Educational Consulting and Standardized Patient Work with Medical Students,
The Third Dimension of Chameleon Audition Survival Training
From 1997 until 2002 Michael worked as an actor and trainer for the Standardized Patient Pool in Vancouver, and in 2002 he took over the company. The SP Pool specialized in delivering actors trained to do repeatable patient simulations for the purposes of teaching communication skills, practice training, and practical examinations of students and working professionals in many different areas of the medical field.
In the decade he was involved with the Objective Structured Clinical Examination or O.S.C.E. process, Michael portrayed dozens of roles geared towards teaching communication skills for clients such as The Medical School of the University of British Columbia, the College of Pharmacists of British Columbia, The Canadian Department of Veterans Affairs, The College of Midwives of BC, and the Clinical Competency Program which examines doctors who have been sanctioned and need to be reinstated as well as doctors trained at foreign universities who must prove they have the same level of training as locally trained doctors before they can practice, to name only a few.
Between 2002 and 2009, Michael developed cases and ran the Standardized Patient Program for the British Columbia Institute of Technology School of Nursing and for the British Columbia Justice Institute Paramedic Academy Advanced Life Support examination process. During this period he also worked for the University Of British Columbia Medical School as an in-house trainer for their Standardized patient program, supervising and running practical examinations and workshops for students at all levels of medical training, and as well he was the site coordinator for the LMCC Medical Licensing Board of Canada’s Vancouver Examination location. The LMCC examination tests candidates for their MD license.
His work with this method of training medical professionals and of teaching communication skills has added a third dimension to the Chameleon Audition Survival Training System and has provided the system with many new techniques never before used for training Film/TV actors. During a typical full day MD Licensing Exam, an actor can perform his or her 5 minute role between sixty and eighty times. Each time has to be virtually identical to the next, so that each candidate doctor will be dealing with the same situation. There is always a real doctor in each room marking the candidate doctor’s performance, so the actor will perform the role in a small examination room up to eighty times in a day for an audience of two.
Michael explains: “The thinking behind it is this: when medical students are trained in most places, groups of residents are brought around the hospital to practice their new skills or lack thereof on real patients during rounds. There are many potential problems associated with this process. First, real patients don’t always appreciate being practiced on by groups of students… second, real patients’ behaviour is not standardized to be repeatable from student to student or group to group, third, every group of students will have a different set of patients and therefore experiences, and fourth, the students will make their mistakes on actual patients, which is potentially upsetting or even hazardous to individuals who are already in a weakened or injured state. The concept behind the standardized patient process is that an actor or retired medical professional trained to do a repeatable patient simulation will be able to give any student at any time a virtually identical training experience by being a believable patient that is predictable and repeatable. Also, any actor can be trained to play the role the same way, and can be taught specific ways of giving feedback to the students. That being said, there is a tremendous amount of improvising within the structure, based on the behaviour of the student doctor. The standardized patient needs to understand the intentions of the case, and the parameters of the exercise…his or her rules and limits, so to speak… is he allowed to yell? Will she cry when she is asked a certain question? Will he exhibit aggressive behaviours like pacing and hovering?
Doctors need to be trained in every subtle situation they will encounter, because in the real world, they are expected to behave perfectly and to not make behavioural mistakes; they are not allowed to say the wrong thing out of inexperience or clumsiness, and they need to be taught how to do that, and they need to practice…. They need not only flawless medical skill, they also need impeccable communication skills, and that’s the part we specialize in. By giving the students many years of experience in dealing with standardized patients before they begin doing rounds as residents, we help to ensure that their communication skills will be better developed by the time they deal with their first real patients.
The standardized patient process is also ideal for neutrally examining and evaluating complex professional situations, for example when doctors lose their license and need to be re-evaluated, or when foreign trained doctors need to be evaluated to be considered for a Canadian MD license. In order to deal with the different approaches by different doctors to the same situation, the actor must be able to not only play the scene with repeatability, but also must learn to improvise appropriately within the structure. This translates directly to on camera acting, because that’s exactly what we do when we are acting on set for film or TV. Improvise appropriately within the structure.”
