effectively and support their understanding of the patient’s perspectives of illness.
Through the years, Jan has had many proud moments on stage (most recently as Sonia in Vanya and Sonia and Masha and Spike); however, she feels the production she is most proud of, is the role she has played in the blended family she and her husband have created. Between them, they have three beautiful children and six amazing grandchildren. The love and respect they all have for one another brings her the most joy.
07/19/2023
This week we are thrilled to feature Steve Wozniak in our SP Spotlight!
Steve grew up in northeastern Pennsylvania where he participated in school theatre productions, the men’s chorus, and took accordion lessons. Following high school graduation, he attended Penn State where he received a BS Degree, and then moved to Philadelphia where he started a 43-year career in Commercial Insurance. While living in Philadelphia, he met his lovely wife (celebrating their 50th wedding anniversary this year!). Steve's career eventually took him to the Midwest (Chicago, Kansas City, St.Louis). While in Chicago he received his MBA from DePaul University and upon returning to St. Louis, he revisited his acting roots with improv, street performance, MC work, modeling, and even pulled his accordion out of the closet. Steve recently completed 21 years as a character/street actor for St. Charles Christmas Traditions and Legends and Lanterns holiday festivals and was recently featured in a documentary about these festivals. When not working as an SP, Steve and his wife enjoy spending time with their adopted Weimaraner named Wolfgang.
Steve has participated as an SP for nearly 23 years. His first assignment was at SLU Med where he worked on the beta testing project for the development of student encounters that then became a part of the National Boards. Most recently he was involved in interactive training/group discussions on the important topics of depression and su***de and communicating with patients who are dealing with end-of-life situations. Steve feels that SP work is extremely rewarding and has enjoyed being a part of the Wash U School of Medicine for over 13 years.
05/16/2023
This week we celebrate actor and educator, Rachel Bailey, in our SP Spotlight. Rachel has been with our SP Program for over three years and has helped hundreds of Wash U med students to become the best doctors of tomorrow!
Rachel is an actor, teaching artist, crafter, and devoted dog mom. Some of her favorite recent credits include Triassic Parq (Stray Dog Theatre), Gremlins: A Live Parody (Cherokee Street Theater), and Macbeth (R-S Theatrics). Outside the theater, Rachel can be found writing original cabarets, teaching at the Missouri History Museum, knitting, reading heavy books, photographing her dog, and drinking too much coffee.
When asked what her favorite thing is about being an SP, Rachel replied “I love focusing on communication and empathy skills that can be learned, improved, and added to the student’s toolbox for providing care to all sorts of patients.”
What’s up next for Rachel? She has been working on custom artwork and photography projects (available at www.rachelbaileycreates.com) and is currently in rehearsals for Vampire Le****ns of S***m and soon Godspell, both at Stray Dog Theatre this summer!
05/08/2023
It is my great pleasure to introduce you to Deborah Dennert, our SP Spotlight for the week of May 8th. Our center is grateful for her time and expertise over these past 12 years (and counting!).
Deborah worked most of her early adult life as a paralegal. One of her areas of expertise was in the litigation of medical malpractice, pharmaceutical, and wrongful death cases. This gave her experience in researching how the practice of medicine is related to communication and the importance of a good working relationship between patient and doctor. During this time, she was looking for a creative outlet to relieve her stress in working in the fast-paced world of litigation, so she decided to audition for a theatrical role, got bitten by the acting bug, and has been doing it ever since.
She’s always been an advocate of education and health, which is why she later became certified to teach fitness classes encompassing exercise and indoor cycling. Additionally, she has volunteered as a reading tutor for students in St. Louis public schools as well as tutoring people who have moved to the U.S. and helping them to study for their citizenship test. She has enjoyed keeping herself fully occupied within the educational and creative realm and acting was always fun, so it seemed logical to become a standardized patient. For over a dozen years, she has enjoyed interacting with medical students as well as doctors, trainers, and fellow actors/standardized patients.
Deborah appreciates the training that WUSM and the standardized patient program have given her and the experiences of interacting with the bright young minds of tomorrow. She enjoys guiding students through feedback to encourage them to think about how their words and actions all contribute to their future careers. It is rewarding to think standardized patients have a small part in influencing tomorrow’s doctors, nurses, and medical staff for a better healthcare system.
05/01/2023
Happy Monday! This week's SP Spotlight focuses on a fantastic SP and well-known actress that has been with our center for nearly three years, Meme Wolff!
