Simulated Patient From the First Hour


Introduction and Translation by: Jan-Joost Rethans , Maastricht University, Netherlands


The pool of simulated patients at Maastricht Medical School (Skillslab, FHML, Maastricht, The Netherlands) recently said goodbye to a friend who retired this year after serving as an SP since 1976. (Incidentally, she holds the world record for the number of roles played as an SP).  Because she contributed so much to our teaching and operations for so many years, we have officially named one of our SP rooms in her honor. The “Mrs. Berthie Hamelers” room bears a plaque to display this tribute. I asked her to tell her story to ASPE members through ASPE News and she was gracious enough to do so. Here is her story.

 Jan-Joost Rethans, SP coordinator Maastricht.

Two years after the medical school in Maastricht (the Netherlands) was established (1974) an article in the newspaper ” De Limburger ” asked for people who wanted to play the “role” of a patient. After these volunteer were provided with some training, they would be used in the teaching of students of the medical faculty . They were called “programmed patient” or  “standardized patients”.Berthie_0304

At that time, the use of standardized patients was unique in the Netherlands. But, to me, it seemed like a fun thing to do, since acting had always been my hobby.

After my wedding in 1966, I quit my job. When a girl married in those days, it was expected that she would become a housewife and over time a good mother. Although I had two children, a 10-year-old son and a 9-year-old daughter, I knew I would have time to participate because the activities were during school hours and the university was closed during the children’s school holidays. In 1976, travel to the university was only a 10 minute bike ride for me, which was another advantage. So, I signed up to be a simulated patient at the medical facility.

All of the applicants were sent a questionnaire and after careful review some were invited to a personal interview. The acceptance letter I received in September 1976 stated that they had received an overwhelming response – 300 applicants. I later heard that in the beginning the question was no longer “How do we get enough simulated patients?” but rather “How do we get rid of them?”

In January 1978, I received my first role as a patient. The student-SP interviews were videotaped, so the encounter could be reviewed by the student and instructor. The recordings also allowed other students from the tutorial band to observe the encounter and participate in a discussion. The student who conducted the interview was assisted by an observer, a peer student, with whom (s)he could consult during a time-out and who started/stopped the video. I founded it very interesting and fascinating to see how varied the responses and the behavior from different students were. As it turned out, the majority of my roles involved portraying mental health problems.

The feedback we gave after a consultation was very simple. We were given a form which contained questions like “Would you like to have this student as a GP?” and “Did you feel at ease with this student?”. Our options for each question were “Yes/No/Maybe/I don’t know”. There was also a space for us to write comments. I found it very interesting and fascinating to see how varied the students’ responses and behaviors were to our questions.

Besides the medical history interviews, we were asked to undergo simple exams like measuring blood pressure or testing reflexes. After a few years, we were also asked to undress (remove our bra) for some physical exams. I remember that this was quite a shock for some women because they were not  prepared for this! However, we soon got used to this. Another interesting component was when the university informed our family doctors that we played roles as SPs. They were afraid we would simulate with our doctors, too!

Several changes have occurred since I first started working as a SP. Now, there are many more students, so we are scheduled more often. Another transformation is our feedback has improved significantly; we were taught to give feedback based on our feelings and experiences without giving a mark to the student. The roles that we played and our training also evolved. Initially, our roles and training were standardized – the same for everyone. However, some people had trouble empathizing with a situation that was not their own and this hampered their feedback. For example, if you were asked to play a role where you were supposed to have a bad headache, your real background would impact your performance. You would respond differently if you were single and could go back to bed after the activity than you would if had several children who demanded your attention or if your parent had died from a brain tumor. Because such differences in perception had an impact on feedback, our roles in educational situations were individualized rather than standardized. (This change did not apply to assessment situations.)

A few more things have changed at the university during the past few years. The university has not only grown bigger but it has also become more businesslike, which I consider a natural thing. And, nowadays we have to print and keep our scripts ourselves, whereas in the old days we received all copies for free.

My functioning as a simulated patient certainly had a big influence on my life. I learned to listen to what was said or asked by others and to formulate my answers. I seemed to do well as a SP because I was regularly asked to join faculty as they taught courses on “problem-based-learning” throughout the Netherlands. During  these lessons, the phenomenon of “simulated patients” was discussed. More and more, I was also asked to participate in external simulations, such as nursing courses in other cities (Sittard, for example) and hospitals in Eindhoven and Helmond.

Outside the university, I benefited from learning to articulate what my feelings/thoughts were. One area where I was able to use the skills I learned as a SP was in my parish liturgy group.  Sometimes, during the holidays, I along with other members of the group helped our pastor by conducting a service of word and prayer. For some services, I also wrote the consideration.

As I look back over the years that I have been a simulated patient, my fondest memory is the camaraderie I had with other simulated patients and the skills lab staff. Again and again, I experienced a lot of fun while I was there. It is with pain in my heart that I must leave now due to health issues. I have had Parkinson’s disease for several years and my mobility has deteriorated in recent months. Now, I can no longer function as a simulated patient and that hurts!!

It is a sweet thing, however, to learn that I hold the record for being the world’s longest working SP!