A handyman is replacing a window at a chiropractor's office. A woman working there suddenly hears a loud crash and a scream. She ushers the handyman into a treatment room, points to a shard of glass protruding from the man's arm and then faints, leaving the physician with two emergencies. This is not a typical situation for a chiropractic physician, and certainly more than what a chiropractic intern expects to encounter.
However, that's exactly what is played out during one of the interactions between Los Angeles College of Chiropractic (LACC) students and "actors" assisting with the institution's Standardized Patient Program (SPP). Within the seventh of 10 terms, they test students for two days, duplicating a range of emergency symptoms: an asthma attack; heart attack; stroke; fainting spell; and impalement by a piece of glass.
Peers and professors watch closely to see how the student handles the two patients. For the handyman, the doctor needs to stabilize the wound and seek emergency assistance while making sure the office worker has simply fainted or is showing symptoms of something far more complex.
"Granted, these aren't the kind of situations a chiropractic physicians are likely to face," says Nancy Gour, RN, program coordinator, "but today's practitioner must be prepared for anything. As the chiropractic profession continues to improve its relationship with other medical disciplines, more and more people are turning to their chiropractic provider for primary care." Gour believes that this training prepares LACC students for a myriad of potential interactions, including urgent care.
Gour points out that traditional chiropractic education is based on lectures and laboratory instruction, with practical clinical experience, such as patient relationships, emphasized during the final stages of curriculum. "In that kind of setting," she says, "chiropractic interns face real-patient encounters without the benefit of past interpersonal experience. The classroom and lab can give you sound treatment knowledge, but that's only a part of being a good doctor."
This training was specifically developed to help LACC students make the transition to intern status. Before the students are assigned to work in one of the college's three public health centers, they must undergo the training. A different interaction is highlighted each term, focusing on a skill integral to positive patient/physician outcomes.
Actors in the roles of patients are used throughout the program, which covers history-taking; psychological disorders; patient examinations; orthopedics/neurology; telephone communications; geriatric care, among others. Development of specific scenarios usually begins with actual case histories to compare real and student-related experiences.
"Our patients are selected, coached and trained by the faculty to make sure the condition presented is as authentic as possible," explained Gour. "And, as in the case of the injured handyman, makeup professionals are brought in to assist in the illusion, enhancing the interaction for both patient and student."
Many of the LACC program's "patients" are stage, commercial and film actors, and local residents that have been involved in previous standardized patient presentations. "Once they've been a part of the program, they're usually hooked," Gour observes. "It doesn't take long to realize that you are having a dramatic impact on a student's life as well as making him or her a better chiropractic physician. We've been blessed with participants who are not only good at what they do, but do it with such dedication and enthusiasm."
During the emergency scenarios, students are videotaped, then critiqued by their peers and professors. During one-to-one sessions with patients, students work in teams of four, each taking a turn acting as the consulting physician. This gives each student the opportunity to participate directly with a patient and to watch three other interactions with their classmates.
The greatest satisfaction of the program (implemented nearly 10 years ago) is how well it's received by the students.
"The program is an invaluable part of the LACC experience," assessed third-term student Josette Addarich.
"I can't begin to express how exciting it is to sit in front of a patient and finally listen with the ears of a doctor," explained Craig Manning, a ninth-term intern. "I feel I will be a better doctor because of the program. It's one of the real strong points of the college."
Angela Davidson, in her eighth term, comments: "The program has given me exposure to interesting and difficult situations, stimulating the thought process about how to handle them before they arise in the real world. With a standardized patient, the only thing at stake is my pride and, perhaps, a grade. Invariably, I find myself leaving a standardized patient encounter thinking 'The next time I'm in that situation, I'll be able to manage it more effectively by doing this or that differently.' It's that thought process which will make me a better prepared doctor when the patients are real."
Michael Nash
Director of Communications
Los Angeles College of Chiropractic
Whittier, California
