Stars of the show: Standardized patients bring simulated medical scenarios to life
At VCU’s Center for Human Simulation and Patient Safety, trained actors known as standardized patients help medical students practice both clinical and communication skills.
Claire Whelen (left), a standardized patient at VCU's Center of Human Simulation and Patient Safety, interacts with a medical student during a clinical encounter. (Photo by Arda Athman)
SOM Series: Inside the Sim Center
This article is the second installment of a multi-piece series exploring VCU’s Center for Human Simulation and Patient Safety.
Maria Lewis sits in an exam room, checking her watch and fidgeting as she waits by herself. Her husband is out of town, and after an ultrasound appointment due to some minor spotting at home, she was sent across the hall to see the OB-GYN. When a young woman in a white coat enters the room, she introduces herself, consults her clipboard and asks Lewis a series of questions about her health history and how she’s feeling.
After a few minutes of chatter, the doctor looks the patient in the eye and says in a calm, steady voice: “I have some unexpected news.” Lewis’s pregnancy, eight weeks along, is no longer viable. Lewis’s eyes immediately widen and fill with tears. She nods along as the expert in front of her lays out the next steps and explains, with a blend of empathy and professionalism, the pros and cons of each treatment option.
As they wrap up the appointment, a female voice announces over the loudspeaker: “This simulation has ended. Please begin feedback.”
Claire Whelen, a professional actor portraying the part of the patient, breaks character and smiles encouragingly at the person in front of her — a third-year medical student. They discuss the student's communication choices in delivering the difficult news and her ability to convey all the necessary information, with both clinical accuracy and compassion, within the 20-minute period. Whelen fills out a form to document her observations, then waves goodbye and resets the room for the next student. Retaking her seat on the swivel chair, she is once again 28-year-old Maria Lewis, an elementary school teacher who is about to find out that she has had a miscarriage.
“Maria Lewis lives in my bones at this point,” said Whelen, who has played out iterations of this scene dozens of times over the past three years. “We have certain lines of dialog that we have to hit, but we also kind of improvise based on what the student says and does.”
Whelen is one of about 40 standardized patients, or SPs — trained actors who simulate realistic clinical scenarios for current and future physicians to practice and assess their skills — who work at VCU’s Center for Human Simulation and Patient Safety. SPs are at the forefront of the M.D. program’s clinical training, often providing medical students with their first ever clinical encounters. They are part of a robust, collaborative system that helps future doctors develop the bedside manner and communication skills they need to treat real patients.
According to Aaron Anderson, Ph.D., a professional actor and founding director of VCU’s standardized patient program, taking on the role of an SP is unlike any other acting job.
“They don’t do this for the money, and I know this to be true because I trained most of them,” said Anderson, who is also a professor and associate chair in the Department of Theatre at the VCU School of the Arts. “They do this because being a standardized patient is the most straightforward, uplifting, purely good thing, with no ambiguity. If you do this right, you will make the world a better place. That’s your job.”
‘What you practice is what you will practice’
As students progress through the M.D. program, their encounters with SPs become more complex. According to Stacie Rearden Hall, manager of the standardized patient program and a longtime theater performer, during the first couple of workshops with first-year medical students, SPs may break character as needed. This allows them to point out what they notice in real time and encourage the students to try a different approach, like pressing harder during an abdominal palpation. But after those first few sessions, both the SPs and the students are expected to stick it out until the end of the scene.
Students practice taking patient histories and performing physical exams, and depending on the learning objective of the day, SPs may present with anything from kidney stones to a muscular disorder. SPs evaluate the students not only on clinical skills, but also their ability to communicate effectively, often in sensitive scenarios such as interacting with a patient during a psychiatric episode, delivering a cancer diagnosis or declaring a brain death.
"The actual result we want is for patients to feel safe to come back for a second appointment,” Hall said. “When patients feel safe, they reveal more information, get better diagnoses and have better outcomes overall.”
Studies show that simulation-based training results in better patient outcomes, fewer malpractice lawsuits and better patient-provider relationships. For Whelen, who has worked as an SP since 2022, this direct translation to future clinical care is what makes the long hours and emotional toll worth the effort.
“I have had students share that they are having trouble taking it seriously, and I try to allow them to settle in and enjoy the experience for what it is,” Whelen said. “What you practice is what you will practice, so the more seriously you take it, the more you’re going to get out of it.”
For Guiliano Melki, an M4 and aspiring emergency medicine physician, SP encounters have had a lasting impact — he said he will never forget his first simulation during new student orientation. He described the SPs as “stellar at what they do,” and said some of his classmates have cried during simulations because the acting feels so real.
Melki said one of the greatest challenges in medicine is sitting in silence with another person after delivering difficult news. It can be unnatural and awkward, he said, but being uncomfortable during a simulation is essential in preparing for real patient encounters.
“How can I be empathetic and give them the facts without sounding robotic, but also not give them false hope?” Melki said. “It’s about learning to empathize with someone you may be meeting for the first time. Every patient we will see is going to be different and react differently, but I think our training with SPs really accounts for that.”
