LEBANON, N.H. (AP) – Medical schools generally concentrate more on passing on medical knowledge than teaching bedside manners, but that’s starting to change.

At Dartmouth Medical School, doctors-in-training work with actors who play the role of patients to help them practice communication skills, including delivering bad news.

In one recent seminar, third-year medical student Fiyuki Hirashima was asked to tell a patient that her mammogram showed signs highly suggestive of cancer.

Her patient, Betsy McCann was an actress, trained to answer all of Hirashima’s questions about family history and symptoms.

McCann played out a range of natural reactions to the news: panic, denial, confusion, and endless detailed questions about what to expect.

“I’m so not ready for this.” McCann said, putting her head in her hands. “I was just starting a new life here.”

All the while, a video camera was recording their exchange so that Hirashima could review it and get additional feedback.

Part of what Hirashima had to get right was medical. She described how the mammogram test worked, what the next diagnostic step would be, and how likely the mass was to be cancer. But much more of her job was addressing McCann’s anxieties. At the end of the encounter, McCann broke character to tell Hirashima that she’d been solid and professional, and that Hirashima’s attitude had given her confidence.

Training opportunities like these are driven in part by a new section of the medical licensing exam that requires candidates to interact with actors playing patients.

Each patient has a scripted disease, and students must diagnose the illness, examine the patient properly and treat the patient kindly in order to pass.

Breaking bad news, the subject of Hirashima’s seminar, is one of the hardest things to learn and something evaluators look for.

“If you get it wrong on the communication piece . . . everything from there on can lead to more problems and errors and challenges,” said Ann Jobe, who’s involved in developing and administering the actor-patient portion of the board exam. “It’s so important that the communication piece is effective and good.”