Meme has had a versatile career working in many areas of “show business”. Her work in radio includes stints at KLOU and KTRS as a morning drive and midday cohost, as well as news anchor and public service shows. She served as a station announcer on local television at both KETC and KSDK. Her theatre experience extends to stages across the US and in Canada and her on-camera work encompasses multiple commercial and corporate clients, as well as independent films. She is the Executive Director of Tallbroad Media Services, offering video editing for specialty clients, and most recently completed a project for the Italian Club of St. Louis.
At Wash U, Meme enjoys the opportunity to portray various patients and the challenge of interacting with the students. Although sometimes intimidated by the proper pronunciation of medications, she believes the encounters keep her skills sharpened and enjoys it when the sessions call for face-to-face discussions with the students.
Despite being semi-retired, Meme is still working in the business while taking time out for some fun. Travel is high on her to-do list having not long ago returned from London and Paris and looks forward to broadening her horizons in the near future. She recently completed an acting project for the Veterans’ Administration playing a role she felt very comfortable with…a patient!
04/20/2023
Our SP Spotlight this week focuses on the amazing and multi-talented Amy Kelly. Amy has been with our SP Center for over a dozen years. Her extremely creative brain and ability to think quickly on her feet, help to keep our sessions running smoothly at Wash U.
Amy feels that performing patient cases for med students has been a fulfilling practical way to utilize her Bachelor of Fine Arts degree from MSU in order to contribute to the greater good. For the past couple of years, Amy has primarily worked as an Event Assistant helping to run exams, though occasionally you can see her sporting an SP gown if the need arises. She is married to St. Louis actor and goofball Nick Kelly and is currently balancing a busy life of other odd jobs, motherhood, and creative pursuits. She has performed locally in St. Louis with several professional companies and dabbled in costume design, prop crafting, and puppetry. She owns three hot glue guns but can still never seem to find one when she needs it. She’ll happily warn you not to ask about her cats unless you’ve got some time to spare.
04/13/2023
It is with great enthusiasm that I introduce you to our SP Spotlight of the week, Ryan Lawson-Maeske. Ryan is celebrating 4 years with our program!
Ryan is a St. Louis-based theatre artist that is extremely grateful for the many opportunities this city has to offer. Originally from New Mexico, he made his way to St. Louis for school and graduated from Saint Louis University in 2017 with his Bachelor of Arts in Theatre and Communication. As an actor and fight choreographer, Ryan has had the privilege to work with such companies as Metro Theater Company, the Black Rep, The New Jewish Theatre, SATE, Cherokee Street Theater Company, and Shakespeare Festival St. Louis, amongst others. He proudly received three St. Louis Theater Circle Award nominations over the past few years, all for acting. Additionally, Ryan enjoys serving and bartending at The Fountain on Locust.
Shortly after graduating college, he got involved with the SP Program. At Wash U he performs a variety of roles as an SP from communication fishbowl sessions to an ultrasound model, to resident remediation cases, and more. The students, faculty, and staff often comment about how realistic his portrayals are and how approachable and helpful he is in feedback sessions. His favorite part about working as an SP is that he finds it a nice amalgam of scripted work and improvisation, all the while admiring the humanity, care, and tact the medical students bring to the table.
Upcoming projects this summer include Clash of the Titans: A Live Parody with Cherokee Street Theater (www.cherokeestreettheatercompany.com) and The Sound Inside with Moonstone Theatre Company (www.moonstonetheatrecompany.com).
04/06/2023
Introducing you to this week's SP Spotlight, Chrissie Watkins, is a pleasure. Chrissie has been with our program for nearly two years and is one of the kindest humans I've ever met.
Chrissie is a blooming actress in the Midwest. She always strives to expand her horizons within the theatre and film industry. Her work in Sylvia as the title role was recognized with a Theatre Mask Award for Outstanding Leading Actress in a Comedy. In the production It Is Magic, she received a nomination for Best Supporting Actress in a Comedy as well as a win for her ensemble work. Chrissie has also starred in several short films and commercial projects while also writing and producing a few projects of her own. You can catch her next in the films The Company You Keep and Pitiful, Lost Creature. You’ll see her next on stage at a special one-night show entitled Powell Hall Playlist with St. Louis Symphony Orchestra on May 7th! Visit slso.org for more info!
When asked what she feels is the most rewarding aspect of being an SP, Chrissie replied: "What I like best about being an SP is helping future doctors to remember to show care. I’ve had medical issues especially when I was younger, and I remember loving my doctors because they were so kind and caring to me. As I’ve gotten older, I have had a couple of unsavory experiences. I hope and believe the work that we do will prevent future caregivers from neglecting the overall care of their patients."
