the language of medical education
The simulation game: an analysis of interactions between students and simulated patients
Article first published online: 21 DEC 2012
© Blackwell Publishing Ltd 2013
Volume 47, Issue 1, pages 49–58, January 2013
How to Cite
de la Croix, A. and Skelton, J. (2013), The simulation game: an analysis of interactions between students and simulated patients. Medical Education, 47: 49–58. doi: 10.1111/medu.12064
- Issue published online: 21 DEC 2012
- Article first published online: 21 DEC 2012
- Received 15 February 2012; editorial comments to authors 28 March 2012; accepted for publication 23 August 2012
Context Institutional interactions are often asymmetrical in that the professional has more control over the conversation. It is difficult to say who the professional is in simulated consultations between simulated patients (SPs) and medical students because these feature a real (educational) institutional context and a simulated (medical) institutional context. This study describes this asymmetry and makes educational recommendations based on the description.
Methods One hundred assessed conversations between SPs and Year 3 students were transcribed and analysed using discourse analysis (DA). We aimed to find linguistic patterns in predefined parts of the conversations (questions, topic initiations, openings, closings) that might suggest conversational dominance.
Results The SP is conversationally more dominant, despite performing the role of the patient, in that he or she asks more direct questions, is more likely to initiate topics, is more likely not to follow topic changes by students, and closes the consultation. The student is likely to follow topics initiated by the SP and to seek permission to pre-close the consultation.
Conclusions The apparently greater dominance of the SP indicates that the simulated consultation differs from the doctor–patient consultation in certain key aspects. It is in that sense unrealistic. We argue, however, that ‘realism’ ought not to be a goal of simulated consultation and that what matters is that such consultations are sufficiently realistic for their educational purpose. We discuss the educational implications that follow from this.