One "patient" fell asleep. Another compulsively searched for food. The third, curious and easily distracted, wandered off.

The future doctors were perplexed. First-year students in Stanford University's School of Medicine, their impressive GPAs and MCAT exam scores didn't matter to these dusty volunteers.

But the students quickly discovered that other skills did. Like patience. Persistence. Rapport. Over a single afternoon, their "patients'' - three horses at Menlo Park's Webb Ranch - started paying attention.

"I figured it out," said Joslyn Woodard, 24, from Irvine. "I was watching and thinking: What's he doing? What am I doing? And is it working or not?"

The course, called "Medicine and Horses: A Communications Model For The Doctor-Patient Relationship," was created by Stanford physician and equestrienne Beverly Kane as a way to help medical students practice self-presentation, non-verbal communication and bedside manners. In the sun, dust and flies, the six students worked with the gentle but apathetic 1,000-pound animals to hone skills not learned in the classroom.

Once a week for four weeks, the students worked with their "patients": a chestnut quarter horse called Dunbar, an aging gray Arabian named Dream and Monty, a big bay. Kane has taught similar classes at the University of Arizona Medical School and the University of California-San Francisco. This was the third time Stanford has offered the course; this year's final course ended Wednesday.

Horses are perfect patients for these fledgling doctors, only months into their medical careers, said Kane. Like humans, horses are social animals with distinct personalities, attitudes and moods, she said. But because they are prey animals, they are easily frightened. Their survival has depended on their sensitivity to cues like body language, innuendo and emotional tone.

The horses forced students to rely on their instincts, emotions and senses - aspects of "intelligence that may have atrophied in our quest for the correct answers on exams," said Kane.

"Animals in general respond to people in ways that are so transparent and honest," said Dr. Sam LeBaron, professor of medicine and director of Stanford's Center for Education in Family and Community Medicine. "They hold up a mirror for students that they may not get from human patients."

The course starts with a simple introduction; most of the students, raised in urban or suburban settings, have never worked with a large animal. Then it moves on to larger challenges, such as leading, applying a stethoscope and persuading a nervous animal to walk across a fluttering and reflective piece of plastic. In a semester filled with intellectually rigorous courses like genetics, anatomy and developmental biology, the students said they welcomed the chance to think with their hearts, not just their heads.

In one exercise, the students unhaltered the animals and tossed off the lead lines - and then tried to persuade the horses to join them on a walk.

Gently, 23-year-old Natalie Badowski encouraged Monty by patting his neck. Monty dozed off, enjoying the attention. But he refused to budge.

Classmate Shah Ali was having a different problem with the lively Dunbar, in a hurry to explore the arena. "Hey, Dunbar, we need to turn!" said Ali. "Come on, Dunbar! Turn! Turn!"

Like a hungry patient, Dream ignored all instructions as he moseyed off in search of a blade of grass. "Dream is a nightmare," sighed Nadim Mahmud.

By the end of the day, the horses were following the students' orders with more or less enthusiasm. Much as a reluctant patient might quit smoking, start jogging or embark on chemotherapy, the animals had surrendered to encouragement - and quiet persistence.

"See things through the patients' point of view," said Kane. "Take baby steps. Reward every change. People, like horses, may not want to change. Or they may be frightened of change."