Picture this: a doctor walks into an emergency room, and a patient starts screaming at him, throwing objects across the room and becoming increasingly violent.

It's a daily reality for health professionals dealing with anxious, upset or confused patients, but one Toronto doctor has developed a way for his colleagues to better prepare for the challenge.

Dr. Brian Hodges is the executive vice president for Education at the University Health Network and a professor in psychiatry at the University of Toronto. Using actors called "standardized patients," Dr. Hodges helps to teach doctors how to react to patients in a psychological crisis.

It's good to try different responses with an actor in a simulated environment and really solidify your approaches ... - Dr. Brian Hodges

"They sit in waiting rooms, they learn about the lives of the person they're going to portray, and it's largely ad-libbing," he said. "They have to get into the mind-set of someone struggling with one of these conditions."

The doctors always know when they're dealing with an actor, but that doesn't mean the situation is any less intense.

"The actors are trained to adapt the emotional tone to what they're receiving from the health professional," Dr. Hodges told CBC Radio's Metro Morning.

"So, if somebody is in fact very empathic and has good techniques and calms them down, they'll respond to that. But if on the other hand they're cold, they don't make eye contact, they show poor interpersonal communications, the situation will escalate such that it becomes more and more challenging."

Dr. Hodges began to research this approach following his own schooling in medicine, realizing students needed more practical experience in uncomfortable situations.

Dr. Brian Hodges, second from the left, uses simulated scenarios to teach future doctors how to deal with a crisis. (UHN)

After being appointed to his position in the early 1990s, he began to look at how that system could be fixed.

Initially his idea received criticism from fellow doctors, but with more experiments, they realized simulating human emotions could be a huge asset to a doctor's preparations.

Today, he said, students need to go into these scenarios and prove they have the required skill set before they can be licensed. His research is also used across the world to help train and assess new health professionals.

But even with the right training, Dr. Hodges said every doctor can experience "compassion fatigue," where the high-stress environment becomes overwhelming.

The actors give doctors the opportunity to practice and ensure they're prepared for their most vulnerable patients.

"It's good to try different responses with an actor in a simulated environment and really solidify your approaches so that you have a skillset, a toolkit you can use when you encounter these challenges in real practice," he said.

Dr. Hodges also teaches his approach at Addis Ababa University in Ethiopia through a collaborative project with the University of Toronto.

His research has also recently won him one of the world's most prestigious awards in medicine — the 2016 Karolinska Institute's prize for Research in Medical Education.

He'll receive the prize in Stockholm, Sweden on October 13 and plans to donate his prize money to future research.



