Stuff You Should Know - How Standardized Patients Work

Episode Date: June 29, 2017

Even the most brilliant medical minds need a good bedside manner, and thanks to standardized patients, they can improve their skills. What are they? Part-time workers who pretend to be real patients so doctors can practice on live humans. If you're remembering Kramer on Seinfeld right about now, you're not alone. Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.

On the podcast, Hey Dude, the 90s called, David Lasher and Christine Taylor, stars of the cult classic show, Hey Dude, bring you back to the days of slip dresses and choker necklaces. We're gonna use Hey Dude as our jumping off point, but we are going to unpack and dive back into the decade of the 90s.

We lived it, and now we're calling on all of our friends to come back and relive it. Listen to Hey Dude, the 90s called on the iHeart radio app, Apple Podcasts, or wherever you get your podcasts. Hey, I'm Lance Bass, host of the new iHeart podcast, Frosted Tips with Lance Bass. Do you ever think to yourself, what advice would Lance Bass

and my favorite boy bands give me in this situation? If you do, you've come to the right place because I'm here to help. And a different hot, sexy teen crush boy bander each week to guide you through life. Tell everybody, ya everybody, about my new podcast and make sure to listen so we'll never, ever have to say. Bye, bye, bye.

Listen to Frosted Tips with Lance Bass on the iHeart radio app, Apple Podcasts, or wherever you listen to podcasts. Hey everybody, it's us, Josh and Chuck, and we want you to know we are coming somewhere near you. We're sure if you live in North America this year. That's right, we're going on tour, and why don't we just rattle through these dates?

Okay, Toronto, August 8th at the Danforth Music Hall. Chicago, August 9th, the next day at Harris Theater. Then we are taking some time off to recover after that two day grind. We're in Vancouver, the Vogue Theater, September 26th, followed by Minneapolis. We're gonna be at the Pantages Theater again on September 27th.

That is correct. Yep, and then Austin, Chuck on October 10th at the Paramount Theater. Yes, and very special show in Lawrence, Kansas at Liberty Hall on October 11th. Yep, and then we're gonna do a three night stand October 22nd, 23rd, and 24th at the Bell House in Brooklyn, New York, and then Chuck, take it home.

Well, take it home, literally, because we are finishing up November 4th right here in Atlanta at the Bucket Theater, and this is a very special benefit show. And all the proceeds will be going to Lifeline Animal Project of Atlanta and the National Down Syndrome Society. Yep, and for more information and to buy tickets,

just go to sysklive.com. Welcome to Stuff You Should Know from HowStuffWorks.com. Hey, and welcome to the podcast. My name is Josh Clark, and I'm proud to introduce my partner, co-host in crime, one of those two, Mr. Charles W. Chuck Wayne, Chuck Tran Bryant. Chuck Tran.

Yep, and this week, Chuck, we have a very special guest producer filling out the seat. That's right. It is the Rump of Noel Brown. Yeah, Jerry's. She's at the beach, because she needs a vacation. Oh, oh, I'm getting pale, guys. Yeah, Jerry's romping at the beach

with her wife and her daughter and a bunch of friends, and, you know, I think that sounds lovely. Well, yeah, the beach rocks. I'm going to the beach in September. Who doesn't like the beach, you know? Even Miley Cyrus likes the beach now. I don't get it. She's got this new single out about how her boyfriend

introduced her to the beach. It's a pretty sweet song, actually. You know this stuff? I just, my wife. Oh, okay. She introduces me to things sometimes that I otherwise would never, ever have come across. Like, I can pick on you for that,

but I would never pick on you, me for that. Right, sure. You know. What are you, a monster? Yeah, you don't pick on a man's wife. Right. So, yeah, it is a cute, cute sweet song, though. I can give it a hearty endorsement.

Miley has her little secrets, too, from even me. She was singing the song the other day that was on some TV show. I was like, how do you know this? I've never heard this song. And she said, no, you know, it's a song I know. What song? I don't even know what it was.

It was just some kind of bubblegum poppy thing, you know, and that's kind of not her. But you never know, you know? Yeah. She learned it from her boyfriend. Sure. Todd. Todd.

Todd's into bubblegum pop. He's a jerk. He's got frosted tips on his hair. He's got a severe ombre. So, which one are we doing? We're going to do standardized patients. And it's funny, the thought occurred to me to go through this entire episode

without mentioning Seinfeld at all, just to make people really angry. Man, we would have gotten so many emails though. But that's kind of like, you can't not mention the very famous Seinfeld episode with Kramer. And who was the other guy? Mickey?

Oh yeah, I forgot Mickey was one too. Was that his name? Yeah, his friend who was a little person. Yeah, and they were, I think Mickey got him into it. And they were, they were, and I didn't even know they were called standardized patients. I doubt if they said that on the episode.

Right. I don't remember what they called them. Surely they called them something. Well, they have a few names. Simulated patients, standardized patients, care actors. Well, those are, some of those are different. They're generally under the umbrella of say like a simulated patient.

