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A breakup with her boyfriend of four years rocked Phoebe Lansbury. An undiagnosed panic disorder and general anxiety about her own wellness paralyzed Anna Trenton. And Isabella LaFollette spiraled into a very dark situational depressive episode after an abrupt end to a relationship.
Concerns about their mental health and emotional well-being led each to seek out help. As the fall semester unfolded last year, each began online sessions, meeting with graduate students in Carroll’s Behavioral Health Psychology (BHP) program. Nothing remarkable there, except that Phoebe, Anna and Isabella weren’t real people.
The three were personas, created as part of a unique program that trains Carroll students as standardized patients – people who “act out” various health issues to aid in the training of healthcare students. The use of standardized – or simulated – patients began in the second half of the twentieth century to provide consistent and safe ways to train healthcare students as they communicate with, evaluate and diagnose patients. They are now used routinely to help train and evaluate medical students and healthcare providers, even in Carroll’s health science programs, which sourced them from other institutions and organizations.
Phoebe, Anna and Isabella were characters portrayed by Una Fortier, a junior nursing major at Carroll who is also seeking a minor in theater. It was in a theatre class that she first heard about the standardized patient opportunity, a unique partnership that utilizes Carroll’s liberal arts strengths.
“This is a new collaboration between the behavioral health psychology program and the theatre department,” explained Dr. Jessica Lahner, a clinical associate professor of psychology and director of the BHP program.
Discussions about training Carroll’s own students to perform as standardized patients began several years ago, and conducted a small trial in the summer of 2019 before being put aside during the pandemic. That effort saw two theatre students receive training so they could undergo patient assessments by students in Professor James Brandes’ class in the physician assistant (PA) studies graduate program.
Laura Gray, an adjunct lecturer in Carroll’s theatre program and an experienced professional actor, worked with those two students. They began with two case studies, each describing a patient, detailing medically valuable information such as lifestyles, past events and illnesses. “We approached it as a character study,” explained Gray, a task typically performed by actors and writers, who build up the background of a character so they can better inhabit the role of that character.
After some improvisation and further coaching by Gray, the students participated in simulated diagnostic sessions with the PA students. Brandis and other faculty reviewed recorded sessions and provided feedback on the PA student’s information gathering and diagnostic skills. The recordings also allowed Gray to provide further mentoring to the theatre students.
Those sessions were productive, but the tumult of the pandemic paused the program until last year when students began taking classes in Carroll’s new graduate program in behavioral health psychology. First-year students in that program take a course called Pre-Practicum: Advanced Interviewing. The semester-long class teaches practical skills in interviewing and consultation through active role-playing sessions.
“We really needed to find people our students can practice their counseling skills on,” said Lahner. “That usually starts with pairing our psychology students with their peers – who have to pretend to be patients.” Students take turns role-playing the two sides of the counselor/client relationship, but the fact the students in each cohort are usually familiar with one another makes the “pretend” more difficult, she added. “You just don’t have that authentic dynamic in the relationship. It minimizes the amount of data that the counselor has to work with.”
The first problem was finding a pool of students. A decision was made to make the standardized patient training and session work a part of Carroll’s work-study program, so the time students spent in training and acting would be a part of their campus employment. Next, they sought out interested students.
Theatrical training was step one, as students learned some basic acting preparation techniques, developing the ability to express another character with their own voice. They followed that up by working on character development, allowing the soon-to-be patients the chance to develop a more thorough picture of their characters.
“This really is applied theater,” said Gray, “an opportunity to work on critical skills as a performer.”
Then the standardized patients were ready to deploy, attending virtual online counseling sessions with the BHP students.
For Oliver Ignazzitto ’23, who himself plans on attending graduate school to become a counselor, portraying a standardized patient served as a great opportunity to gain a broader understanding of the profession and to observe both sides of the counselor/client relationship.
“I know that I was able to be very helpful for some of the grad students,” he said. It also provided him with a glimpse of the innovative experiences Carroll offers its graduate students. “It was very nice and reassuring to see how prepared the students were.”
It’s the sort of career preparation for which Jolie Ausloos, a behavioral health psychology graduate student, is grateful. “(Prior to) standardized patients, we were interviewing one another in class,” she said. “We all did a kind of practice group therapy session in our class, but we’ve all known each other for two years now – we’ve already established a rapport that makes it easy to open up with one another. But working with the standardized patients really forces us to use the skills that we're learning, in building that rapport with a patient and helping them see connections.” The standardized patients provide students with a more realistic experience – closer to what they're going to encounter as they start their careers.
Sometimes, that experience felt very real, according to graduate student Brittany Drag. She, too, worked with standardized patients in her fall pre-practicum course and in simulated intake and diagnostic sessions in spring. “We each had two patients, and each of them had two different background stories,” she recalled. “The first student I worked with was amazing! If we would not have known they were standardized patients, we wouldn't have been able to tell. It was very convincing.” So much so, she said, that it was nerve-racking at times.
“It’s a challenge, but it’s very beneficial in that you are able to effectively do telehealth, which is very prevalent in the real world today.”
The use of standardized patients continues in the graduate program’s second year, in courses on clinical psychological assessment and group psychotherapy. In the latter, a pair of psychology students lead a group session with five standardized patients.
The group psychotherapy experience was particularly intimidating, Ausloos recalled. "You know, it’s one thing to be one-on-one with a standardized patient online, but then to have five come into a room and sit there, and you're expected to lead the group – it was intimidating and scary." And that helped make it an amazing and beneficial experience, she said. “It mimics what we are going to experience, but it’s happening in a way that we can practice and take risks and learn from.” The group sessions, like the one-on-one meetings, are recorded so that both the psychology students and the standardized patients can receive feedback from professors.
“It's definitely lessening my anxiety going into my practicum internship experience,” she said. “Now I’m more aware of what it’s going to be like walking into a session with somebody I’ve never met before.”
It’s the sort of unique and innovative offering that sets Carroll’s program apart, added Ausloos. “I have spoken about the standardized patient program with both of the (healthcare) providers that I work with in my day job, and they're blown away by the program that Carroll has created.”
Lahner considers the program a success and would love to see it expand. “I love how effective this is, and I don't know of any other counselor training program that does this,” she said. “It’s a differentiator for Carroll.”
And it might not be solely the graduate psychology students that benefit. Beyond the financial impact of the work-study employment, Fortier said she found the experience of being a standardized patient quite educational. “I think this program is helping a lot of people see the benefits of therapy and counseling. Because when you role-play as this character, you go on this journey with them. In the beginning, it is silly because you are this fake person with this fake problem, and they are only pretending to help me.” But then came the breakthroughs for her character, breakthroughs she said also taught her things about herself and other people.
“There were a lot of things that I learned about coping with my emotions, or procrastination and taking time for myself, stuff like that. I genuinely benefitted from this experience with the BHP students because they had a lot of great feedback.”