If you’ve seen the TV show “The Pitt” or any medical television drama, you know the actors have to get comfortable in hospital settings, know how to pronounce medical terms and understand the basics of handling hospital equipment.
It’s not unlike what’s required of the actors at the CAPE, short for the Center for Advancing Professional Excellence, at the University of Colorado Anschutz Medical Campus. These often-formally trained actors — known as “standardized patients” — play doctors, nurses, patients and family members in an array of scenarios that train and test medical providers and students.
In fact, the CAPE actors do on occasion compare their medical scenarios to those on shows like “The Pitt.”
“I always tell our medical students, if you want to know how to get through your scenarios, watch 'The Pitt,'” said Devra Keyes, the Simulation Education Project Coordinator at the CAPE. “That'll teach you everything you need to know here.”
Most students studying to become health professionals on the CU Anschutz campus are required to do some of their training at the CAPE. The Center also does mid-career professional development training and evaluations for medical professionals.
While many of the CAPE’s actors or standardized patients have had formal acting training, they also have to learn medical lingo and maintain some fundamental knowledge of medicine to do the job.
On a recent visit, Dennis VanderHouwen, a trained actor-turned-standardized patient who has been at the CAPE for nearly 30 years, was preparing for his role in about six labor and delivery scenarios, each more intense than the last.
The scenarios will be a series of tests for a real OBGYN, who was required to undergo the evaluation in order to get his license renewed. The CAPE staff doesn’t know the circumstances as they play out the tests. We are not disclosing the doctor’s name to protect his privacy.
The doctor enters what is designed to look like a typical hospital operating room. A manikin – a highly-advanced medical simulation system – that looks vaguely like a pregnant woman, is lying on a hospital bed.
“I'm going to be playing the father for each of the scenarios that he does with the manikin,” VanderHouwen explained. “So I'll be talking to the manikin as if she was my spouse or partner.”
When the OBGYN is called into the room, Vanderhouwen stands, holding the manikin’s hand and offering comforting words. A nurse, also an actor, tracks the patient’s status on several machines.
Devra Keyes, the program’s head and an actor or standardized patient herself, sits in an adjacent control room with a one-way glass window facing the room. She speaks through a microphone, acting out the voice of the manikin or laboring woman, named Michelle, for the first scenario.
“Doctor, I really feel like pushing,” Keyes says. “This is my second baby. Can I push?”
The manikin can accurately replicate the entire birthing process, including fetal delivery, hemorrhaging, seizures, and physiologic responses like pulses, heart rhythms, lung sounds, breathing, sweating, and bleeding. These capabilities are important, staff say, to ensure that the assessments and training closely mirror real clinical environments. In just a few minutes, the “baby” is successfully delivered. The doctor exits the room and waits to return for the next scenario.
When he is called to the room, the patient, Gabriella — whose voice is again played by Keyes — gets very agitated when the doctor tells her she needs a C-section.
“No, no, I don’t want a c-section!” Keyes tells the doctor in heavily accented English. “I want a natural birth.”
The doctor tells Gabriella that the procedure is necessary, and while there was no real-life C-section, he eventually pulls a doll — meant to be a baby — from the woman’s abdomen.
The doctor would undergo several more scenarios before the test was complete. Later, videos of the scenarios are sent to physicians for evaluation to determine next steps.
That same day, the CAPE was also training physician assistant students on the Anschutz campus. They walked in and out of mock exam rooms seeing patient actors with problems like abdominal pain and trouble breathing. Afterwards, they got feedback on their performance from standardized patients like Christie Cass, who gives some tips to one student after a simulated medical exam.
“I did notice at the end you asked me if I had any questions then you continued to tell me what was going to happen next,” Cass told the student. “So I thought that would've been a really great time to ask an open-ended question followed by a pause.”
Second year PA student Tia Miller said her training at the CAPE helped her come out of her shell and remembers one encounter in particular that taught her why making connections with patients is so important.
“I had a patient that was having … an asthma exacerbation and the patient was saying just how much it had affected their activities of daily living. And I was feeling like, ‘Oh my God, I want to get to the bottom of this so that this isn't happening,” Miller recalls. “But I didn't vocalize that … [and say] I'm so sorry that you're going through that.’ A lot of what the Cape teaches you is how to empathize with the patient and let them know that you want to help them.”
Another invaluable part of the training, Miller said, has been the ability to practice sensitive medical exams with CAPE staff acting as patients.
“So we had a simulation where we did a prostate exam on a real person and so I think that there was some discomfort on both ends,” Miller recounted. “And [it really helps] being able to talk through that and have someone who can say, ‘Use sensitive language and don't say these words when you're doing this with the patient.’”
Dennis VanderHouwen, who played the father in the delivery room, said the students who come to the CAPE really want to learn and he hopes the work he does helps them not just with clinical skills but with the less tangible, more emotional parts of the job.
