The research ‘Human Simulation’ investigates how the human body, a person and various health concerns are being simulated in medical education by using ‘standardized patients’ (SP). SPs work with medical students helping them practice their clinical and interpersonal skills in preparation for medical exams. The research uses performance and film to explore the work of SPs in medical education. It focusses on the training and assessment of SPs, and highlights some of the unscripted performative techniques they use. The research has resulted in two documentary films, Scenes of Disclosure and Standardized Synchronized.
Researcher: Kaisu Koski
Funding: Academy of Finland; Tampere University
Scenes of Disclosure (2017). Still image from the film. Image courtesy of Kaisu Koski.
This work is part of Kaisu Koski’s Academy Research Fellow project ‘Video Scenarios in Medical Education: Polyphony and Non-linearity in Audiovisual Doctor–Patient Narratives’ between 2015 and 2020.
As part of this fellowship, Kaisu Koski developed performative methods to explore the tension between standardization and authenticity in human simulation. The data collection took place in 2016 during a field trip in the Surgical & Clinical Skills Center at University of Texas McGovern Medical School.
Understanding the role of the standardized patient
Koski underwent training to become a ‘standardized patient’ whilst inquiring into the trainers’ ways of directing the SP performance. To further understand the medical students’ task, she played the role of the physician and practiced delivering unfavourable medical information to the SPs. This performative interview method recognizes SPs as medical educators in their own right, eliciting their advice in character, in terms of what an appropriate way to proceed would be.
One aspect of the project focuses on the SP training and assessment in a simulation clinic. The other focuses on the specific simulation scenario of breaking bad news (BBN) in which SPs use personas and pre-scripted repertoire of responses. The research identified previously unknown unscripted performative techniques in the SP work.
- Koski K, Ostherr K. (2020) “I guess I didn’t like that word unfortunately”: standardized patients’ unscripted techniques for training medical students. Simulation in Healthcare, Publish Ahead of Print. doi: 10.1097/SIH.0000000000000519
- Koski, Kaisu (2019) Standardized Synchronized. Film, 12’25”. Documentary about training and work of standardized patients in medical education. Finalist at the AVANCA Film Festival, Portugal. https://player.vimeo.com/video/350477152
- Koski, Kaisu (2017). Scenes of disclosure. Film, 23’06”. Documentary about teaching breaking bad news in medical education. Finalist at the Fort Worth Indie Film Showcase, Fort Worth TX. https://vimeo.com/227863178
- Koski K, and Ostherr K. (2020) “I Guess I Didn’t Like That Word Unfortunately”: Standardized Patients’ Unscripted Techniques for Training Medical Students. Simulation in Healthcare.
- Koski K, and Ostherr K. (2021) Ambiguity and uncertainty in ‘breaking bad news’ simulation: lessons from standardized patients’ different personality types. Research and Humanities in Medical Education, 8:75-82.
- Koski K, and Ostherr K. (2022) “Props in Breaking Bad News Simulation” in Making Sense of Medicine edited by J. Nott & A. Harris. Intellect Books: Bristol.
The Fellowship was funded by the Academy of Finland 2015–2020, and co-funded by Tampere University. The project also received funding from the Rice University Humanities Research Center.
This project is a collaboration with Professor Kirsten Ostherr, Director of the Medical Futures Lab at Rice University.
Thanks to the Standardized Patients program in the Surgical & Clinical Skills Center at the McGovern Medical School, including the faculty, staff and students involved in the Breaking Bad News teaching.
Project Dates: 2016-2021