Yeah. But there's slightly, there's little nuances there that make the whole thing revoltingly fascinating. Programmed patients, isn't that what the first guy called it? If that's not like a brain doctor's name for it, then I don't know what it is. Well, should we start there?

Yeah, let's go back to that guy. A doctor named Howard Barrow. He worked out at USC, Go Trojans. And he was teaching back in the early 60s, late 50s, I believe. And apparently at the time, Chuck, they would just teach you everything and then say, okay, you've graduated, you're done, goodbye.

Go practice medicine. Good luck with a live human. Exactly. You've never encountered one throughout your entire training, but you are a doctor now. So we wash our hands of you, right? And so this guy was teaching neurology and realized like,

I think he had a friend who had come to start like observing his graduates in a clinical setting. But like after they graduated and we're practicing doctors and we were like, whoa, whoa, whoa, you guys are doing this all wrong. Yeah. Who taught you this? And they're like, you did?

And he's like, all right, well, we got to do something different. So that doctor figured out that he could sit down and go through, basically observe a doctor doing an entire patient history and exam and everything. But each one took like two to three hours. And they're like, there's got to be a better way to do this. Sure. So Barrow's was, it was his idea and his idea alone, right?

From what I understand, I saw, I came across another doctor, a woman, a pediatrician, a woman named Paulus Stillman, who came up with this idea also seemingly independently in the early 70s. Because it didn't catch on big time in the 80s. So I think she and Barrow are kind of like the earliest practitioners of this thing. Well, it wasn't a big hit at first.

Like people kind of made fun of them. I know in this one article you found they, there were newspaper articles, one in the LA Herald Examiner that had a headline that said Hollywood invades USC Medical School. Right. And in the San Francisco Chronicle of all places, they said scantily clad models were making life a little more interesting for the USC medical students.

Which is really, I mean, I guess it's a sign of the times, but really kind of a crappy way to, you know, they made it sound like it was some titillating sexual thing. Right. Because, you know, they had these people that are really doing what, you know, what I learned was a super valuable service. Well, yeah, for sure. I think they were just trying to sex it up for the paper, you know what I mean?

Yeah, of course. For their reading audience. Because they were like Zodiac killer coming soon. What's that? Stay tuned. But he wasn't around yet, so they had to do something. So they were just trying to take something that was actually, yeah, a valuable service and pretty straightforward.

And again, sex it up a little bit. Yeah. But it actually, it kept it from catching on for a while, at least at first, it wasn't until I think the mid 80s that Barrow was able to like get it to start to become adopted throughout the medical universe in the United States at least. Yeah. And you know what, we've done that thing again.

Yeah, I know. Where we haven't said what it is yet. No. You had to have seen Seinfeld and know how to read between the lines of our conversation. Yeah. So a simulated patient or a standardized patient is sometimes you're an actor. Sometimes they have no acting experience.

Sometimes it will get to who these people are, but they're generally people looking to make a buck who are, who fit the profile and of being a fake patient to a medical student. So they can get a real practical human to human experience in medical school. Exactly. Because there's a big difference between book learning and real life. Right?

Yep. And if you're a doctor, a huge, huge part of your, your job, especially non-surgical doctrine, is conversing with a human being, a patient. And on the one hand, treating them as a human being, not a set of symptoms, that's a big one. But then also getting out of them, what's wrong with them so that you can diagnose them?

Yeah, that's, I thought this was all sort of just about bedside manner and like being, you know, because it's a big part of the job. You know, you want a doctor. If you've ever had a doctor that had a poor bedside manner, you know what I'm talking about. If you haven't, then you might take it for granted that everyone's like that, but that's not the case. Right.

But the second part of that I didn't really think about, but the director of the standardized patient program at University of Pittsburgh School of Medicine, Valerie Fullmer, who they, I don't know if they interviewed her for this or if she was just, they pulled some quotes, but I never really thought about it. She said, communication is at the root of proper diagnosis. Patient safety and patient satisfaction and miscommunication

can lead to medical error. The big part of the job is drawing out of the patient what the heck is wrong with them because they can examine until the cows come home, but they need words. Right. So like, yeah, a patient who comes into the doctor's office or the ER isn't going to be like,

I have an abscess on my right kidney that needs to be treated or else I'm going to die of sepsis in the next 12 hours. It's my side hurts. That's what you get. So you have to ask more questions and know what questions to ask. So yeah, it's diagnosis, learning how to diagnose from talking to people and drawing info out of them,

but that bedside manner, that's not to be overlooked. Like that's a big part of it because, you know, if people start to think every doctor I've ever interacted with treated me like I was just a bag of organs and bones. Yeah, which we are. Couldn't, sure. But you're not supposed to let on that everybody's like this.

