Assessing health professionals’ communication through role-play: An interactional analysis of simulated versus actual general practice consultations

Abstract

Simulations, in which healthcare professionals are observed in dialogue with role-played patients, are widely used for assessing professional skills. Medical education research suggests simulations should be as authentic as possible, but there remains a lack of linguistic research into how far such settings authentically reproduce talk. This article presents an analysis of a corpus of general practice simulations in the United Kingdom, comparing this to a dataset of real-life general practitioner (GP) consultations. Combining corpus linguistic and conversation analytic methodologies, key interactional features of the simulations are identified, particularly those associated with successful/unsuccessful performance in terms of the examiner's grading. The corpus analysis identifies various forms of the phrase 'tell me more about' to occur significantly more frequently in the simulations compared to real GP consultations, typically in the opening sequences and most frequently in successful cases. It falls to a conversation analysis of the data, examining this phrase within the interactional context of these opening sequences, to better understand the actions it performs. Successful candidates in the simulations are found to perform a consistent sequential pattern, often incorporating this phrase. Although simulated, these interactions have real professional consequences for those being assessed. Linguistic findings about what constitutes successful interaction or differences to real-life practice therefore have important implications for professional education and assessment.

Can humans simulate talking like other humans? Comparing simulated clients to real customers in service inquiries

“…Drawing on the same dataset, Stokoe and Sikveland (2017) further showed that real suspects and actors respond differently to questions from police officers, whose questions were also often formulated differently for each group. Atkins (2018) has reported similar and consequential differences in general practitioner practice and training.…”

The role of standardized patient assessment forms in medical communication skills education

“…Similarly, in investigating how successful communication occurs in simulated medical interactions, Roberts and Sarangi 24 27 uses corpus linguistics and conversation analysis to compare simulated and actual general practice consultations, noting that successful MSs use the phrase tell me more about... more often that practicing physicians. Similarly, in a comparative study of simulated and actual patient-provider interactions, De la Croix and Skeleton 28 note the simulated interactions contain more SP interruptions (vs doctor interruptions in actual consultations), SP topic selection utterances (vs physician topic selection utterances in actual consultations), and SPs initiating closing sequences (vs physicians ending the interaction in actual consultations).…”

“…However, SPs and future patients can and often do interpret such statements as insincere or uncaring. 23,24,27 While the form portrays sample statements as coins MSs can deposit into the conversational black box to achieve particular outcomes, creating an unquestioned if this then that communication equation, it ignores the interactional nature of medical consultations.…”

“…This item not only ignores the unique experiences of SPs and future patients, but also the actual experience of MSs, who in the context of a simulated interaction are not likely to empathetically engage with who they know is a fake patient, requiring more interactional work to inoculate them against sounding formulaic or insincere (pp. [26][27]. 23 This item demonstrates the dilemma of empathy in communication skills training, which decontextualizes emotions and empathy from the everyday experience of SPs and MSs and creates seemingly observable standards (canned sample statements) that do not work in actual medical practice for the sake of standardized assessable phenomenon.…”

Politeness in Professional Contexts

“…While recognising the distinct nature of simulated interactions in comparison to real-life healthcare talk (for discussion, see Atkins, 2019), we wish to hypothesise that such simulated scenarios importantly provide a vital site for the formation of future professional practice and a means of determining what discursive practices are evaluated positively by experienced medical staff. Therefore, they are worth investigating and analysing with the prospect of gaining a better understanding of the rapport building strategies observed in the context of ad hoc medical teams and informing professional practice and communication skills training in medical education as well.…”