A key facet of the IHP education is the Institute’s use of Simulated Participants – people who typically play the part of someone with a condition, disease, or ailment; sometimes, they also portray family members, caregivers and healthcare workers.  The idea is to provide student a real-world, real-time experience that will help prepare graduates for their future careers. Most Simulated Participants (SPs) are actors, some are retirees from various professions including healthcare, and some are students themselves (from other institutions).

All IHP programs utilize Simulated Participants in some capacity. In fact, Mass General Brigham groups such as Emergency Medicine and the Brigham and Women’s Hospital Nursing Department use IHP SPs for training programs. Formally established in 2018, the SP program has a roster of 70 actors.

One of those actors is Diane Lopes, who has been an SP for five years. Previously in the law and real estate field, Lopes stumbled upon the opportunity after talking to a friend who shared her own experience as an SP. Lopes tried it and has never looked back.

In this month’s “IHP Interview,” Lopes provides a closer look at what being a Simulated Participant is all about. Our conversation has been edited for brevity and clarity.

Being a Simulated Participant is more than just showing up. There’s considerable preparation involved on your end before you even come to campus. Talk about that.

You’re right, and some patient roles we simulated require more prep than others. The people in charge of the program will send a scenario of what the case is going to be, the name of the patient you’re going to play, date of birth. what your issue is, why you're coming in. I won’t receive a script per se but rather, an outline that the student might be following and some responses that you might have. I can look up extra information about the disease or condition if I want to know more about it. In the end, it’s really making sure you know the information so that you can give that information accurately to the student.

It seems like there’s a fair amount of pressure to make sure you play your part just right.

And that's why you practice ahead of time - you do really have to be prepared. If it's physical therapy, then it's more that they're working motions on you. So, there's not a lot you have to prepare for, but I played someone who was paralyzed, so you have to work to give the students that realistic view of having somebody that really can't move.

The people in charge of the program are really good because when we come in in the morning, there's time to meet; they’ll give us information and go over any questions I have. A physical therapy case that we had a couple of weeks ago, they showed us what the student may do to test our muscles to give you an idea of what to do; maybe don't raise your arm fully, bend it this way or something just to give the student something that they can look at, and actually get a real feel of what that person's going through.

When you’re talking with the student during the examination, can you see the teaching going on? Can you see the lightbulb turn on when they connect the dots?

Yes. The program leaders want to give certain information, but not too much information because they want the student to be assess this situation and think outside of the box. So, the program leaders might throw a few little things in there that would throw the students off so that they don’t go directly to what the diagnosis might be. Today, for instance, the student took a look and asked if I had a rash. I said I didn’t, but she looked on my shoulder and said, “You have a rash on your back” and now it's like, “OK, we know what this is” because they're looking at a couple of different pieces of information. And then it's putting it all together and watching them give their differential - what they think it might be. It's great. I love it.

What’s your favorite role to play?

I do really like them all. I have learned so much about the medical field that I feel like I went to school.

What has been your most difficult role to play?

I would one of the most difficult was a person who came in with a cough because it was then determined that there was a mass on the lung, and the student didn’t know what to expect. There’s the X ray and they're looking at this and they have to tell you what they found. So, that was tough because you're watching their reactions of now having to deliver bad news: “We found something on your lung.” For my part, I can either play the part of someone now in denial, or become angry or say, “I think you made a mistake, you must have mixed my X-ray up with someone else.” The student doesn’t know how you're going to respond, either.

How did you respond?

I played someone who was in shock, and I remember saying, “No, this can't be right. I just came in here because I had a cough. You have it wrong.” Once I accepted what had been discovered, I transitioned into someone who was overwhelmed like, “Are you kidding me? What are you saying?”

Not only are the student receiving feedback from the proctors in the room and program directors watching on the cameras, but you provide feedback as well. Talk about that.

Mostly it’s about how the student made me as a patient feel. Did the student understood the scenario and what was going on? Were they empathetic? Did they seem confident? Did they know the information? How do they portray the information? There's a 10-question form I fill out where I can indicate good, excellent, fair, etc. And then on the back we can provide a personal comment that says, “They were very empathetic, they made effective use of visual aids, they made me feel comfortable, and they made me feel very confident. I felt like I was being well-cared for, or they spoke too fast. I didn't really understand the medical terminology.” Feedback like that is helpful.

How often are you portraying patients?

It all depends on what the programs need. Today, for example, I have seven cases, so I’ll be here all day. Simulated Participants will get an email indicating the scenario and the kind of acting that is needed, the days and hours. Sometimes they're virtual assignments and sometimes it’s on campus. If it works with your schedule, then you put in for it and if selected, you'll get an email saying if you've been chosen for an assignment. Once you confirm your availability, they'll send you the information.

What keeps you coming back?

Simulated Participants are providing a realistic learning experience, which is incredibly valuable and important because there are a lot of physicians and personnel in the medical field who really don't know how to interact with people. So, this really teaches them how to interact with people in a realistic situation. Everything in the medical field today is based on time, crunching the numbers, and making a profit, especially with all the mergers and everything like that. So, I think it's important that whoever comes to see you, the patient feels comfortable. This is an excellent teaching method for that.

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