We all have to pretend in this big grand manner, right? Exactly. But it'll keep you from going to the doctor. And if you stop going to the doctor, then health problems can start to accumulate and it's all the doctor's fault for being a sociopathic jerk. Well, yeah, but you also, you know, in that, which one were we talking about doctors being too empathetic?

The empathy one. Oh, yeah, okay, there you have it. You didn't want a doctor who fell to pieces. No, you need to learn to walk that fine line between being too clinical and too much of an empath to where the patient feels at ease and taking care of, but you feel confident and they're not like breaking down and crying because they have to tell you

that you may be dying, let's say. Yeah, but that lady from the University of Pittsburgh who is interviewed in this article points out that there was, she remembered at least one medical student who did break down because of an interaction with a simulated patient or standardized patient. And that's the point of a simulated or standardized patient is so that you can go ahead and break down like that

and get it out in basically a classroom setting so that when you encounter this in the real world, you'll have already gone through that. Yeah, and we'll get into the nuts and bolts of it in a bit, but if you're wondering, if you want to go do this, if you have to like, you know, get a prostate exam, you don't have to, but if you're open to that kind of action, you can sign up for a more intense,

and I imagine those are the ones that pay a little bit better, but you can go in and volunteer for a prostate exam or breast exam or anything that involves something a little more invasive. But you're not going to get cut or you're not going to get a needle or anything like that. They're not going to practice that kind of stuff on you. Right, I was reading the FAQ on the University of Pittsburgh site about their simulated patients,

and they point out that simulated patients will not be given drugs. They're not going to inject you with like a cocktail of antipsychotics for the stimulation. This may be a good way to score. Right, but it's on you as the simulated patient to act as if you're going through a psychotic break right then potentially so that the doctor can learn how to deal with that kind of thing. That's probably one of the more dramatic examples.

I think a lot of them are a lot more pedestrian, but that is definitely in the mix as well. Well, even though you're, as we'll see, it's not scripted, you do have to be an improviser of sorts, but you're supposed to stick to kind of, I don't think you're supposed to throw any just curveballs that you think of in the moment, which is what I would want to do,

which is probably what I would not be a good SP. That's what Kramer did. Yeah, he kind of made it into like a real acting gig, right? Right, and they say that actors can be good at this, but it's not acting. Like they point out that there's no, you're not searching for moments of drama. Right.

You're not there to entertain. You're not there for you. You're not playing to the audience. So yeah, it could be helpful to learn, say, I don't know, would it be character acting or method acting in this one? Probably method acting. So it would be useful to learn some nuts and bolts of that,

practice and rehearse that type of acting, but you're not going to, like you're not going to go get your big break or something doing this. That's not the point of it. No, I think I would, I would try and fart a lot or something. Just something very subtle.

That'd be your trademark? Yeah. Yeah, that would be in the lounge afterward. They'd all be like, did you get the guy that, I think he was farting? Right. Was that on purpose or? That'd be your standardized patient card.

It's a Charles W. Chuck Bryant. Ask about my trademark. Or it's on command. All right, that was dumb. So we should take a break. Yeah. So I can get it together. We're going to use Hey Dude as our jumping off point,

but we are going to unpack and dive back into the decade of the 90s. We lived it and now we're calling on all of our friends to come back and relive it. It's a podcast packed with interviews, co-stars, friends, and non-stop references to the best decade ever. Do you remember going to Blockbuster?

Do you remember Nintendo 64? Do you remember getting Frosted Tips? Was that a cereal? No, it was hair. Do you remember AOL Instant Messenger and the dial-up sound like poltergeist? So leave a code on your best friend's beeper because you'll want to be there

when the nostalgia starts flowing. Each episode will rival the feeling of taking out the cartridge from your Game Boy, going on it and popping it back in as we take you back to the 90s. Listen to Hey Dude, the 90s, called on the iHeart radio app, Apple Podcasts, or wherever you get your podcasts.

Hey, I'm Lance Bass, host of the new iHeart podcast, Frosted Tips with Lance Bass. The hardest thing can be knowing who to turn to when questions arise or times get tough or you're at the end of the road. Ah, okay, I see what you're doing. Do you ever think to yourself, what advice would Lance Bass and my favorite boy bands

give me in this situation? Well, if you do, you've come to the right place because I'm here to help. This, I promise you. Oh, God. Seriously, I swear. And you won't have to send an SOS because I'll be there for you.

Oh, man. And so will my husband, Michael. Um, hey, that's me. Yep, we know that, Michael. And a different hot, sexy teen crush boy bander each week to guide you through life, step by step. Oh, not another one.

