Communication Skills in Medical Education: A Discourse Analysis of Simulated Patient Practices

Communication is regarded as one of the most important skills physicians develop. The most common approach for training medical students to be skilled communicators is by way of simulated patients, who are persons hired by a medical school to perform the role of patient for medical students in simulated consultations and assess those students on their communication skills. In this project, I examine how communication skills are conceptualized by looking at how they occur as a practice. My analysis focuses on the Communication Skills Learning Center, an organization designed to train medical students to be skilled communicators through consultations with simulated patients. Specifically, I examine the Communication Skills Practice Exam that is designed to prepare third-year medical students for the United States Medical Licensing Step 2 Clinical Skills Exam. Like the licensing exam, the practice exam requires students to perform physician in twelve simulated consultations to demonstrate their communication skills. I use discourse analytic approaches to examine the three simulated patient practices that constitute the Communication Skills Practice Exam–(1) the twelve Scripts issued to simulated patients by the Communication Skills Learning Center to prepare them for their Simulated Consultation; (2) ninety-seven Simulated Consultations between simulated patients and third-year medical students; (3) and the multiple-choice and open-ended Assessment Form that simulated patients complete after Simulated Consultations to evaluate medical student’s communication skills. I investigate the metadiscourse that participants use to constitute communication in these three practices and consider the implications of such conceptualizations. Through my analysis, I demonstrate how the Communication Skills Learning Center conceptualizes communication in Scripts and multiple-choice Assessment Form items by way of a container paradigm, in which medical students extract patients’ concerns by questioning patients. Communication functions as a transparent exchange of relevant medical information about a patient and effective communication occurs when medical students retrieve the information needed to diagnose and treat patients. Yet in Simulated Consultations and open-ended Assessment Form responses, communication is a dynamic and communication skills are negotiated amongst participants. I conclude this project by initiating a metatheoretical dialogue, considering the affordances and constraints of these different conceptualizations of communication, and offering suggestions for ways to enrich simulated patient practices in communication skills education