Culturally and Linguistically Diverse Simulated Patients: Otherness and Intersectional Identity Transformations Revealed Through Narrative

Simulation aims to replicate the important aspects of a situation to aid learning. Simulated patients (SPs) should ideally represent the diversity of patients encountered in clinical practice. Culturally and Linguistically Diverse (CALD) people are underrepresented in simulated patient groups in comparison to population demographics. Little is known about CALD SPs. The research aim was to explore the experience of CALD people who have worked as simulated patients.\ud The methodology is narrative. In accordance with the intention to reveal values, beliefs and actions embedded in a particular context, participant stories were explored to reveal rich and meaning-making content. This approach offered motivations, rationales and driving emotions rather than outcomes. Participant stories were developed preserving the coherence of their account using a modified version of Emden’s (1998b) process. The theoretical framework of intersectionality was used as this supported the complexity of individual identities whilst reflecting contexts and cultures. Using an interpretive scheme of significance, value and intention a thematic analysis was undertaken. This analysis was intensified through intersectional analysis.\ud Five themes and four intersectional identity groups emerged. The five themes: The SP experience, The SP imperative, Otherness, Learning and Identity emerged. These themes encapsulate the changing selves of the SP through their life journeys and more poignantly their simulated journeys. The four intersectional identity groups: shielding emotion, taming stigma, influencing image and overcoming ignorance represented the dynamic way the SPs identities were represented to themselves as well as to others through simulation. A CALD SP model named “BLOSSOM” was developed that demonstrates the movement of identity through simulation akin to the liminal processes described by van Gennep and modified by Turner (1987). The model is crosscut by intersectionality and the pluralism of otherness. The outcomes of this model have implications for the recruitment, retention and simulation scenario development incorporating CALD SPs and form the basis for the recommendations