‘A doctor that’s not a doctor’: How Emily Piette helps teach the next generation of physicians

WASHINGTON — When Washington Community Theater regular Emily Piette steps into an exam room at the University of Iowa, it isn’t usually because she is actually sick. She’s helping train first- and second-year medical students to meet real people with real feelings before they ever meet real patients.

“I’m a simulated patient for the University of Iowa, College of Medicine,” Piette said. “They get lectures on ways to communicate actively to patients, and then they get to practice with us.”

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The work looks simple from the hallway and feels very real inside the room. Piette receives a case “blueprint” with a name, age, job and a reason for the visit. She and other simulated patients work hard to play the same scenario the same way for each student, so every learner gets a fair shot to practice.

“Everybody has the same case,” she said. “We learn everything you’d want to know about a person … and then what is wrong with us.”

Students meet her in clinic-style rooms with exam tables, sinks and a blood-pressure cuff on the wall. Cameras record the sessions so learners can see themselves the way a patient would. Additionally, students receive feedback from the simulated patients.

“They can be like, ‘Ooh, I say “um” every three seconds,’” Piette said. “We wouldn’t say ‘annoying’ — we’d say, ‘It was really distracting when you tapped your pen on the table.’ We get a lot of training on how to give feedback.”

Her first encounters with new students often start with shaky introductions, but repetition builds confidence.

“They’re very nervous,” she said. “They’re used to being very, very good at what they do. Now they’re thrown into a situation where this is a test, but it’s how you talk.”

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As students make their way through more simulated patient sessions, however, Piette says she really gets to see them grow through experience, coaching, and trying again.

The scenarios feature a wide variety of characters. While Piette is a full-grown woman, her small stature allowed her to play the role of a teenager for many years when she started out. Adding this type of variety can help prospective doctors learn how to communicate with parents and children simultaneously and when to ask a parent to step out for privacy.

Piette also assists with a pre-clinical “difficult conversation” week for students about to start hospital work. They come in and have to have a difficult conversation with a simulated patient.

According to Piette, these cases range from an angry patient to delivering hard news. Students practice the words, then process how it felt.

“The feedback is always amazing … they really appreciate a chance to, you know, get those words out of their mouth once when they’re allowed to mess up,” she said.

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Piette’s acting skills play an important role in her position as a simulated patient.

“I enjoy the cases where I get to portray emotion,” she said. “I’ve gotten to cry and I appreciate seeing the students learn how to comfort people in those situations.”

She encourages the students she works with to keep one rule in mind for these types of situations.

“We always joke it’s like a TSA thing,” she said. “If you see something, you say something — acknowledging emotion and ways to provide comfort. The patient will appreciate it if you hand them the box of tissues.”

How does someone even become a simulated patient? Obviously they have to audition. It also doesn’t hurt to know someone who knows someone.

“It’s kind of the classic, like somebody knows somebody who knows somebody kind of thing,” Piette said of her start with the program.

A friend mentioned the program needed people in her age range who could memorize, convey emotion and improvise. With past experience performing and those skills in her back pocket, Piette decided to give it a shot. The flexible schedule—she accepts only the sessions that fit—is really what sold her on the position.

As a mom to four daughters, Gwen, Greta, Anna, and Cora, she wanted to continue to prioritize them while enriching herself.

“I needed something to use my brain,” she said. “I needed a challenge, and I also needed flexibility. I’m able to do it around my girls’ schedule, and I’m still learning a lot.”

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After submitting her information and an audition, she was given a lot of training before actually interacting with students. That training is continuous. For every case she does there is a group training, regardless of whether someone has performed that case before or not.

“They try really hard to have us all be the same … so every student gets the same experience,” she explained.

Piette also holds a second role as a physical exam teaching associate for first-year students.

“We teach them how to do physical exam skills,” she said. “How do you take a blood pressure, how do you look in somebody’s ears?”

The students practice on trained associates and hear immediately what works and what hurts. Piette has a lot of understanding for the students as they’re just learning, because even as a physical exam teaching associate, there was a decent learning curve,

“I had to practice on my daughters,” she said. “One of my girls would say, ‘You’re just tickling me!’ They call me a doctor that’s not a doctor,” she said.

Before she stepped into simulated exam rooms, Piette worked as a vocational instructor at Systems Unlimited and spent nearly a decade as a birth doula. The hospital setting felt familiar even if the content changed daily.

“I was totally comfortable in this setting,” she said.

She describes the job as acting with a purpose: hold the scenario steady, watch closely, and give honest, usable feedback. Sometimes, though, the hardest part is knowing when to let go.

“Some students have trouble acknowledging that simulated patients are actually people,” she said. “We try to point that out in our feedback. Some receive it, and some don’t — and I have to be okay with that. Their outcome isn’t actually on me.”

Either way, many of the communication skills that she helps teach the students easily translate into the rest of her life. Some of these include chunking information and checking for understanding before moving onto the next bit of information. Those participating in the program even have a name for this.

“We call it talking like a pineapple, where you have to check and chunk — you chunk, and then you check … you can always stop and ask, ‘Can you tell me what you would tell another person about what I just told you?’” Piette explained.

Additionally, Piette has learned to ask people what questions they have instead of asking if they have any questions.

“It’s just a little turn of phrase, but it makes a big difference,” Piette said,

Her own clinic visits run differently now. She knows what the maneuvers mean, even if she doesn’t diagnose.

“When I watch the girls get their physical or something, I’m like, oh, I know what they’re doing,” she said. “I don’t know why you’re doing it, but I know it’s what you’re doing.”

While she appreciates the challenge, paycheck, and skills learned, Piette says her favorite part of being a simulated patient is seeing students grow.

“I see them the first week of school … and then I see them progress through and then, like, part of their testing at the end of their third year,” she said. “Seeing how far they’ve come — from very, very new, almost unsure med students to very competent, thoughtful, like doctors, basically. That’s probably my favorite part.”

In Washington County, many know Piette from the stage; at the University of Iowa, students know her from the exam room. And she is more than happy to play her part so others can grow into theirs.

“It’s a really good part-time job,” she said. “It’s really, really satisfying.”

Comments: AnnaMarie.Kruse@southeastiowaunion.com