By Ken Mammarella
Contributing Writer

A simple, five-word question (“Could you send me actors?”) has led to a unique multidisciplinary and accredited educational program at the University of Delaware. 

The question came from Amy Cowperthwait, then the nursing skills and simulation lab coordinator, to Allan Carlsen, an assistant theatre professor. She wanted to improve upon simulations to train healthcare professionals, involving mannikins and people trained as standardized patients to consistently behave and respond to questions during the simulations. The result: Healthcare Theatre.

“The standardized patient may be prepared for 15 questions, but we can’t write a script” for the much more realistic scenarios created at and for UD, Carlsen said. “It has to be improv.”

One of the simplest of the 200 to 300 scenarios involves the anxiety of a patient with a sexually transmitted disease. One of the more complicated, played out during a recent interview at UD’s STAR campus, features four stages of care for a child with cerebral palsy, a feeding tube and a stomachache. The students must “pay attention” to all that’s going on, said Javonte Perry, the program coordinator.

Healthcare Theatre has grown since its 2009 creation from just one class to multiple classes. In 2023, it also became a minor, with those students taking three core courses (an introductory course, an advanced course and an internship) and two other classes, from a selection in animal and food sciences, business administration, communication, leadership, nursing and theatre.

It has grown to encompass a dozen spaces at McDowell Hall, UD’s main nursing building, and the Science, Technology and Advanced Research Campus. The spaces can be customized with mannikins (the most advanced can speak from typed text, bleed and do other lifelike things, said James Burget, a simulation operations specialist), technical equipment, virtual backgrounds and stuffed animals (which may represent pets or may be a child’s treasures) to become an apartment, an emergency room, a maternity facility, labs and hospital rooms. “You name it,” said Carlsen, “and we can make it into it.”

Training and performing

A dozen or so other universities have reached out to UD about starting similar programs, but so far none has, he said. “You have to find a champion in the theatre department,” he explained. 

They also have to embrace an “interprofessional education,” the program homepage says, spelling “theatre” with the ℞ symbol used for prescriptions. “The mission of Healthcare Theatre is to combine the science of healthcare with the art of communication by creating live, standardized encounters.”

At UD, 443 students have taken the introductory course. In three weeks, they are taught how to be a standardized patient, learning the background for certain scenarios, answers to typical questions and how to improvise for whatever happens. For the rest of the semester, they commit to 30 to 32 hours of portraying a standardized patient. 

After the course ends, they can be hired – at $40 per performance hour – for more simulations. Over the years, the program has built a bank of dozens of performers of varying ages, ethnicities, genders, religions and other attributes that contribute to more realistic scenarios. For instance, people are diagnosed with Parkinson’s disease, for instance, at an average age of 60.

The program has contracts with 18 outside organizations, such as Nemours Children’s Health, the Veterans Administration and Sean’s House, the downtown Newark mental health safe haven. It involves students from five of UD’s 10 colleges and schools, but 90% to 95% of the students in that first course are going into healthcare. By getting the perspective of being in the hospital bed, “you’ll be a better communicator,” doctors who were UD undergraduates have told Carlsen.

It has also handled scenarios involving UD’s facilities staff on safety and for physical therapy students in court cases. “We can use a simulation for anything,” he said.

Code Bravo, if needed

Kate Bergwall, a doctoral student in educational statistics and research methods, took a Healthcare Theatre course because she has “a love of theatre.” Plus “it’s a breath of fresh air instead of being in front of a computer,” she said. “And it helps me be more confident professionally.”

She portrayed the mother of the patient with the stomachache, with two students in the room with her for the scenario, and five more watching. After the first two stages, she debriefed them, in language couched in the third person to focus on her feelings. She said she felt frustrated by their using jargon, supported by their discussing financial options, offended by their laughter and valued for being heard.

“When I direct, I don’t tell actors it was good or bad,” Carlsen explained about the debrief, which must be twice as long as the scenario. A pre-brief is not timed. Those pre-briefs and debriefs simulate the sharing of information during shift changes at hospitals.

The setups have been designed as safe spaces, with a sign taped to the wall inviting participants to call out “Code Bravo” if they faint (yes, that’s happened) or have other negative reactions.

Healthcare Theatre “is a safe haven to mess up in,” said Alexis Zitofsky, a junior nursing major, also acknowledging that the scenarios can be “nerve-wracking.” That assessment has been confirmed by measuring participants’ levels of cortisol, a hormone that plays a crucial role in stress response.

Nursing students devote 30 to 40 hours to simulations, Carlsen said, noting the stat came from his two daughters, Olivia Bryde and Andrea Taylor, who are both UD nursing alumnae. 

They and their brother Allan also helped out portraying patients as he was developing the program, and they also helped in an unexpected way for the program’s future. They were classmates at St. Mark’s High School of Heather Mekulski, who Carlsen recruited to take the program’s introductory class and now, as program manager, is being groomed to take it over when Carlsen retires.