Whelen, who started working as an SP when Melki was an M1, said watching students’ growth over the years is one of the most rewarding aspects of the job. By their third year, she said, students are often more comfortable “bringing themselves into the exam room” and speaking to patients not just as an educated figure of authority, but as a person.
“M3s do some pretty intense, formative events with us, so the stakes are higher for them,” Whelen said. “To see them work through the kinks in real time is really gratifying. You can see them realizing that they do, in fact, have the communication skillset to handle a difficult interaction.”
Setting the stage
Much like rehearsals for an acting gig, SPs receive extensive, behind-the-scenes training before they get in front of a student. And they do more than simply practice their lines — SPs work with program leaders to review each case’s learning objectives, performance expectations and assessment criteria. David Sennett, an SP of nearly 14 years who has worked for multiple organizations, said that in his experience, this level of preparation is unmatched.
“Nobody trains as efficiently and effectively as VCU,” said Sennett, who now helps teach SPs at other institutions. “They don’t just train SPs on specific cases, but within the overall context of getting a medical education."
Sennett, a former theater actor and director, initially pursued SP work hoping it would be fun — “I’m not good at doing things that aren’t,” he said. But it wasn’t long before he realized there was something more substantive to these scenarios. After his first ever simulation role — a chest pain case, which he still plays to this day — he began to see what the team behind the program already knew: that theater tools and skills could have a profound impact on the way future doctors connect with and treat real patients.
“It was really great fun to get into character and do the role, and I saw immediately what value it was to the medical students,” Sennett said. “It helps them practice and use empathy and active listening skills, the sort of things that many doctors could benefit from doing more of.”
The desire to help physicians enhance their empathy and listening skills was where it all began 20 years ago. Using his years of theater training in active listening and improvisation, Aaron Anderson, Ph.D., teamed up with School of Medicine faculty to develop communication workshops for house staff. Those sessions eventually became VCU’s standardized patient program in 2010.
Fifteen years later, Anderson still loves helping the SPs prepare for their jobs and is happy to step in as needed in simulations. He never passes up an opportunity to tell people about the work of the Sim Center and credits the program’s success to the power of interdisciplinary work.
“Years ago, we started asking whether we could use theater skills to teach bedside manner,” Anderson said. “Now, we've built this structure so that one group of experts can use their skills to help another group of experts, in a completely different field, to use their own skills. And together, they make the world better."
The next installment of Inside the Sim Center will highlight the experiences of students during various stages of their training.
Send us your stories!
The School of Medicine communications team is always looking to highlight student success, faculty achievement, cutting-edge research and innovative initiatives around the MCV Campus. If you have an idea for a story, please submit your pitch to laura.ingles@vcuhealth.org.
SOM Series: Inside the Sim Center
This article is the second installment of a multi-piece series exploring VCU’s Center for Human Simulation and Patient Safety.
Maria Lewis sits in an exam room, checking her watch and fidgeting as she waits by herself. Her husband is out of town, and after an ultrasound appointment due to some minor spotting at home, she was sent across the hall to see the OB-GYN. When a young woman in a white coat enters the room, she introduces herself, consults her clipboard and asks Lewis a series of questions about her health history and how she’s feeling.
After a few minutes of chatter, the doctor looks the patient in the eye and says in a calm, steady voice: “I have some unexpected news.” Lewis’s pregnancy, eight weeks along, is no longer viable. Lewis’s eyes immediately widen and fill with tears. She nods along as the expert in front of her lays out the next steps and explains, with a blend of empathy and professionalism, the pros and cons of each treatment option.
As they wrap up the appointment, a female voice announces over the loudspeaker: “This simulation has ended. Please begin feedback.”
Claire Whelen, a professional actor portraying the part of the patient, breaks character and smiles encouragingly at the person in front of her — a third-year medical student. They discuss the student's communication choices in delivering the difficult news and her ability to convey all the necessary information, with both clinical accuracy and compassion, within the 20-minute period. Whelen fills out a form to document her observations, then waves goodbye and resets the room for the next student. Retaking her seat on the swivel chair, she is once again 28-year-old Maria Lewis, an elementary school teacher who is about to find out that she has had a miscarriage.
“Maria Lewis lives in my bones at this point,” said Whelen, who has played out iterations of this scene dozens of times over the past three years. “We have certain lines of dialog that we have to hit, but we also kind of improvise based on what the student says and does.”
Whelen is one of about 40 standardized patients, or SPs — trained actors who simulate realistic clinical scenarios for current and future physicians to practice and assess their skills — who work at VCU’s Center for Human Simulation and Patient Safety. SPs are at the forefront of the M.D. program’s clinical training, often providing medical students with their first ever clinical encounters. They are part of a robust, collaborative system that helps future doctors develop the bedside manner and communication skills they need to treat real patients.
According to Aaron Anderson, Ph.D., a professional actor and founding director of VCU’s standardized patient program, taking on the role of an SP is unlike any other acting job.
“They don’t do this for the money, and I know this to be true because I trained most of them,” said Anderson, who is also a professor and associate chair in the Department of Theatre at the VCU School of the Arts. “They do this because being a standardized patient is the most straightforward, uplifting, purely good thing, with no ambiguity. If you do this right, you will make the world a better place. That’s your job.”
