Indiana University-Purdue University Indianapolis (IUPUI) / In relationship-centered care, the relationship formed between physician and
patient is critical to the creation of positive patient outcomes and patient satisfaction
(Inui, 1996; Laine & Davidoff, 1996; Tresolini, 1994). Medical educators have
increasingly utilized Objective Structured Clinical Examinations (OSCEs) to assess
medical students’ abilities to utilize a relationship-centered approach in clinical
interviewing. OSCEs, however, have recently come under scrutiny as critics contend that
the overly scripted and standardized nature of the OSCE may not accurately reflect how
medical students build and maintain relationships with patients. Although some studies
have looked at how standardized patients help teach medical students interviewing skills,
few studies have looked specifically at how the structured nature of the OSCE may
influence relationship-building between standardized patients and medical students.
Therefore, this study asks the question “How is relationship-centered care negotiated
between standardized patients and medical students during a summative diagnostic
OSCE?”
Using an ethnographic methodology (Bochner & Ellis, 1996), data consists of an
ethnographic field journal, transcripts of semi-structured interviews with SPs and medical
students, and transcripts of headache and chronic cough videotaped scenarios. Using
grounded theory (Strauss & Corbin, 1990, 1998), a back-and-forth thematic analysis was
conducted in discovering the saturation of conceptual categories, linking relationships,
and in critically comparing interpretive categorical concepts with relevant literature
(Josselson & Leeblich, 1999).
Findings suggest that standardized patients and medical students hold differing
expectations for 1) diagnostic information gathering and 2) making personal connections
upon entering a diagnostic summative OSCE. SPs “open up” both verbally and
nonverbally when medical students “go beyond the checklist” by asking discrete
diagnostic questions and when overtly trying to connect emotionally. Fourth year medical
students, however, expect SPs to “open-up” during what they experience as a rushed,
time-constrained, and overly structured “gaming” exercise which contradicts their own
clinical experiences in being more improvisational during empathetic rapport building.
Differences between SPs and medical students’ expectations and communication
practices influence how they perform during summative diagnostic OSCEs. Findings may
suggest the re-introduction of more relationship-focused OSCEs which positions SPs as
proactive patients who reflexively co-teach students about the importance of making
personal connections.
| Identifer | oai:union.ndltd.org:IUPUI/oai:scholarworks.iupui.edu:1805/1187 |
| Date | 20 November 2007 |
| Creators | Budyn, Cynthia Lee |
| Contributors | Schrader, Stuart M., White-Mills, Kim D., Goering, Elizabeth M., Schultz, Jane E. |
| Source Sets | Indiana University-Purdue University Indianapolis |
| Detected Language | English |
| Type | Thesis |
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