Our Simulated Patient Trainer and Facilitator, Daphne Franks, has many years of experience training Simulated Patients and knows what it takes to be a highly skilled and valued SP. We asked Daphne a question that people in the field of Simulated Patient work are often asked, in order to share her invaluable insight:
“But how can an actor know what a real patient feels?”
I was asked this often in my early years of Simulated Patient work, and I’m still asked it occasionally now. A well-known neurosurgeon, Henry Marsh, suggests something similar in his excellent book Do No Harm. He couldn’t understand how an actor’s feedback to a healthcare professional could be meaningful at all.
I have tremendous respect for him – – but I disagree with him on this.
Simulated Patient actors, firstly, have to have excellent emotional intelligence – the ability to understand other people’s feelings and their own. Also, when they are not acting, they have all, at some time, been “real patients” themselves and they understand that feeling of slight worry about some trivial ailment: or, in some cases, that feeling of blind terror that it might be something hideously life-threatening.
When working as a Simulated Patient in a teaching session, there are several things going on in your head at once.
Firstly, you are remembering the brief. Date of birth? Number of siblings? Past medical treatment? How much alcohol?
Secondly, you are thinking of the appropriate challenge for the level of learner. “He’s coped well with that – I’ll ask him something a bit trickier now.”
Thirdly, you are considering what feedback to give afterwards. “I wish he’d stop clicking his pen. It’s really annoying. How can I tell him tactfully?” or “Wow! When she looked at me like that and paused, I could tell she really understood how worried I am.”
And fourthly, you are feeling the feelings.
That’s the strange thing in roleplay. You react emotionally more or less as you would in real life. If the learner is empathic, you feel a rush of warmth towards them. You might even find tears welling in your eyes, even though you’re in role and you are still thinking of the brief, the level of challenge and the feedback.
If the learner doesn’t listen, it’s real anger you feel welling up inside you. Because, however, this interaction is for the benefit of the learner, you control it. Whereas in real life you might yell and leave the room, in a learning scenario you wouldn’t do that, because once you’ve gone, the learner loses any opportunity to “get it back” and do better.
The situation may be false, but the feelings are real. So I don’t ever believe the excuse that students occasionally make “Well I wouldn’t be like that with a real patient, it’s just because this isn’t real”.
If the Simulated Patient is doing his or her job well, the conversation will feel totally real to the student (or doctor, or nurse, or whoever the healthcare professional may be).
Trained, skilled Simulated Patients feel the feelings. Then, after the roleplay has finished, they can give supportive analysis of what has happened during it. They know how to phrase their feedback so it won’t make the student feel threatened. Finally, they know how to help to build the student’s confidence and techniques so that they will be well-equipped for their career working with “real patients”.
By Daphne Franks, Training & Development at Peel Roleplay