‘What you practice is what you will practice’
As students progress through the M.D. program, their encounters with SPs become more complex. According to Stacie Rearden Hall, manager of the standardized patient program and a longtime theater performer, during the first couple of workshops with first-year medical students, SPs may break character as needed. This allows them to point out what they notice in real time and encourage the students to try a different approach, like pressing harder during an abdominal palpation. But after those first few sessions, both the SPs and the students are expected to stick it out until the end of the scene.
Students practice taking patient histories and performing physical exams, and depending on the learning objective of the day, SPs may present with anything from kidney stones to a muscular disorder. SPs evaluate the students not only on clinical skills, but also their ability to communicate effectively, often in sensitive scenarios such as interacting with a patient during a psychiatric episode, delivering a cancer diagnosis or declaring a brain death.
"The actual result we want is for patients to feel safe to come back for a second appointment,” Hall said. “When patients feel safe, they reveal more information, get better diagnoses and have better outcomes overall.”
Studies show that simulation-based training results in better patient outcomes, fewer malpractice lawsuits and better patient-provider relationships. For Whelen, who has worked as an SP since 2022, this direct translation to future clinical care is what makes the long hours and emotional toll worth the effort.
“I have had students share that they are having trouble taking it seriously, and I try to allow them to settle in and enjoy the experience for what it is,” Whelen said. “What you practice is what you will practice, so the more seriously you take it, the more you’re going to get out of it.”
For Guiliano Melki, an M4 and aspiring emergency medicine physician, SP encounters have had a lasting impact — he said he will never forget his first simulation during new student orientation. He described the SPs as “stellar at what they do,” and said some of his classmates have cried during simulations because the acting feels so real.
Melki said one of the greatest challenges in medicine is sitting in silence with another person after delivering difficult news. It can be unnatural and awkward, he said, but being uncomfortable during a simulation is essential in preparing for real patient encounters.
“How can I be empathetic and give them the facts without sounding robotic, but also not give them false hope?” Melki said. “It’s about learning to empathize with someone you may be meeting for the first time. Every patient we will see is going to be different and react differently, but I think our training with SPs really accounts for that.”
Whelen, who started working as an SP when Melki was an M1, said watching students’ growth over the years is one of the most rewarding aspects of the job. By their third year, she said, students are often more comfortable “bringing themselves into the exam room” and speaking to patients not just as an educated figure of authority, but as a person.
“M3s do some pretty intense, formative events with us, so the stakes are higher for them,” Whelen said. “To see them work through the kinks in real time is really gratifying. You can see them realizing that they do, in fact, have the communication skillset to handle a difficult interaction.”
Setting the stage
Much like rehearsals for an acting gig, SPs receive extensive, behind-the-scenes training before they get in front of a student. And they do more than simply practice their lines — SPs work with program leaders to review each case’s learning objectives, performance expectations and assessment criteria. David Sennett, an SP of nearly 14 years who has worked for multiple organizations, said that in his experience, this level of preparation is unmatched.
“Nobody trains as efficiently and effectively as VCU,” said Sennett, who now helps teach SPs at other institutions. “They don’t just train SPs on specific cases, but within the overall context of getting a medical education."
Sennett, a former theater actor and director, initially pursued SP work hoping it would be fun — “I’m not good at doing things that aren’t,” he said. But it wasn’t long before he realized there was something more substantive to these scenarios. After his first ever simulation role — a chest pain case, which he still plays to this day — he began to see what the team behind the program already knew: that theater tools and skills could have a profound impact on the way future doctors connect with and treat real patients.
“It was really great fun to get into character and do the role, and I saw immediately what value it was to the medical students,” Sennett said. “It helps them practice and use empathy and active listening skills, the sort of things that many doctors could benefit from doing more of.”
The desire to help physicians enhance their empathy and listening skills was where it all began 20 years ago. Using his years of theater training in active listening and improvisation, Aaron Anderson, Ph.D., teamed up with School of Medicine faculty to develop communication workshops for house staff. Those sessions eventually became VCU’s standardized patient program in 2010.
Fifteen years later, Anderson still loves helping the SPs prepare for their jobs and is happy to step in as needed in simulations. He never passes up an opportunity to tell people about the work of the Sim Center and credits the program’s success to the power of interdisciplinary work.
“Years ago, we started asking whether we could use theater skills to teach bedside manner,” Anderson said. “Now, we've built this structure so that one group of experts can use their skills to help another group of experts, in a completely different field, to use their own skills. And together, they make the world better."
The next installment of Inside the Sim Center will highlight the experiences of students during various stages of their training.
Send us your stories!
The School of Medicine communications team is always looking to highlight student success, faculty achievement, cutting-edge research and innovative initiatives around the MCV Campus. If you have an idea for a story, please submit your pitch to laura.ingles@vcuhealth.org.
Interested in being a standardized patient?
While many SPs have theater backgrounds, previous acting experience is not required. SPs employed by VCU, who represent a broad range of ages, ethnicities and genders, work on as as-needed basis, typically up to 29 hours per week.
