"(AP) Practice Patients Break in Med Students"

Most women want to put off that dreaded once-a-year pelvic exam. Imagine volunteering to have one four times a week _ by a trembling novice doctor.
AP Medical Writer

That’s what Kat Wentworth does. She works as a stand-in patient to help train medical students how to give below-the-waist exams.

Some say she should get battle pay. But Wentworth says she is happy to move medical residents “from a place of fear and anxiety to a place of ease and success.”

The student doctors say her advice is invaluable.

Wentworth is among thousands of regular citizens across the country who are willing to let budding doctors practice on them so the rest of us can be in better hands when real illness strikes. Of course, most fake patients aren’t volunteering for such an intimate exam.

Chicago actress Vickie Daignault, for example, has suffered breast cancer, drug addiction, obesity and dizzy spells to help train medical students at the University of Illinois at Chicago. She’s had the fun of seeing the occasional cocky young doctor miss the mark in his diagnosis when she holds back crucial information _ such as the use of crack cocaine _ just as a real patient might.

Students know these patients are fake, but each gets an identity and a medicalhistory, and the pretend office visits often seem very real. They have one big advantage over the real thing, however _ allowing many “takes” to help students get it right.

“In real life, you can’t yell ‘Cut!'” said Dr. Rachel Yudkowsky, who oversees the Chicago program.

Wentworth realized the need for better training for pelvic exams after having uncomfortable checkups from uneasy doctors. She now runs her own business in Oakland, Calif., supplying male and female practice patients for everyone’s least favorite doctor visits _ genital, rectal and breast exams. Some have health backgrounds, but there are an editor, musician and real estate consultantamong her group, too.

In her first visit with the nervous newbie docs, Wentworth says she tells the students, “Don’t be afraid to hurt, I won’t let you. I will be guiding you with my voice and sometimes my hands.”

Dr. Nick Rubashkin, an obstetrics-gynecology resident at University of California at San Francisco, did his first pelvic exam on Wentworth a few years ago when he was a med student at Stanford.

“I was totally nervous. I remember the sweat breaking out on my forehead,” he recalled.

Having a practice patient who was calm and knowledgeable and who gave instant feedback “was invaluable,” said the 31-year-old doctor.

In aUniversity of Massachusetts study published last year, graduate-level nursing students reported learning better pelvic exam skills from trained “fake” patients than from practicing on each other.

“Thank God there’s somebody to teach the students how to do it so they don’t do their first one on you,” said Yudkowsky.

If book smarts were the only thing required to make a good doctor, she said, no one would care “if you’re an obnoxious, arrogant physician. But we do care, and patients really care.”

A big change in medical education in 2004 helped solidify fake patients’ role. That’s when a clinical skills exam, using phony patients to test bedsidemanner, became a requirement for a medical license in the United States.

Some medical schools since have started requiring a similar exam for graduation.

The pay is generally good; Wentworth declined to say how much she gets but it’s considerably more than the usual $14- to $25-an-hour fee many schools offer standard fake patients.

They “deserve battle pay,” said Linda Morrison of the education and curriculum department at Southern Illinois University’s medical school.

Medical students have high praise for more standard fake patients, too.

At the University of Illinois at Chicago, second-year student Shawn Roofian, 22, grewflustered during one of his fake office visits with Daignault, who was portraying a lesbian with dizzy spells. Ruffian wrongly assumed she was straight _ and kicked himself over it later, saying he “wasn’t properly sensitive.”

Such communication lessons are priceless, he said.

“If the patient isn’t comfortable with me, then they’re not going to come back, and I’ll never know why,” he said. “I want my patients to leave saying, ‘That’s a good doctor.”

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