Chrissie is most proud of "Going after tiny kid Chrissie’s dreams every day!"
03/31/2023
We're a little late in posting our SP Spotlight this week, but it's because we were waiting for the official green light from OAT so we could share some of her exciting news! See below for more info.
Sabra Sellers has been with the SP Program for over a decade and adores working with the staff (past and present), her fellow SPs, and students. A self-described music nerd, Sabra has been singing since forever and likes to arrange songs into three-part harmony and then force her sisters to sing with her. She loves folk music, plays the piano, guitar, pennywhistle, kazoo, and would love to learn the fiddle as well. Sabra holds a BFA in Musical Theatre. She is a proud member of Actor’s Equity Association and has been acting professionally since 2009. In addition to acting, Sabra is also a theatre educator and director. Her latest directing project (Addams Family, Spotlight Productions) received Best Performance Awards nominations from the Arts for Life Organization in every eligible category, including Best Musical Production and Best Director. When she’s not in rehearsal or at the SP center, Sabra spends her time with her beloved family. She loves binging all the latest shows with her partner and lecturing encouraging her 15yo son as he practices his trumpet.
“Being an SP is one of the most rewarding jobs I’ve ever had. I believe effective communication is the single most important skill a human can have. It encourages self-reflection and empathy while deepening relationships and understanding. I believe it can heal the world. It is my honor to be able to foster these values in our medical students, who are quite literally our future healers.”
Upcoming projects: Sabra will be spending the summer at Ozark Actors Theatre performing Sibella in A Gentleman’s Guide to Love and Murder, Dot in Sunday in the Park with George, and ALL the female roles in Ken Ludwig’s Baskerville. (Information on OATs Summer Season: https://www.ozarkactorstheatre.org/seasontickets )
(Photo: Sabra with her partner John, and their son Seamus)
03/23/2023
I am happy to introduce Pam Knobeloch, an extraordinary SP celebrating her seventh year with our program and our featured SP Spotlight for this week!
As an SP, Pam plays many roles in her life. Happily married for 41 years, the closest roles to her heart are wife, mother, and grandmother. For 25 years Pam was a junior high biology teacher, dean of students, and principal. She is drawn to teaching whether in a classroom, lab, SP room, garden, or kitchen. After retiring from public education eight years ago, Pam learned about the role of a standardized patient from a medical student in her family and immediately reached out to Washington University School of Medicine to find out more. For the past several years portraying patients, collaborating with fellow SPs, and assessing students to help them be the best doctors of tomorrow has brought her much fulfillment. She feels that face-to-face feedback with the students is the most gratifying facet of assessment. Highlighting a student's strengths and seeing them smile, especially if they lack confidence or are critical of their performance during the encounter, is one of the best rewards of being an SP.
When portraying a patient in a group or multi-disciplinary scenario, Pam works to imagine how that particular patient feels emotionally in response to the medical student's questions or comments. At times, while in character, she works with the faculty to evolve her character’s different emotional states: nervous, scared, or sometimes, just plain difficult. By varying her responses, she provides a unique learning experience for each student. This way, all of the students see a variety of how the same scenario could play out which leads to a great, collaborative discussion afterward.
03/16/2023
Happy Thursday! It is a great pleasure to introduce you to a tremendous professional actor and SP that has been with our program for over seven years, Rae Davis, our SP Spotlight for this week!
Rae is originally from Kansas City. She likes food, art, and sleep. (She is not a cat, though she has been told that her attitude is similar to one.)
She feels that the best thing about being an SP is the ability to help correct biases that have plagued the medical field for years. Through mock exams and the face-to-face feedback that follows, it gives an opportunity to the student to have a conversation with the SP and learn how it felt to be a patient under their care. Additionally, she feels that it's a great challenge to bring so many different patient portrayals to life as real humans and just not a case on the page.
Rae recently appeared in the play “Feminine Energy” with Mustard Seed Theatre. This important work centered around black women and their experiences with the healthcare system while dealing with gynecological issues. It delved deep into how the process of receiving a diagnosis, treatment, bedside manner, and bias can come into play when black women receive medical assistance. Her portrayal and the work itself received numerous glowing reviews from critics.
You can see Rae in these upcoming projects with the St. Louis Shakespeare Festival
Confluence Reading: Dogs - April 15 @ 7pm
Tour Co: Merry Wives - August 2023
Find out more about both projects here: https://stlshakes.org/
08/02/2023
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03/31/2023
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03/16/2023