A decade of training standardized patients and of playing complex physical and psychological roles himself has taught Michael more about repeatable acting and about listening than has all of his formal theatre training. “Hardly anyone teaches this stuff, I don’t understand why because it’s some of the most important stuff in our business. Everyone tells you to listen, to be repeatable, to play the situation or the affect without sacrificing the scene, but hardly anyone tells you how to do it. I will. It’s helped my acting improve, and I’ve developed ways to teach it to film and television actors and not just to standardized patients. To me, a scene is the same as a 5 minute patient interaction and vice versa, and I know from experience that after I’ve believably performed a role 80 times in a row, my lines, affect, character, and the scene itself are all truly and finally in me. Much more so than they were at the beginning of the day when I met my first candidate doctor, and I was already fully rehearsed and performance ready at that point. So in my acting and teaching work, I am a true believer that repetition is the secret to absorption, and that’s why I say that running a scene 50 times while preparing for an audition is really the bare minimum. I’ve run my standardized patient role at least 50 times when I arrive at the event in the morning, and it’s taken me 80 full performances to get to the point where I am able to attack it effortlessly and to say I really get it now, and I’m finally ready to perform the scene. There is no substitute for repetition.”
The standardized patient training method has a number of layers that it contributes to Chameleon Audition Survival Training, techniques and approaches not traditionally used for training Film/TV actors, including but not limited to the following examples:
1: Every actor must realize that he or she doesn’t even begin to be able to play the scene freely or truthfully until they have played it at least 50 times at full performance level. That means after the lines are memorized and the scene is on its feet with choices in place so it’s basically ready to audition. This is where most actors stop their preparation, but this is where C.A.S.T. asks you to put in the extra time to practice or run your completely prepared piece another 50 times, to practice the execution of your choices over and over until the whole audition with all its transitions feels as smooth as cream; C.A.S.T. encourages you to see how far you can take your performance. There’s a big difference between preparing and practicing. The sheer number of repetitions necessary to get the scene completely in your body may seem extreme, but there is no substitute for repetition. Any actor will tell you, after 50 solid performances of a play the cast really gets what the play is about, and the performance has grown tremendously since opening night. The audition deserves no less. If your audition exceeds ‘good enough for opening night’, if it also incorporates the growth that 50 performances will bring it, then it will more solid. How could it not be? It will have a depth and a level of craft that not many actors bring into the audition room, and it will get you noticed and talked about. The actors who put the hard work into their preparation will always be glad they did, as they will leave the audition room confident they did everything they could to nail the audition and own the room. Also, remember that most scenes are only a minute or two long, so 50 repetitions of the scene may only take you an hour or so.
2: Many auditions, many scenes require the actor to work with or against a physical or psychological circumstance. How is an actor supposed to simulate a heart attack if he has no training in playing the physical symptoms of a heart attack? How much should the level or intensity of the symptoms be affecting the character’s ability to communicate or to play the scene, in other words, how much affect do we play? How is it that no traditional acting training incorporates actual technique in how to play the circumstance that the character finds himself or herself in? These scenes play out constantly on TV and in the movies. The character in the scene being auditioned may be having a baby, an overdose, a nervous breakdown, a panic attack, a psychotic episode, a heart attack, they may be having trouble breathing, they may be injured, they may be very cold or very hot or very tired, they may have sword sticking out of their stomach, a wooden stake through their chest, or a number of bullets in them. They may be dying…And now they have to play the scene. How much affect is too much, and how much is not enough? How much of that physical or psychological circumstance needs to be in the audition, and once you book the role, how much of that affect needs to be in the performance? How does an actor prepare for this? Through portraying dozens and dozens of these roles as well as by teaching hundreds of other actors how to portray them not only well but also in a repeatable way as well as with accuracy and believability which reaches the standards of the Medical Council of Canada amongst others, Michael has developed the judgement and the techniques needed to train actors to play these conditions believably in film and TV auditions and on set.
3: The standardized patient must play the five minute long scene realistically and believably to an audience that is 2 feet away, which is how TV/Film actors must look at on camera acting, and they must play it 60-80 times in a day. The 70 year old actor portraying the heart attack victim has to have a certain amount of physical tension as he plays his role in order to appear credible, i.e. difficulty breathing, difficulty speaking more than a few words at a time, he has to seem to be struggling… anyone can be easily do this role a few times, mostly riding a wave of nonspecific adrenalin… the 70 year old actor who does it 80 times repeatably in 9 hours is risking having an actual heart attack unless he is highly trained in how to do these simulations in a completely safe and relaxed manner. The character is in spasm, the patient is relaxed and using technique to simulate spasm and tension. The patient who coughs uncontrollably for 80 different doctors for 5 minutes each won’t be able to speak for a week if she doesn’t use proper technique to avoid injuring herself. The actor who is hyperventilating for the case will not be able to maintain it all day or even for 5 minutes without passing out unless she is using breathing techniques to simulate hyperventilation without actually hyperventilating. The actor who is in rage for having been kept waiting and who screams at the doctor for the entire 5 minutes will exhaust himself in less than an hour without proper training on how to seem like he is fully exerting himself when actually he is actually completely relaxed. Imagine how difficult it might be if each of 80 doctors comes into the room to tell you that you have developed a fatal illness and your job is to break down sobbing and then deteriorate psychologically for the rest of the 5 minute simulation, the goal of the case secretly being to see how the candidate doctor deals with the psychotic episode he or she is currently confronted with. It may be easy for you or for any actor to do a few times but it won’t be easy to maintain the repeatability hour after hour. The ability to repeat these behaviours indefinitely requires highly developed technique, because although any good actor can do it a few times in a row, hardly anyone can cry real tears and really break the other character’s heart 80 times in a row for 9 consecutive hours without using technique and craft.
