Viewpoint: Power and Communication: Why Simulation Training Ought to Be Complemented by Experiential and Humanist Learning

Division of Medical Ethics, Department of Public Health, Joan and Sanford I. Weill Medical College, Cornell University, 435 East 70 St. Suite 4J, New York, NY 10021, USA.
Academic Medicine (Impact Factor: 2.93). 04/2006; 81(3):265-70. DOI: 10.1097/00001888-200603000-00016
Source: PubMed


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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    • "Implications for assessment are profound because the importance of authenticity challenges the validity of simulation in assessment [133]. Perhaps, at best, simulated-patient encounters might only detect students who lack the ability, or are too overwhelmed by anxiety to appear to be concerned for a patient [134]; at worst, by rewarding pretence, they might inadvertently teach inauthenticity [89]. "
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