CHS Students Get Unique Narrative Medicine Experience Serving as Standardized Patients for the CNU College of Medicine

Operating in an institution housing medical, pharmacy, dental, and clinical psychology programs affords CNUCHS undergraduate and post baccalaureate students unique opportunities. Dr. Katherine Whitcome, Associate Professor of Anatomy and Biological Anthropology, serves as course director for the MEDS410 Standardized Patient Clinical Experience (SPCE) course series. These courses are combined experiential and seminar courses available to upper division and post bacc students wherein they undertake the role of standardized patients in medical educations. Students are trained to embody the patients' symptoms, life histories and illness concerns during real-time scenarios with medical students and their faculty preceptors. By listening to and telling the complex and unique stories of patients' illnesses, CNUCHS students learn to recognize, interpret, and represent patient care scenarios.

When asking Dr. Whitcome her perspectives on the course she reports that students may anticipate the course to be about seeing what lies ahead for them in medical school, an opportunity to observe first-hand how they will be trained in a medical skills curriculum. This course series is a valuable opportunity to earn preview of that may improve their performance when they are put on the spot in the future to examine a “patient” with a particular set of symptoms.

Additionally, Dr. Whitcome identifies they might view their experiences as chances to critique the attempts of the medical student. These notions are common and not entirely dismissible. However, as the patient in the exam room, students enrolled in this class will hold a unique position. A liminal one, and their perspective will differ from that of the medical student and the preceptor. As the “standardized patient” they are both an actor with a prescribed role and an audience with an unrehearsed vulnerability. They alone will experience what the patient receives, and they must internalize that experience in order to fully participate. This course is the premed student’s opportunity to mine the depths of the patient experience. As Rita Charon (2007) writes, “the clinician caring for a sick person must begin entering the sick person’s presence and absorbing what can be learned about that person’s situation. A combination of mindfulness, contribution of self, acute observation, and attuned concentration enables the doctor to register what the patient emits in words, silence and physical state.”

Apart from the College of Medicine standardized patient performance, students will meet as a community of learners to focus their experience philosophically - orienting them as future physicians towards patients with fresh vision and ethical strength. They will learn the skills of close reading to convey the basic skills of clinical attention to absorb all that patients have to tell. The course vehicle is narrative writing in the clinical setting as a means to make audible and visible those elements that would otherwise pass through the premed student experience without notice. They will read patient accounts of illness experiences. While this approach might seem tangential as they begin the course, the overarching goal is to improve health care through self-awareness. This is a goal that can be partially accomplished together in the CHS seminar with the integrated SPCE. Students will not only read narratives, they will also write them.

CNUCHS student experiences as a standardized patients allow them more than mere observation and critique of medical students. Dr. Whitcome states, "They allow students to experience and understand what being a patient with illness is. Their position of liminality in the SPCE scenario affords them privilege. They will explore their experience in thought, discussion and writing. “Until a perception is captured as a representation, it is evanescent and unavailable for consideration” (Charon et al 2016). Once it is written, it can be communicated. Their writing will be creative and does not need to start with clinical matters (the examination, the diagnosis, the prescription). What matters most is that they develop creative and imaginative powers of discovery, vision and representation of the patient experience. In the end, they all want to serve patients and solve health care problems. Creativity, imagination and vision are key to that end."