Learning the Art of Care through YSM’s Simulated Participant Program

Excellent communication skills are a fundamental part of practicing medicine. The art of asking questions, listening carefully, and communicating with compassion takes time and effort to master, ideally before real patient interactions.

At Yale School of Medicine (YSM), one of the ways in which students and clinicians can practice patient-focused communication and care is by engaging in practice scenarios with simulated participants (SPs). SPs are actors trained to portray patients with specific medical concerns, allowing students and healthcare professionals to practice their communication skills in a low-stakes environment.

The SP Program (originally known as the Standardized Patient Program) began in 1993 after Frederick Haeseler, MD, former associate clinical professor of internal medicine, attended a clinical conference presentation that featured SPs. He immediately saw the educational potential and returned to YSM inspired to build a program where students could learn and grow their skills before interacting with patients.

With the support of the YSM Teaching and Learning Center, Haeseler recruited eight actors from the shoreline area of Connecticut.

“They were happy to have the chance to do some acting and help medical students,” said Haeseler. A grant from the Robert Wood Johnson Foundation funded generous stipends for the actors, which also helped attract talent.

Haeseler wrote scripts for each SP, often taking inspiration from the actors themselves, and rehearsed them before each educational session.

The program was an instant success with students, with Haeseler noting, “it was well-received–more so than I ever expected.”

One of Haeseler’s goals for the program was to introduce students to a new way of interacting with patients. He noted that at the time, clinical interviewing was mostly transactional, with doctors asking a series of yes or no questions.

“I offered students a different approach to communication,” he said. “Instead of asking ‘did you do this or that’, I encouraged them to use open-ended questions like ‘what brings you here today.’”

This approach aligned with contemporaneous literature that advocated for more patient-centered communication.

After each interaction, Haeseler helped translate the SP’s experience into actionable feedback.

“The SP would say, ‘when you said this, it closed me off; had you said that, it would have been different’,” Haeseler recalled. “It gave students the opportunity to reflect on what they were doing during an interview. It was a great way for them to get real-time feedback from both the SP and the supervising faculty member.”

As the program’s popularity grew, so did its reach. In 2004, YSM dedicated seven clinical practice suites in the basement of Harkness Hall to the program. The suites, which are still in use today, replicate clinical rooms and create an immersive experience for SP interviews.

Recognizing the potential to improve patient-centered care for practicing clinicians, the program expanded its training opportunities to all health professionals at Yale. In 2022, the name was updated to “Simulated Participant Program” to encompass the variety of roles SPs now portray, from patients and caregivers to parents and clinicians.

A year later, the program moved from the Teaching and Learning Center to the Center for Healthcare Simulation, cementing its place as a core educational resource for both YSM and the Yale New Haven Health System.

Today, the program has a robust library of scripts, over 60 SPs, and offers bespoke training scenarios to meet specific objectives and educational goals. The program’s continued popularity is not only a testament to its educational value but underscores the importance of human connection in medicine.

Haeseler, though retired, is still finding ways to participate in the program he started over thirty years ago, recently completing a script that will be used in patient scenarios for years to come.

“I may not be in the room anymore, but if the work I leave behind continues to help students become better clinicians, then I've done my job.”