On set, we do so many takes of every scene that repeatability and consistency are absolutely necessary. It’s also true that the actor must have the mental and physical endurance to be able to play the scene over and over for hours both during the audition preparation phase and on set, and since on set the close-ups are usually last, we want to make sure that we still have our best work available at that point and that we haven’t exhausted ourselves playing the scene with full commitment in all the previous takes. Our last take must be as good as our first take or better, and we never know which one is going to be our last take because we only find out when the director decides to move on, and we will never know which take they decide to use in editing until we see the final product. Every take has to be absolutely nailed. Michael gives an example: “The three minute scene I was involved in for the movie White Chicks took us 22 consecutive hours to film. I cannot imagine how many times we repeated the scene in that time, but I can tell you that before my close-up which was the last shot of the day, I had to shave again.”
Actors cannot work well with tension in their bodies, and yet certain situations require the appearance of specific tensions, safely executed. Michael is unique as an acting teacher because through his decade of work in the Standardized Patient field, he has created and developed dozens of breathing and relaxation techniques which can be easily taught and learned, so that the actor who has to audition for scenes which involve physical or emotional distress can know exactly how to play the obstacle of the scene realistically and at the appropriate level without injuring himself, exhausting himself, or distracting from the acting and communicating aspect of the scene, and all without seeming tense on camera. These techniques, not previously used to train Film and Television actors, add a third dimension to Chameleon Audition Survival Training and to any actor’s work.
4: The standardized patient, like the actor on set, must improvise appropriately within a structure all day. The scene, the medical situation, and the affect are always the same, but all 80 doctors will handle the patient and the situation differently just as different actors will handle a scene differently. On set you will quickly find that even the same actor playing the same scene over and over will often throw something different at you. Just because you are paying attention to repeatability and consistency doesn’t mean that they are. You have to be listening all the time, and your attention has to be on your scene partner. Your job as an actor or standardized patient is to adjust to what they throw at you, receive it, and respond appropriately. The standardized patient must be prepared for any question or style of approach from any doctor, not only with the answer but with an intention and with their own agenda. They must be prepared to shift tactics based on what they encounter. The patient with the bad cough may actually be a heavy smoker that will get defensive if the doctor mentions it, suddenly standing up and beginning to pace, speak, and gesture aggressively, and the whole case is actually an examination of how the doctor will handle being yelled at by a defensive patient who behaves in an aggressive way. And that’s only if the doctor figures out the case and even asks about smoking. So the actor must listen constantly for cues, must keep their attention on the doctor all the time, and must be prepared to adjust to anything the doctor throws at them. We cannot dictate how the other person will approach the scene, we must be fully armed, fully prepared, fully present, and ready to turn on a dime. The structure stays the same, the moments become improvised adjustments. Acting on set or in the audition room is the same, although hardly any actors get to shoot a scene 80 times or bother to commit that fully to their own preparation. Chameleon Audition Survival Training suggests that even with proper breathing and the appropriate level of physical or emotional affect, there is no substitute for repetition, and that every actor will admit that a scene gets effortless after enough repetitions. The standardized patient process has taught Michael that, in the same way that a martial artist who receives a black belt is considered to finally have the tools to be able to begin to be a good student, the actor who attacks the scene 50 times once he is already at full performance level is finally able to begin to understand how to play it effectively, easily, and truthfully. When asked by actors “what should it feel like when I’m acting well, with full commitment, and I’m honestly attacking the scene with everything I have?” Michael’s answer is always the same: “It should feel effortless. And your attention should be on the other person anyway, so why are you paying attention to how you feel while you’re playing it. Do you pay attention to how you are feeling while you’re performing CPR on your child after you’ve pulled her out of the pool, or while you’re ending things with a lover who has betrayed you, or while you’re running for your life?”