Frequently Asked Questions

Please click on the links below or scroll down for answers:

What types of clinical vignettes do you produce?
Do your training titles contain actual patients?
Why don’t you film actual patients?
Why do you have introductory training titles?
Why are your patients “groomed too well? Why are your patients too disheveled?
You don’t have the training titles I’m looking for to use in my class.

Answers

1. What types of clinical vignettes do you produce?

During the past 30 years, Dr. Fidler and the professors and instructors at universities, medical schools, nursing schools, and social work programs who use his clinical training vignettes succeed in part because Dr. Fidler presented at regional and national meetings how to use the training titles as well as developing teaching guides. He developed two types of clinical vignettes:

Simplified vignettes to be used as building blocks for novice students to learn symptoms and diagnoses.
Complex vignettes which present patients as they appear in real life with confusing mixtures of symptoms from many diagnoses and often with more subtle symptoms which are not always clear to interviewers without obtaining collateral information or conducting further interviews which are more appropriate for more advanced students/programs.

We intend to expand the second type of complex interviews, moving beyond the building blocks and into the more nuanced areas reminiscent of real-life clinical scenarios. For continuity as students advance in their skills, instructors can use the complex training titles to build upon the skills or recognition learned from the introductory clinical vignettes. In these nuanced training titles, new sets of challenges and debates will present, including whether portrayals are accurate or realistic, what diagnoses the patient has, and the symptoms of the patient. Just as in a clinical setting, the symptoms and diagnoses may be debated upon depending on the person interviewing the patient.

Dr. Fidler tested his early training titles upon the Video Subcommittee of the American Psychiatric Association, by showing his clinical vignettes and not telling the experts which training titles were actual-patient interviews and which were with actors. Even the members of this committee had great difficulty, and sometimes disbelief as to which were real and which were acted. It is essential to have clinical experts – psychologists, psychiatrists, social workers and/or psychiatric nurses – who are experts in diagnosing as well as experts in working with actors/directors/writers present and collaborating when producing these training titles. We are committed to achieving this.

2. Are these actual patients?

All segments are portrayals by actors. The training titles DO NOT include actual patients.

3. Why don’t you film actual patients?

Dr. Fidler has several reasons he moved from filming real patients to working with actors when producing training titles:

University lawyers and risk managers (and the IRB) noted that as with research, people with mental illnesses may lack decision-making capacity and thus there can easily be challenges to acknowledging that patients truly were capable of giving “informed consent.”
The former APA Video Subcommittee worked to draw up guidelines two decades ago when guidelines were less strict than they are now with HIPAA. Contracts with patients who are filmed must now have the clause that patients at any time may change their minds and transcend their permission for films to be used for any use including educational uses. Since producing high-quality films is expensive, it is too much of a risk to produce educational training title packages and suddenly have one or more patients request that their training titles be removed.
When the APA Video Subcommittee tried to edit training titles with real patients to demonstrate the multitude of symptoms teachers wanted to show, almost no patients truly demonstrated all of the symptoms, which were desired to show, and often even then the symptoms were not clear because patients were guarded and inhibited by cameras, lights, and microphones, hiding their symptoms.
By using actors, the training titles can be used in settings ranging from patient groups to other settings which are not usually covered by patient contracts and to which patients and their families and lawyers would not agree.

4. Why do you have introductory training titles?

The introductory training titles are all intentional as they are meant to create building block training. We are the first to admit these symptoms and patient presentations would never or rarely be found in actual clinical scenarios. We believe and have demonstrated that novice students learn better by simplifying symptoms. Rarely do patients present with all of the symptoms listed for pure DSM diagnoses, and certainly not without having confounding and comorbid symptoms from other diagnoses. In fact, the DSM often states a patient must have 4 of 7, or 6 of 10 symptoms, where as we write scripts for our simulated patients to have all of the symptoms listed for any diagnosis. The intention is to create hyperbole to develop memorable visual/auditory representations of diagnoses. Symptom Media’s introductory training titles demonstrate all of the classic symptoms of many clinical diagnoses.

5. Why are your patients “groomed too well? Why are your patients too disheveled?

Another set of challenges that the training titles have presented is regarding the nature of our patients being “dressed and groomed too well” or “too disheveled.” Part of the benefits to these training titles is that these vignettes help reduce stigmas associated with mental illness.

Many people in the public inaccurately assume that people with marked mental illnesses only live under bridges or live in poverty. Even students if they are only assigned to work at the poorer public clinics come away thinking that people with mental illnesses must be living in poverty. Downward socio-economic drift certainly occurs, but thinking this applies to all people with mental illnesses fosters students into distancing themselves from psychiatric patients and often missing diagnoses in wealthier, more educated patients. We wish to dispel such stigmatizing notions.

For example, the Post Traumatic Stress Disorder Combat Veteran training title actually based on a patient who also now teaches about PTSD at a university. This former combat veteran most often appears as a well put together, attractive, calm, high functioning individual unless he is in a situation which cues his memories of traumas. When first interviewed, he was twenty-five suffering from Post-Traumatic Stress Disorder, having returned from overseas combat and also having been stabbed by his girlfriend. Even though he appeared to be relatively normal and well put together, fireworks at a festival indeed sent him running and the police chased and tackled him, thinking he had stolen something. Only when he yelled that he was a combat veteran did the police help him to his feet and got him a glass of water. These same symptoms may exist in a CEO, a university teacher, an actor, or a homeless person.