Viewpoint: Power and communication: Why simulation training ought to be complemented by experiential and humanist learning
ABSTRACT The authors present an analysis of communication training for medical students using simulation patients, and its possible influence on later doctor-patient relationships. Many empirical studies have shown the various benefits of using simulation patients to teach communication skills, but theoretical sociology and humanistic reflection shed light on some fundamental differences between the student-doctor/actor-patient interactions practiced in simulation encounters and real doctor-patient relationships. In contrast to the usual power dynamics of a doctor-patient relation, those of simulation encounters are inverted and overwritten by an entirely different set of power relations, namely, those of the evaluator-student relationship. Since the power dynamics of real doctor-patient relations are generally overlooked, the altered dynamics of the simulation encounter are not readily perceived, and simulation encounters are thus often mistaken as accurate representations of clinical reality. Exclusive reliance on this pedagogic approach of simulation training may be encouraging students to become "simulation doctors" who act out a good relationship to their patients but have no authentic connection with them. The authors propose that liberal-arts learning and encounters with real patients should be used to cultivate students' abilities to create good doctor-patient relationships, as a compliment to the pedagogic benefits of simulation encounters.
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ABSTRACT: We think of medical education as a process that moves novices from a state of incompetence to one of competence. This paper explores the idea that education may, at times, actually lead to incompetence as a result of over-emphasizing particular discourses that construct what competence is. This paper explores four discourses each with its own terminology and core conceptualizations of competence; each of which creates different roles for students and teachers. No one discourse is ideal and all drive teaching and assessment in particular ways. Sometimes these forms of teaching or assessment may inadvertently foster incompetence. In this paper I argue that, as with medical treatments, medical educators must pay more attention to the side-effects of the discourses that shape medical education.Medical Teacher 01/2007; 28(8):690-6. DOI:10.1080/01421590601102964 · 2.05 Impact Factor
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ABSTRACT: The Final Professional Examination for medical students at Leicester Medical School involves the use of real patients, and senior clinicians assess students over a series of consultations with these patients. What the patients themselves think of the students is not known. This qualitative study identifies the perceptions and opinions which patients who have been used in this examination have of the student candidates, and whether these may be used to enhance the training of medical students. Patients who had participated in a number of examination diets were interviewed in either a group interview or individually. The interviews were loosely structured in order to discover the experiences that these patients had and how they interpreted them. Data was analysed inductively using the constant comparative method. The large majority of views of patients fell into the following categories: observations on student conduct during the examination (both in terms of affective and professional behaviours), demographic characteristics of students and views on student performance. Based on the results of this study, educational recommendations are made which might improve student performance in the examination and lead to greater patient satisfaction with the 'end product' of the medical school, namely the graduating student. These include the incorporation of students' observation of infection control measures within the assessment schedule, and more direct preparation of students in handling uncertainty and their anxieties within the consultation.Medical Teacher 07/2007; 29(5):478-83. DOI:10.1080/01421590701509621 · 2.05 Impact Factor