When your standardized patient can’t be two years old
Most simulation programs have a strong roster of standardized patients. Almost none have a convincing two-year-old.
That’s the gap Dr. Emily Thomas built her pediatric pertussis case to fill. Thomas teaches at the West Virginia School of Osteopathic Medicine, where standardized patients are a core part of clinical training. Toddlers, however, aren’t exactly available to hire. Pertussis is rare enough that many residents will only see it a handful of times in training, if ever. Thomas wanted residents to recognize it in simulation before they had to recognize it on a real shift.
Enter Nala, a 26-month-old whose mother brings her in for a cough that won’t quit.
Ask about the character of the cough, and learners find out Nala coughs until she gags. Check the record, and there’s a growth chart and an incomplete vaccination history. Dig further, and every other child at her daycare recovered from the same illness weeks ago. Nala didn’t. No single detail gives away the diagnosis. Together, they point away from a routine viral illness and toward a pertussis PCR.
Here’s what that interview actually looks like.
At the time Thomas built the case, InvolveXR didn’t have a pediatric cough sound. So she played one from an iPad during the encounter, timed to the dialogue. She also split the vaccination image in two after finding it read as a blur inside the headset. Neither change was flashy, but both made the clinical cues easier for learners to catch.
The medicine is only half the case. Interview Nala’s mother long enough, and the vaccination gaps trace back to a cross-country move, a job loss, and a stretch without insurance. Thomas built the case to steer residents away from assumptions and toward the actual question: what happened, and what does this family need now.
Even the medication drawer is deliberate. Thomas stocked it with distractors, medications unrelated to pertussis, so no one can guess the diagnosis just by scanning the drawer.
Nala’s case doesn’t branch or deteriorate. It’s one state, built entirely around the interview.
That’s exactly why Thomas sees it as an extension of her standardized patient program rather than a replacement. Virtual patients give learners another chance to practice encounters that are hard, sometimes impossible, to stage with traditional simulation, starting with the ones too young to hire.