Fiksjonsbasert kommunikasjonstrening i medisinsk utdannelse - med bruk av teaterfaglige virkemidler

Simulated patients are today used world wide in clinical communication training. Using simulated patients will imply the use of theatrical fiction. Basic elements of a theatrical fiction are relocation of time and space in addition to character(s) in some degree of acting/simulation and text. The main aim of this thesis was to elucidate and describe fiction based medical communication training with devices from the art of theatre with special focus on art didactical elements as the fourth wall's didactical function, the believability of the simulation and the importance of the in situ building of the simulated patient's character in elucidation of culture theory. The thesis consists of four sub-studies (Article I – IV). Sub-studies 1, 2 and 4 are based on recently developed communication training model aiming at training individuals in greater groups (Model 1). In this model students are stimulated to define own context-based learning goals. Sub-study 3 is based on a conventional training model used in most North-American medical schools (Model 2). This model is based on individual encounters, and the student gets feed-back from the simulated patient based on pre-defined learning goals. Sub-study 1 describes how theatrical tools mainly, as described by Stanislavskij, were utilised in Model 1. Through participation and reflection we stimulated the students to collectively develop a consultation with a simulated patient. The students reported learning outcomes in terms of mastering difficult consultations. In sub-study 2 close-reading was used as methodological tool in the analysis of a video-recording from a session of Model 1. The aim was to explore the positions and didactic functions of the fourth wall in medical communication training, using a role-play model basically similar to a theatrical performance. Three different positions were identified, all depending on the direction of the ongoing communication. In sub-study 3 we let the three central aspects of Bakhtin’s dialogical theory interplay with data from training students by Model 2 in an abductive process. The aim was to explore the impromptu interaction between the medical student and the simulated patient with a specific focus on the in situ building of the SP’s character. Three features from Bakhtin’s theory of the utterance were applied in an abductive processinvestigate the impromptu interaction between the student and the simulated patient with a focus on the in situ building of the simulated patient's character. We derived, through examples, how Bakhtin’s theory may contribute to the impromptu building of the simulated character. In sub-study 4 the students evaluate their learning outcome in Model 1. The analysis is based on field notes, the students’ free-text evaluations, and two group interviews. Analysis was done by Systematic text condensation, inspired by Giorgi's method, with focus on students’ learning experiences. Utilising theatrical tools in clinical communication training is challenging, and made me adopt various methodologies. My research may be regarded as a contribution to increased focus on the qualitative and humanistic aspects of fiction based communication training