Truth, trust, and transparency are key in a patient’s relationship with their healthcare provider. Good health for ourselves and for our pets requires near-perfect interactions with healthcare professionals that meets a range of experience and results. The humanistic element of medical, pharmaceutical, and veterinary training transcends bones, organ function, blood type, and a list of medications. How to bridge the gap? How to teach these students to develop their bedside manner?

The Advanced Communication Training Resource (ACTR) program supports development, training, and assessment for students and professionals in a variety of fields through developmental workshops and crafting simulated live encounters with authentic and meaningful role-playing experiences with trained actors. Since 2009, the program, once known as the simulated patient program, has applied high-level theatre skills—in developing creative thinking, empathy, teamwork, physicality, and improvisation—to help train medical students, pharmacy students and veterinary students at the University of Georgia.

“I’ve had really good health care, and I’ve had really bad care and it makes a difference, not just in addressing the physical health of a patient but also their psychological well-being,” said Jennifer Marks, Academic Professional and Managing Director of the ACTR program in the Franklin College of Arts and Sciences department of theatre and film studies. “Getting the patient or client to be compliant with the care you’re trying to give, getting the whole story from them, the dynamics of good care make or break this balance.”

The practice of using simulated patients goes back decades. The late American physician and medical educator Howard Barrows, Professor Emeritus at the Southern Illinois University School of Medicine, pioneered several innovations in medical education, including Problem-Based Learning and the assessment of clinical skills using simulated patients.

Training health and life sciences students in communication

The method Barrows developed to train physicians emphasizes consistency and standardization, regardless of how the student behaves. The UGA approach, rooted in contemporary actor training techniques, diverged from Barrows by emphasizing the ability to perform authentically in the moment and respond with subtlety and sensitivity to what the other person is doing.

Participants are called standardized patients in that every patient must be consistent with each encounter with each healthcare or life science student, so that each of them has an equal chance of passing their test. And while some simulated encounters are done for testing purposes (Barrow’s emphasis), the ACTR program is also utilized in pedagogy. SP/SC encounters are now an essential part of clinical training in many fields.

“It’s not only about getting those communication skills but learning to do physical exams, ask the right questions, convey important information, establish trust,” Marks said.

ACTR uses acting methods to train its simulated patients/clients, local actors as well as non-actors who are often retirees in the community, how to perform the physical, emotional and psychological circumstances required. They need to know how to exhibit abdominal pain in the right place for accurate diagnosis, perform as a harried mother needed over-the-counter medications for their sick child, or react to serious news about their pet or themselves. In its work with the College of Veterinary Medicine, the program trains actors to work as the client (pets are the patient).

Effective communication is as important as more ‘traditional’ clinical skills such as performing ultrasound imaging or examining specimens under a microscope.

“The ACTR program is essential for the training of DVM students. Communicating effectively with clients about patient needs is the most important skill that a veterinarian can possess,” said Andy Moorhead, associate professor in the UGA College of Veterinary Medicine who has worked closely with the program. “By interacting with trained actors throughout their training, it allows veterinary students to not only solidify essential core communication skills, but also exposes them to the more difficult conversations that often happen with owners.”

The ACTR program, which began in 2009, has also supplied actors for the School of Social Work and the Interprofessional Education program. The medical school hires and schedules their standardized patients in house. Dr. Stephen Goggins, who was charged with developing the UGA/AU Medical Partnership’s clinical training program, collaborated with theatre faculty member David Saltz to create a new approach to Simulated Patient training that became an integral part of the clinical curriculum. ACTR trained their standardized patients from 2009 to 2024 when the partnership was paused with the establishment of the UGA School of Medicine.

The power of improvisation

Simulated patients/clients use improv techniques to react authentically to each possible scenario, whatever the case is. They learn to react in the moment—responding directly to the student in front of them while also maintaining consistency from encounter to encounter.

“You can design a program, but it’s hard enough to get students to suspend disbelief, because they know they’re coming into the room with an actor, but that’s our goal,” said Saltz, professor of theatre and ACTR Executive Director. “As soon as they can buy into this scenario, forget that this person is an actor and see them as a real patient or client, that’s when the real learning happens.”

The UGA College of Pharmacy began collaborating with Theatre in 2017 to integrate simulated patient counseling experiences in the curriculum. “Early on, theatre provided valuable insight on how to successfully integrate SPs into pharmacy simulations,” said Kay Brooks, associate director of Introductory Pharmacy Practice Experiences. “Over the years, our reliance on their expertise has grown.

The addition of the ACTR Program Managing Director position provides a centralized UGA structure and expertise needed to expand the program resulting in a more diverse and qualified pool of SPs and SCs.

“The simulated encounters offer pharmacy students a safe place to practice clinical decision making and communication skills learned in the classroom in an authentic way,” Brooks said. “When asked, students often describe the importance of the SP counseling sessions to help build their confidence and skills.”

A critical part of the job with the standardized patient or client is to provide feedback, so they have to be able to read the person in the room with them, while they are performing.

“The actor has to be able to perform, but realize that they have a scene partner and be able to give feedback to that scene partner,” Marks said

For students in the health and life sciences – they’re getting a chance to practice on a real human being, who is not a peer or faculty member and thus might not respond the way they expect. It’s a chance to practice the skills, say the right things, in the right ways, and then also practice physical exam skills. For pharmacy students, it’s the information that they convey, how much they say, and tailoring that information to the patient, rather than sticking to a script.

It’s easy to see how the ACTR program is applicable to a variety of other professional training programs, from law to social work to education. ACTR is in the first stage of working with their current partners on using improv to work with students on Personal Identity Formation, helping these students figure out what kind of veterinarian or pharmacist they are as they embody their training and practice their skills.