Uh-huh. Kids, relationships, life in general can get messy. You may be thinking, this is the story of my life. Oh, just stop now. If so, tell everybody, everybody about my new podcast and make sure to listen. So we'll never, ever have to say bye, bye, bye. Listen to Frosted Tips with Lance Bass

on the iHeart Radio app, Apple podcast, or wherever you listen to podcasts. So Chuck, let's get down to the nuts and bolts, the nitty-gritty a little bit, right? So I said earlier that all of this kind of falls under the umbrella of a standardized or a simulated patient. Um, and then underneath that umbrella, which is a little bit of a little bit of a little bit of a

little bit of a little bit of a little bit of a little bit of a little bit of a little bit of a little bit of a little bit of a little bit of a little bit of a little bit of a little bit of a little bit of a little bit of an doctor says this and then you say that but you do have like a you are given a specific set of criteria and it can be really detailed as well and you're expected to stick to that role that character you take on a character and your character is sick your character has a backstory there's certain things

that your character is capable of doing and incapable of doing yeah because of the medical condition maybe because of a prior medical history and then you go in there and you remain in this character and you do it virtually the same way as close to the same as possible for student doctor after student doctor after student doctor yeah usually up to about 10 in a day and the each student doctor is supposed to get the same experience from you yeah and the reason why they want it that standardized because they're being graded on this they're being tested on this it's it's the closest thing to scientifically

reproducible that's something as objective as bedside manner could be made into that's the point of standardized patients specifically yeah and you've the case that you've gotten it's either something that's just made up like hey we need somebody that has and maybe a rupture of appendix or whatever that's kind of a run of the meal meal run of the breakfast run of the mill situation but sometimes it's an actual case like a real case that they base it on like someone who's actually experienced this it's been recorded right and they have this case study and they want the doctor to go through this

very specific thing and in that case they want to really replicate that right down to like the age gender and ethnicity of that actual patient that had that actual case to begin with right exactly I think George Barrow the guy who came up with this in the 60s he based his first standardized patient on an actual case that he handled because he knew exactly how it presented exactly what the medical history was so and it was something that he felt could be reproduced pretty easily again and again and there's this really interesting essay that was run in the believer but I think it made it into a collection in

the writer's book by a writer named Leslie Jamison and the name of the essay is the empathy exams and it's about her experience as a standardized patient oh wow it's really really interesting just how she's really investigating the character that she's given like I think her her main character Scott more than one but her main one or the one that she seems most attached to her brother like drowned in it after tailgating at a football game and then jumping into a river and he drowned years back and she's like still grieving over the loss of her brother and it's led to seizures but she doesn't even she the character

doesn't know that these seizures are basically coming out of grief right so it's for the doctors to suss out that's just one of at least a couple standardized patients that she's played but it's really interesting it's a great great essay well yeah in the in this article that you dug up it said that one of the there are a lot of reasons someone might want to do this but one of them can certainly be that they had like a family member that died of a certain disease or maybe was misdiagnosed even so they feel like this is like something they can do to kind of help out that kind of research or whatever you know right I ran

across though that one of the pitfalls of standardized patients is that the people who do it they can have a hidden agenda sometimes and it may be as benign as yet my brother was misdiagnosed I want to make sure it doesn't happen to anybody else or it can be some I ran across in this comment section on the biomedical blog about some doctor said that while he was in training he came across a standardized patient who was sure to list all of the herbal medications that she was taking right then and then she later said that it was because she wanted to make sure that these medical students were made aware

of alternative medicine as well yeah she had like a specific hidden agenda that she wanted to get across to these med students without going to the trouble of going to med school herself and becoming a doctor teacher oh wow just kind of came in under the radar basically and apparently they try to root people like that out sure it's not the point of the whole thing but it's kind of funny how they slip in there sometimes yeah and you know you're in character unless you're doing and we'll talk about this later but that one thing that you found and sent me it said that seemed like a little bit of a different process where

they might have a really specific goal in mind right where you'd kind of do almost like play acting back and forth with the student doctor but generally they're trying to diagnose you so you walk in the room and you're in character so if you've got kidney pain or a bad back or a limp or whatever then you don't walk in and say all right let's get started and then go oh like they try to make it as real as possible you walk in there in character with you know holding your side or whatever your ailment is right you don't you know run your face over your hand over your face smiling like frowning to get in

character no you don't do that no and apparently I've seen that if it standardized patients really good they'll be basically indistinguishable from some of the patients that the the doctor will eventually run into in their clinical practice right yeah I mean it's it's tough man because you have to I mean if you're not an actor you might be have a talent you didn't know you had if you're good at this because you have to memorize and internalize and study all this stuff because you have to be just as real as someone who is experiencing something and like that's that's the best like you would be the best actor if

you literally become that person that you're playing and that's kind of what you have to do for this right you know I'm saying yeah like these people if they aren't actors they might want to look into it sure if they're good at it yeah so let's talk about that so acting is not a being an actor is not a prerequisite for this right no but you could be an actor and be good at it you could be an actor and become very quickly frustrated by the whole thing because it's not acting necessarily it's very specific type of acting right yeah it's literally medical acting but just that's not enough you need to apparently

