Mike and Stacey Munoz, standardized patients for the WSU College of Nursing
Mike and Stacey Munoz, standardized patients for the WSU College of Nursing. Photo by Cori Kogan.

By Addy Hatch, WSU College of Nursing

As acting jobs go, this one’s not typical.

Rather than being handed the role of “ingenue” or “nosy neighbor,” people who are hired by the WSU College of Nursing might be asked to play “chest pain” or “depression,” or “degenerative joint disease.” They’re called standardized patients, or SPs, and they help teach nurses and other health-science students skills in communication and clinical treatment.

The WSU College of Nursing has had a standardized patient program as part of its Simulation Lab for three years, said Kevin Stevens, Director of the Center for Clinical Performance and Simulation.

“Most schools will use standardized patients for things they can’t do with a mannequin,” Stevens said, referring to the high-tech mannequins used in the Simulation Lab. For instance, unlike a mannequin, a standardized patient might pace the room, jump out of bed or interact aggressively – all scenarios that nursing students could face in their careers.

Standardized patients also give students feedback.

“Sometimes students don’t use good eye contact, or they’re looking down at a paper the whole time,” said Stacey Munoz, a standardized patient at the WSU College of Nursing and before that, in Arizona. “Sometimes they’ll tell a joke that doesn’t translate well.”

That’s the exception, however, said Mike Munoz, Stacey’s husband and a fellow standardized patient in Spokane. “I would say 99.9 percent of the time the good outweighs the bad. These students are being trained very well.”

The WSU College of Nursing launched its standardized patient program using actors hired through a Spokane talent agency. The pool of SPs has expanded to include non-actors like Mike and Stacey Munoz – people who have some interest in health sciences and want to help train the next generation of care providers. Mike Munoz had 35 years of experience with emergency medical services as a firefighter in Arizona, while Stacey Munoz worked at a health-sciences university there.

Actors are paid, but hours vary

The standardized patients are WSU employees and are paid an hourly rate. The amount they work varies widely – sometimes it’ll be a couple of weeks in a semester, sometimes just a couple of days.

Dawn DePriest, the Standardized Patient Coordinator for the WSU College of Nursing, said the pool of 25 SPs ranges from ages 18 to 70, though they’re concentrated on either end of that spectrum. “We struggle getting middle-aged people because they’re working,” she said.
When a simulation calls for an SP, DePriest emails everyone meeting the criteria – a woman in her 60s, for example – and sends a description of the scenario. Sometimes SPs are asked to come in and rehearse. Other times they can watch a video at home, or they’re sent a script and asked to memorize certain aspects of it and ad lib the rest. It depends on the point of the simulation, DePriest and Stevens said. If students are being tested, for example, the standardized patient’s responses need to be just that – standardized. Experience in a medical field isn’t necessary.

Students love the feedback, DePriest said. “When a standardized patient says, ‘this is how I felt when you did this,’ it’s really powerful.”

SP’s newer to nursing education

Standardized patients have been used in medical education for decades, but their use in nursing education is more recent. Research has shown that using SPs can decrease students’ anxiety, and enhance their critical-thinking and communications skills.

Portrait of Christine White, a standardized patient at the WSU College of Nursing
Christine White

Christine White, a standardized patient for the WSU College of Nursing, was a physician’s assistant many years ago and left that field, in part, because of the training. Being a standardized patient is a way for her to change that for future generations, said White, who later went into social work. Plus, she said, “I think it’s big fun.”

Kathy Bray is the College of Nursing’s only SP who’s located in the Tri-Cities, working with students at the campus there. She started as a standardized patient in San Diego years ago, where she “was known as a woman who could cry on demand.” That came in handy when playing a depressed patient, she said.

“I would say that I’m pretty passionate about it,” Bray said of being a standardized patient. “It adds an element to education that you just can’t get in the classroom, you don’t get in the lab, and I don’t think you can get with students role-playing with each other. My role is a stranger, which is essentially what a patient is to a nurse.”

Sim Lab will be used by inaugural medical class

Stevens, the Director of the Center for Clinical Performance and Simulation, said the standardized patient program will continue to grow. SPs are being used in undergraduate and graduate nursing programs, and the Simulation Lab will help the WSU Elson S. Floyd College of Medicine with its inaugural class this fall. Plus, the College of Nursing will expand the Sim Lab to include a space set up to look like an apartment, and another where multiple patient simulations can take place.

“The Center for Clinical Performance and Simulation has grown significantly over the last seven years since I arrived,” Stevens said. Last semester, the lab provided 500 hours of simulation for WSU students and community partners like the Washington Air National Guard and the University of Washington’s MEDEX Physician Assistant program. Said Stevens, “We have dedicated, expert simulation facilitators and preceptors who are invested in making our simulation program the best in this region across all our WSU campuses.”

For more information on the Standardized Patient program, visit the WSU College of nursing website