Playing doctor

In a few months of medical school I have made more tiny graphite circles than I did in 12 combined years of standardized school testing. Most of our exams (we’ve had at least eight; I’m losing count) use Scantron forms.

But we have been tested, once, on our actual ability to treat patients. Sort of. They were actors, pretending to be patients. But that’s only fair, since we are students pretending to be doctors.

The test is called an OSCE [OSS-key], which stands for Objective Structured Clinical Examination. Students dress like real doctors — nice clothes, white coats, stethoscopes — and go to a part of the family medicine department set up like a clinic. In the rooms are “standardized patients,” actors who portray roles such as a 68-year-old man with chest pain or a 21-year-old woman who drinks a bit too much. We see four of these patients in a row, 15 minutes per visit, the same time allowed for many real primary care visits.

Each encounter is graded on dozens of items, from such courtesies as making eye contact to exam techniques, such as listening for heart sounds in at least five designated spots. After 15 minutes, we leave, fill out a self-evaluation form, then reenter the room for the standardized patients to give us feedback.

Two things set the OSCE apart from other tests. One: It was fun; I actually liked meeting and talking to the standardized patients, as did many of my classmates. Two: the assessment was fast and valuable. My first “patient” was an ex-dialog coach from LA with a perfect radio voice who has been a standardized patient for years. He was playing an older man with chest pains. I did fine on the whole stethoscope aspect, which I’d memorized and practiced. But he was quick to point out errors that are less scientific but no less important to patients: I hadn’t draped his chest, assuming he’d be comfortable because he was male. Don’t make that assumption, he said: men can be shy, too, and may be afraid to speak up. And don’t say, before laying on hands, “I’m going to feel your chest.” It has a different meaning to women, he noted — this was one case where the more complex word (“palpate”) may be better.