be ceaselessly upbeat endlessly upbeat and the reason why is because you're going through this thing say up to ten times in a row and these things last from what I saw about 45 minutes okay so you're doing this for 45 minutes well plus they make you wait a half an hour to an hour in the in the waiting room beforehand exactly filling out forms yeah because you got to get angry before you go in there some guys like coughing along up next to you it's like oh no contagious it drives me crazy when people like I'm not contagious like you don't know you have no idea whether you're contagious or not right but so

you have to do this maybe ten times in a row it's about 45 minutes per from what I saw and that that tenth one needs to be as great a performance as that first one because there those are two different medical students there's ten different medical students seeing you and each one needs to get your best because as far as their concern this is their training they're not looking at your day you know like oh I'm one of ten it's this is my this is my big my big test or my big training yeah so you need to give each one your your your all sure and in that sense you have to have a lot of energy a lot of spunk yeah a lot

of positivity and then you also have to be very comfortable dealing with medical professionals which is not necessarily always the easiest bunch to deal with from what I understand well no I mean if you have a phobia of doctors then this is not the gig for you sure and I think if you are easily crushed by pushy arrogant people it might not be the best gig for you either why is that well doctors can be Ted Erigan sometimes I mean we all saw malice I don't think I saw that yeah you did when Alec Baldwin is like do I have a God complex I don't have a God complex I am God I just thought that was Alec Baldwin like

he tweeted it right no I never did see that actually I remember the movie though um yeah it was a good 80s movie yeah late 80s movie but but yeah so you can't just be like a wilting flower when a mid student gets all mad or pushy or whatever and you also have to be the type who could conceivably take charge and can take control if if a med student is doing that and kind of maybe guide them back a little bit toward where they should be or at the very least being willing to give them feedback to their face about how they just royally screwed this whole thing up because they're over aggressive or because they were under

assertive who knows you I think you run into all of that stuff and you have to be prepared to do this so that brings up another point to you have to have a really good memory yeah yeah because it depending on who you ask a lot of the simulated patients will also be required to give feedback yeah some of them I got the impression I have something to do with like the scoring or grading process as well probably so you have to be in character so you have to have your characters history symptoms everything memorized if the staying character you have to respond to the doctor's questioning and then you have to be

paying attention to all the stuff the doctor should be asking all the stuff the doctor is failing to ask and the doctor's just behavior in general so that you can give accurate feedback afterward and then you have to do it ten times in a row in a day yeah this this serves a very specific need be on the obvious that well there's a few things and then and they're all somewhat obvious but it bears going over an experience of of medical students you don't want them practicing on a real sick person because if they mess up that's not good right so having a almost like a live recessa Annie on your hands is good and alive

recessa Annie my mom used to bring those home she used to teach CPR what would you do with them I tried to teach and then I learned to kiss I knew something weird went on I tried to learn CPR here that I think I've learned it like four or five times in my life as keep keep forgetting it so one thing I do remember is you want to do it to the you want to press the why does it call where you do where you give chest compressions to the beat of staying alive oh yeah and then apparently you don't give a breathing aid like you don't pinch their nose and breathe into their mouth for a couple of reasons one you're exhaling carbon

dioxide directly into their lungs so that's stupid and then two they don't really have a way to expel it so now they apparently from what I understand they just recommend chest compressions until paramedics arrive is that the latest accurate I don't know I should probably look it up before we publish this yeah we should say to that we're not trained medical professionals no we're not even trained medical actors and you are now taking life-saving advice from a guy who learned to kiss from a lifeless synthetic she wasn't lifeless when I was kissing her she went a little curly wigs fun on her head all right so the

first thing is an experience you don't want a medical student to be messing up on real people number two is availability they have to teach they have to run the gamut of medical issues and you just can't count on having real you know being able to source real patients with that specific problem so it's really easy just to teach someone to act like that and finally a real patient isn't supposed to provide feedback constructive feedback for their doctor I suppose they could yeah even if they could though they're not necessarily they're gonna be like again my kidneys abscess them in a lot of

pain really care about your medical career just fix me yeah you can you call seeing at the end of this thing and then they go all right now let's like you said let's talk about it I'm really not in pain so I'm fine to have this conversation sure whereas a patient would be like I'm I got to go urinate blood real quick I'll be right back then I'll give you feedback doctor correct so that's standardized patients right yes but there's there's plenty of other kinds let's take a let's take a break and then we'll come back and talk about those okay

on the podcast hey dude the 90s called David Lasher and Christine Taylor stars of the cult classic show hey dude bring you back to the days of slip dresses and choker necklaces we're gonna use hey dude as our jumping off point but we are going to unpack and dive back into the decade of the 90s we lived it and now we're calling on all of our friends to come back and relive it it's a podcast packed with interviews co-stars friends and non-stop references to the best decade ever do you remember going to blockbuster do you remember Nintendo 64 do you remember getting frosted tips was that a cereal no it was hair do you

