Actors follow a script to help train medical school students

On a crisp January morning, Angela de Caprariis-Salerno, 77, a retired clinical pharmacist, hopped in her car and zipped off from her Garden City home. She felt great and was eager to face the day.

When she arrived in Mineola, she began behaving like a completely different person — someone who was unaware she’d had a brain injury affecting her left side.

It wasn’t a health emergency. It was showtime!

De Caprariis-Salerno is a “standardized patient” hired by NYU Long Island School of Medicine to play people whose ailments prepare aspiring doctors for real-life experiences.

“I never took acting classes,” said de Caprariis-Salerno, who has emerged as a sort of Meryl Streep of med school theater. “But I’m pretty outgoing.”

Since the school opened in the summer of 2019, standardized patients have played a key supporting role in the program to educate students and to build their communication skills and empathy.

“I play about a dozen parts,” said de Caprariis-Salerno. “One is a woman who’s had a stroke, one is experiencing hallucinations, and another shows early signs of dementia. You know, all types of things.”

She’s in excellent company. There are another three dozen standardized patients in the med school’s cast list. Some are professional actors who rely on these roles to fill in the gaps between gigs. Several are retirees whose flexible schedules are a good match for the job.

De Caprariis-Salerno was joined on Tuesday morning by Ron Ulrich, 65, a retired Northwell Health employee from New Hyde Park. He portrayed a man with diabetic neuropathy.

Ulrich typically plays men with respiratory and cardiac issues. But just like on Broadway, where understudies and swings fill in, Ulrich stepped up when a scheduling conflict arose for the actor originally set to play the part.

“I was sent the script on Monday morning,” Ulrich said, adding that he had a Zoom rehearsal later that day and a run-through early Tuesday morning. Practice is needed because authenticity is key.

On Tuesday afternoon he and de Caprariis-Salerno played a married couple in a simulation for fellows in the school’s geriatric program. Her character was grappling with high-stakes post-surgical complications.

“I’ve had at least five husbands,” said de Caprariis-Salerno, whose offstage spouse is a former pharmacist.

‘Standardized’ patients

All the world’s a stage, indeed. For standardized patients their platform is a simulation center on the second floor of the medical school on Mineola Boulevard.

In this cluster of exam rooms, one-on-ones between students and patients during simulations are monitored from a control room. They are also recorded so that faculty can review them and give feedback. Some are graded, some are not.

“There are six students here today. They’ll be meeting with two standardized patients,” said Franny Bavaro, 61, of Sayville, a standardized patient educator, who observes interactions in real time from the control booth.

The official name for the simulations is Objective Structured Clinical Examination, called OSCE. This one was focused on neurology. Others concern medicine, primary care, psychiatry, OB-GYN, surgery and pediatrics. Graduate students go through a geriatrics OSCE.

As in the real world, time is a factor in the simulation. “Students have 20 minutes in the room with patients,” Bavaro said, adding that another 10 minutes are used for a post-exam evaluation.

During the first 20 minutes, students assess patients. What condition do they have? How do I respond to the situation? During the follow-up time, students and patients separately record notes on the case. Students meet with faculty to discuss the cases.

Anthony Anzano, 25, of Levittown, and Jasmine Brite, 24, who lives in Queens, were among the medical students being observed. “We’ve done other OSCEs and we know this one is neuro,” Brite said before the simulation. “Otherwise, we don’t know what we’re walking into.”

Inside the sim lab

The challenge of facing the unknown and testing their skills appealed to the students. “These actors and actresses are amazing. You really can feel like you’re talking to a real patient,” Anzano said. “They get a script they have to follow pretty closely, so you can ask them any question that you would ask a normal patient.”

The simulation started. A digital clock in the exam rooms ticked down the minutes and seconds. Brite and Anzano began the same way — with a friendly hello. From there, like in real life, the cases were dramatically different.

When Anzano introduced himself to de Caprariis-Salerno’s character, she didn’t respond. That was according to the script. Because of her condition, she had no response to any stimulus on the left side of her body. He moved to her right side, and he tried again.

“I’m a medical student from the neurology team,” he said. “Oh, hi,” she said.

“I’m sorry. I was talking to you,” he said. “I didn’t know you didn’t hear me.”

He asked why she was there. She said she’d dropped a cup earlier that day but didn’t know what the fuss was about. He asked her to raise both arms. She lifted her right arm. Her left one didn’t budge.

Meanwhile, in a nearby room Brite asked Ulrich why he was there. In character, he immediately answered. He said he had a tingling in his lower legs. She asked a battery of questions. Can you feel this? Can you feel that?

“You have five minutes remaining,” Bavaro announced from the control booth. When time was up, the students and patients completed their assessments. Then Brite and Anzano swapped patients.

De Caprariis-Salerno and Ulrich, who never broke character around the students, repeated their roles and gave the same performance — which they would repeat four more times that morning. (Fair warning to anyone who thinks two-show matinee days on Broadway are a challenge!)

“Standardized patients are trained to rate communication and professionalism skills,” said Bavaro, adding that they’re selected to be realistic in terms of age, gender and other traits relevant to the case.

Part of the actors’ training includes what details to share freely and what can only be revealed if asked. “The main note I give my standardized patients is to be sure they’re not giving away too much information,” she said. “They want to make sure the students succeed.”

Like other actors, standardized patients get reviews, according to Gil Darrell, a retired Suffolk County salesman. He recently played a man with depression.

“We’re evaluated once a year,” he said. “It’s always been positive. I’m not a candidate for an Oscar, that’s for sure. But if you weren’t that good, they wouldn’t use you.”

Tried-and-true tool

Standardized patients have been used as teaching tools for decades. They broke through to the mainstream in a hilarious way in 1998 on “Seinfeld,” the hit NBC sitcom about nothing.

In the episode called “The Burning,” the always out-there Kramer took a gig as a standardized patient with a sexually transmitted disease. Asked if he was experiencing pain, he went off-script and said, “The haunting memories of lost love.” Then he lit a cigarette and recalled a romantic encounter.

Bavaro tolerates none of that yada yada.

“Each case is specifically designed with the faculty,” she said, adding that they’re called standardized for a reason. Performances are standardized from student to student, and portrayals accurately reflect the content of the case study.

Actors are paid $28 an hour for a minimum of two hours’ work. “It’s nothing to sneeze at,” said Ulrich, who also loves being a part of med students’ education.

“I personally only do it for one reason, for the satisfaction of knowing that I am getting something across to these young people,” said de Caprariis-Salerno.

“The whole purpose of this,” she added, “is so that young students and young doctors can learn how to have empathy and understanding when dealing with patients.”

After the simulations, Anzano said that the interactions took him beyond just reading something in a textbook. “When I see a patient who presents in a very similar way, I’m much more likely to know what to do.”

One of Brite’s takeaways related to time constraints, which are often cited as a barrier to bedside manner. “You can fit empathy into a tiny window,” she said.

Being a standardized patient has been a two-way educational street for de Caprariis-Salerno. “I’ve learned that I’ve got to listen better,” she said.

Some OSCEs have led to diagnoses unrelated to the actual case study. During simulations, medical students have performed exams that uncovered a heart murmur and a breast lump. “They both led to happy outcomes,” said Bavaro.

De Caprariis-Salerno is delighted to be gearing up for a performance in February. “I love doing it,” she said. “It’s fun. It’s challenging. It’s rewarding.”

For her and her castmates, it’s just what the doctor ordered.