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WINSTON-SALEM — Vicki King’s voice trembles as she describes her diabetic brother’s renal failure.

“He’s only 52. It’s such a shock,” she tells the physician assistant in training. “Do you think that I could have that complication, too?”

It is all an act.

Neither King nor her brother has diabetes. Actually, she doesn’t even have a brother.

But on this September day at Wake Forest University School of Medicine, King and her husband, Jim, have been paid to act like they have the disease.

The couple from Climax use their stage and screen acting skills to help train future physicians, physician assistants and other health professionals.

Medical schools call them “standardized patients,” people coached to portray real patients with specific health issues.

The Kings work two to four days each week at Wake Forest and at UNC School of Medicine in Chapel Hill.

Twice a year, they also work with students in the adult/gerontological nurse practitioner program at UNCG.

Medical schools and health career programs employ standardized patients — also called simulated patients or SPs for short — so that students can practice the communication, examination and diagnostic skills they will need on the job.

Students learn how to ask the right questions, conduct physical examinations, use counseling skills, offer emotional support and develop a trusting relationship with patients.

Faculty — or in some situations, standardized patients themselves — evaluate their performance.

“It’s important to train these physicians so that they will be better able to take care of their patients in the real world,” says Becky Wright, standardized patient coordinator at Wake Forest University School of Medicine.

The medical school and UNCG bring in the Kings when they need someone of their age and gender. Their gigs sometimes take them to both Winston-Salem and Chapel Hill on the same day.

“Sometimes we can be two, three, four people in a day,” Vicki King says.

“You really have to prepare yourself. Who am I now? What are my ailments?”

Over the years, she has portrayed patients with signs of dementia, abdominal pain and a brain tumor. Jim King has feigned illnesses such as a heart attack, and, like his wife, abdominal pain and a brain tumor.

When Jim King tells people what he does, “Everyone says, 'Oh, like that thing on 'Seinfeld.’ ”

In an episode of the popular TV sitcom, character Kramer and his buddy Mickey get jobs as standardized patients, and end up competing over who gets what disease. Kramer adds drama and dialogue as he plays a man with gonorrhea.

Amusing, but misleading.

Standardized patients have been trained to follow a script and not improvise.

“One gentleman decided to make the character more interesting and added lots of crazy stuff,” Wright recalls. “So I never called him back. 'Standardized’ is the key word.”

After playing standardized patients for five-plus years, the Kings know the drill.

“I don’t think we would be doing it if we didn’t think it was purposeful, and worthwhile for the students,” Vicki King says.

For their efforts, standardized patient pay starts at $12 an hour at Wake Forest, $13.50 an hour at UNC. UNCG’s nurse practitioner program pays a small honorarium.

There are other benefits.

“I have become a better patient because of it,” Vicki King says. “I will make lists and write down what I need to cover with the doctor.”

Adds her husband: “It helps with the acting and keeps your mind sharp.”

The acting bug bit the Kings after they retired from telephone company jobs.

Jim King, now 59, read about a need for nonspeaking background extras in an independent movie being filmed in Sanford. He ended up not only in front of the camera but behind it, helping to direct and edit.

“It pretty much changed my life,” Jim King says.

He appeared as an extra in “Talladega Nights,” “The Ultimate Gift,” “Home of the Giants,” “Pucked” and the forthcoming “Wesley” and “The Key Man.”

He has played principal roles in UNC School of the Arts student films.

“To me, it was like going out to play when you are eight years old — just having fun, doing imaginary things, pretending to be someone else,” he says.

While on a movie set six years ago, he heard another extra describe her work as a standardized patient at the UNC School of Medicine.

He decided to give it a try, then recruited his wife.

Vicki King, 65, also acts and directs for the Greensboro Playwrights’ Forum and paints portraits.

Triad movie work — and therefore work for extras — has slowed with the economy. But the Kings’ standardized patient work has picked up.

At the UNC School of Medicine, the Kings are veterans among 150-plus standardized patients, who are called on by UNC’s medical, pharmacy, dental and nursing programs, says Erica Clarkson, program coordinator.

Last week in Greensboro, the Kings joined eight other actors using their skills for the UNCG adult/gerontological nurse practitioner program.

The script called for them to have a “common clinical condition that occurs in older adults,” says program director Laurie Kennedy-Malone, who doesn’t want to spill the beans to future students.

Students interviewed them on their medical history, then advised them on managing their condition.

The simulated patients evaluated students on their professionalism and their ability to communicate and to relay information they could understand.

At Wake Forest, Becky Wright draws on a database of 100 standardized patients, 30 of whom she hires regularly. They work for the medical school and the department of physician assistant studies.

She looks for those who are dependable, coachable and can memorize the script. She gives a training session for each case. The standardized patients then study the script to prepare.

In one scenario, rising fourth-year medical students go to 10 exam rooms, with a different patient with different issues in each room — much like a doctor’s office.

But typically, when Wake Forest calls in standardized patients to work one-on-one with students, each patient portrays the same case, Wright says.

That’s the situation on this September morning with these first-year physician assistant students.

They have been trained in diabetes counseling. Now it’s time to practice.

Clinical exam rooms line the hallway in the medical education area. In each one sits a student and standardized patient. One-way windows allow observers to watch. Cameras record the sessions. Unlike some other sessions, these won’t be graded.

The Kings and six others play patients with diabetes. They have studied scripts with the same family and medical history. They play the same role three times with different students.

For this exercise, they are more than patients: They have received six hours of extra training to act as standardized patient instructors.

So instead of having faculty evaluate students, the eight standardized patients will critique them on set criteria, says Carol Hildebrandt, associate project manager for family and community medicine, who helped organized the assessment.

“You have learned the theories, but you haven’t worked them out in practice,” student Melissa Howard says. “It’s important to find out our strengths and weaknesses. And it’s important to get feedback right after the interview.”

The diabetes patients tell students that they skip breakfast, work and dine in their family’s barbecue restaurant, and exercise little.

Students try to gently persuade them to improve eating and exercise habits, so that they lose weight, better manage blood sugars and gain in health.

“There are minor changes that can have really great effects,” Howard tells Jim King.

They take a break so that patients can fill out rating sheets.

“I would say that you are highly effective in most of these areas,” Vicki King tells student Kimber Roche.

“From the very beginning you made it apparent that you cared, that you wanted to be involved.”

Jim King gives Howard high marks on rapport, body language and agenda-setting.

“There’s one thing,” he adds. “You didn’t wash your hands when you came in.”

Howard is sure to use hand sanitizer on the way out.

Contact Dawn DeCwikiel-Kane at 373-5204 or dawn.kane@news-record.com