remember AOL instant messenger and the dial-up sound like poltergeist so leave a code on your best friends beeper because you'll want to be there when the nostalgia starts flowing each episode will rival the feeling of taking out the cartridge from your Gameboy blowing on it and popping it back in as we take you back to the 90s listen to hey dude the 90s called on the I heart radio app Apple podcasts or wherever you get your podcasts hey I'm Lance Bass host of the new I hard podcast frosted tips with Lance Bass the hardest thing can be knowing who to turn to when questions arise or times get tough or you're at

the end of the road okay see what you're doing do you ever think to yourself what advice would Lance Bass and my favorite boy bands give me in this situation if you do you've come to the right place because I'm here to help this I promise you oh god seriously I swear and you won't have to send an SOS because I'll be there for you oh man and so my husband Michael um hey that's me yep we know that Michael and a different hot sexy teen crush boy bander each week to guide you through life step-by-step not another one kids relationships life in general can get messy you may be thinking this is the story of my life just

stop now if so tell everybody yeah everybody about my new podcast and make sure to listen so we'll never ever have to say bye bye bye listen to frosted tips with Lance Bass on the I heart radio app Apple podcast or wherever you listen to podcasts one thing before we move on to that I think we mentioned yet is that speaking of recessa Annie they have these really expensive surgical dummies now they think they actually they call them robots and this is how surgeons practice now 75 grand to 100 grand I looked them up these things are amazing and life

like they breathe and have pulses and some of them bleed they know how to love some of them give birth birth obviously sure but I kind of did wonder like how do surgeons even practice these days I know they probably cut on cadavers cadavers in sure in med school but that you can only get so far we've come a long way from the days where med students were forced to rob graves yeah now we've got hundred thousand dollar Cadillacs of robots ready for surgery yeah I mean they look like I mean some of them don't have if they don't need it they don't have legs and arms but they cover that up just to make it a little more realistic

sure but they have guts in this one dude I saw had like kind of a five o'clock shadow beard it was creepy and awesome that they have this stuff that's so lifelike oh man so I was on Twitter the other day shout out Twitter and Atlas Obscura had this tweet where they were they had a picture of this it was a decapitated serial killer whose head was pickled in a jar yeah from I think a teaching hospital and I believe Portugal possibly Spain I think it was Portugal as Portugal's like first serial killer and they had his head pickled and it was from 1840 when he was executed wow and man it looks like he

was from the 70s maybe like it's just so I mean lifelike still yeah completely undergraded and just creepy and his eyes are wide open just kind of like his mouth's a little slack but he looks like he could be thinking about something rather than being headless well that's where the old phrase comes from a pickled head never loses its looks all right so if you're a recruiter let's say at the University of Pittsburgh and you're trying to find these people and source them you're gonna be very picky because it's a it's a big deal it's it's not like a fly-by-night job like this is something that medical students take

very seriously you have to be intuitive like you said you had to weed through people that you might think have some other sort of weird motive but you know you're gonna have to weed through a lot of people because you know this is also the kind of thing where you can make twenty to forty dollars an hour so you also want to I mean obviously people want to get paid but their motives have to be more than just money I think well yeah I mean that's it's tricky too because you you expect you know a high caliber of commitment and skill from your your teachers or your standardized patients right yeah and they're

very highly trained and there's a lot of like ongoing education that happens but at the same time yeah you're paid handsomely if you look at it per hour but if you look at it over the course of a month even you're probably not even gonna be able to make rent off of this no it's a part-time gig if that yeah but um you know you have to be a good listener as well as all the things we mentioned like memorization and be a decent actor you have to be able to take direction well you have to be flexible if they change something up on you like if it says in here if the simulation isn't achieving the desired goal they

you know they may come in between sessions and say hey listen I think we had the wrong approach here so can you can you do it this way right act better I think that was Christopher Walken said that was the only direction there was really do it better yeah but I love that guy yeah don't we all so um and you know it's it's probably something you get into if you have a desire to help people if you just have a zeal for interesting jobs you know yeah maybe if you have an interest in medicine or psychology or being an educator like you're kind of you are an educator in some ways and in fact in fact I think some of them call

them educators like medical educators yeah there's a national association a national group called the Association of Standardized Patient Educators yeah and I think they have like ongoing education and core curriculum and it's it's pretty interesting to see just how how much training you can get in this and I imagine if you're really good and really highly trained you you you're not gonna be some part-time you know adjunct employee of a local medical school you could conceivably go around the country or possibly the world especially if you have a specialty sure you know one of the downsides of this is that and

this is kind of a shame but there there is no like controlled randomized trial that can actually prove the effectiveness but by all accounts across the board everyone says this is super important and highly highly effective as it's for students yeah it can't prove it yeah it drives them crazy probably so so you've got you've got standardized patients one of the other ones you touched on that's worth diving into a little more care actors right yeah these are they fall under that same umbrella of a simulated patient but these guys are whereas like a standardized patient is really gonna help a you know second or

third year medical student who has no clinical experience whatsoever yeah and is learning the the very basics of like physical exams or bedtime manner and all that stuff a care actors is much more useful for somebody who's already in practice and has a lot of experience which is wants to get better at it sure right so like a care actor will basically be there to ad lib a little bit based on whatever the the doctor wants to work on say the doctor wants to work on empathy right rather than go through the whole history and the whole and patient encounter from beginning to end they're gonna focus on that one part of

the patient and patient-doctor interaction and they're gonna do it over and over again there's an ability rather than having to start at the beginning and finish at the end you can stop and try something over again if you didn't like it or you want to repeat it like I said there's a lot of ad-libbing and the the doctor can say okay I want to we're gonna do a patient who has psychosis and is in the midst of a psychotic break and it's on a scale of 1 to 10 it's an 11 and I need to be empathetic so let's try it and then they're gonna go from there and they can just kind of switch it up as need be yeah and I think this is

really cool because the doctor can get as specific as they want they can say like you know what I feel like I have a pretty good bedside manner but I have a really hard time dealing with patients when they get angry at me so they'll say all right let's let's dial up an exercise yeah they're like oh you want some anger yeah exactly you asked for it and they'll bring someone in there or like you said if someone was if the doctor was like hey I do pretty well even with patients who have like a psychotic episode but maybe not right in the middle of a psychotic episode I've had some real trouble there so they

again they come in there and like you said this is different they're not surprised on what they're gonna get this is just a very specific training method yeah or the doctors like I I'm fine with kids unless they turn their eyelids inside out and then I can't I just completely lose it so did you ever do that no no I wasn't one of those either I can roll my tongue perfectly and wiggle my ears yeah I can do those things too I can't turn my tongue into like a clover or a club though you know that the kids who could do that yeah I can do that I can't do that I never didn't know you could do that yeah I hadn't pulled

that one out in a while though no you've got to but the eyelids saying that's just there's no reason you do that and unless you're you know you're not going to impress resuscitate you're not going anywhere in life if you're going up to the girls in class with your eyelids turned inside out there's no way to woo a girl no young guys young boys if you're listening to this don't don't don't do that you know what you do be nice to girls and listen to them and trust me on that I'm still learning that one right we all as we grow now I'm always nice but I could always work on the listening sure man I think that's

probably personal that was good advice Chuck hey thanks of you you know if you start out like a if you start a fifth or sixth grade boy out on the right track like that yeah I can be good humans I feel like girls are inherently good sure you don't see girls running around with their eyelids turned inside out never not even Wonder Woman would do that that's true what else so you got standardized patients care actors and then there's I ran across another one called unannounced standardized patients not kidding they they're basically you know what a secret shopper is yes they are highly trained standardized patients

who are secret shoppers at hospitals and doctors offices and stuff like that to go in from beginning to end to rate the experience from the patients eyes yeah that's yeah that's scary yeah yeah but it's cool though that any hospital would do this because you know it's it shows a bit of a dedication to customer service yeah for sure which I think that people forget that you know when you go in for medical care you're the customer you should be treated well like we demand to be treated well from cable providers from car dealers from grocery stores for everybody but we just go into a hospital like complete supplicants like

please don't murder me yeah you know and if you demand to be treated like a good a customer well then well then they do kill you it's a conundrum they're like oh I guess somebody shouldn't have mouthed off and then the pillow goes over the face you sent that one cool article of the the doctor what was he what do you call himself the mood that the guy who basically has recruited medical professionals that are self not actors but you know well they're they're medical actors that dude wasn't even a doctor he was just a doctor no he was a freelance like teaching actor or teaching patient right and he got really

good at it and he specialized in male Euro genital exams right so prostate exam yeah testicular exam and this guy would travel the country doing this and he set up shop actually in Atlanta a company called clinical skills USA right yeah and recruited other people and these people are they just go around the country allowing medical students to give them rectal exams breast exams vaginal exams cervical exams so that they can these students can practice on a live person but more than just a live person because in this article this article is by Elizabeth Coles and I think vocative yeah these medical models

use their own bodies as teaching tools it's really great but she makes mention that apparently medical schools to train med students on gynecological exams back in the day they would hire prostitutes did not know that I didn't know that either I thought these people though had medical background because they're training them as well aren't they yes like a little to the left a little to the right right there it is yes so these people are trained in the exam they're not medical professionals one's a one one that they interview as a real estate agent or no an insurance agent one guys retired from that GM plant which

I suspect probably the one in Dorival yeah and no they're just they know what the exam is supposed to be like and then they've subjected themselves to the exam so many times that they know the right way to do it so well yeah that they can teach med students how to do it but this is still under the supervision of trained professionals right I have the impression that like that the the med school teacher who brings these people in as listen to what this person has to say they're the trained professionals all right well that's interesting yeah so this one guy who's a male urogenic genital teaching associate that they

interview Mike Manning he said that he he estimates he's had somewhere around 4,000 prostate exams man in nine years so yes that guy probably knows more about how to yeah yeah give a prostate exam than anybody in the world well I saw the one picture of the guy like you know been over the table and it's from you know his front and then the the the doctor student doctor behind him and he's kind of looking back like you know that's that's it that's correct yeah I think that was the guy I think that was Mike Manning and Mark Manning yeah what it was interesting yeah I mean what a I don't want to call it weird but what a

just what a fascinating thing to to have a knack for and not and not mind and just be like yeah 4,000 times let's do it yeah it's pretty pretty interesting that these the people who all work for him to are they've kind of become a bit of a family I love that they like go to bars and go to dinner and hang out yeah they do one of the one of them is she's actually she would be considered a gynecological teaching associated GTA rather than a muta yeah her name is Katie Patterson but like she travels the country teaching med students how to correctly insert a speculum yeah I mean like these people are literally donating

their body to science but while they're still alive yeah I mean it's amazing and yeah they're getting paid but I mean they're not getting paid enormous amounts of money they're getting paid something between 35 and 50 bucks per student per day so say you have 10 10 students you make 500 bucks in a day it's not bad at all sure but you're only working 30 days out of out of the year maybe maybe 50 yeah doesn't add up too much so the clearly these people are driven by by much more benevolent thing than the money less their hearts yeah you know yeah you got anything else I got nothing else it's gonna turn out

better than I thought Chuck yeah I think if you um maybe if you're out there and you all this sounds like hey I could probably do that and have a desire to help people learn and I don't mind being you know poked and prodded and I want to make a few bucks look into it we should reiterate that the people who are the male Euro genital teaching associates and the ladies who are the gynecological teaching associates they're very specific and yes you could say I want to sign up for rectal exams and they'd say come on in we need rectal exam volunteers bad right but just becoming a simulated patient of some sort you could say I

never want to do rectal exams yeah just want to do you know bedside man or something like that and they would they would probably just stick to that you know yeah they're not gonna force you to ever do anything that you're not comfortable with no and again regretfully they don't give you any drugs but if you do want that kind of thing yeah if you are interested check out your local med school they probably have some sort of program or again go to the association of standardized patient educators pretty neat yeah and if you're an actor beats waiting tables yeah and in the meantime you can type standardized

patients into the search bar at house of works dot com and since I said search bar it's time for a listener mail I'm gonna call this South African Canadian all right that pick your interest yeah but I know what this one's about hey guys never really had a reason to get into contact into now since you announced your tour up to Canada and that fired my cylinders into action listen to you guys for a couple years probably from early 215 215 2015 215 has been listening forever I was then living in South Africa at 19 fresh out of high school I made the daring decision to leave my family and friends try and make something

of myself I've Canadian citizenship as well due to my father being born in Toronto or Toronto Toronto so I landed there in Toronto early last year made my way a little east and then a lot west to Vancouver where I would be seeing you in September of this year the point is being away from family and friends is brutal at a nine-hour time difference in brutal turns to lethal I often feel lonely or anxious of the future and when this happens if you should know in the three of you lovely people make it not seem so bad as it feels like there's someone right here with me chatting casually about some need a topic it is so

I just want to say thank you for making this move tolerable when it feels sometimes not so great who's that that is KAH and I don't know if KEYA is yeah Kaya Kaya yeah I don't know how Kaya identifies on the gender spectrum well who cares right that's right KAH age sounds for how are you I just want to use right pronoun you know I'm saying sure so what's that one is it cis cis gendered like a gender neutral I'm not sure how about they sure I think they is like making a big a big push right now well a nice email from they yeah thanks a lot Kaya that's pretty awesome congratulations for striking out on your

own it's pretty amazing and thanks for coming to our show in Vancouver and even more than that thanks for giving us a reason to plug our show in Vancouver and the rest of our tour where people can get tickets at sysklive.com and we're right all right well if you want to get in touch with us like Kaya did you can tweet to us at syskpodcast you can join us on facebook.com slash stuff you should know you can send us an email to stuffpodcast.howstuffworks.com and as always join us at our home on the web stuffyoushouldknow.com for more on this and thousands of other topics visit howstuffworks.com

on the podcast hey dude the 90s called David Lacher and Christine Taylor stars of the cult classic show hey dude bring you back to the days of slip dresses and choker necklaces we're gonna use hey dude as our jumping off point but we are going to unpack and dive back into the decade of the 90s we lived it and now we're calling on all of our friends to come back and relive it listen to hey dude the 90s called on the iHeart radio app Apple podcasts or wherever you get your podcasts hey I'm Lance Bass host of the new iHeart podcast Frosted Tips with Lance

Bass do you ever think to yourself what advice would Lance Bass and my favorite boy bands give me in this situation if you do you've come to the right place because I'm here to help and a different hot sexy teen crush boy bander each week to guide you through life tell everybody ya everybody about my new podcast and make sure to listen so we'll never ever have to say bye bye bye listen to Frosted Tips with Lance Bass on the iHeart radio app Apple podcast or wherever you listen to podcasts