Description:

The Master of Arts in Medical Humanities & Bioethics

presents

A Montgomery Lecture

With

Laura E. Hirshfield, PhD
Assistant Professor of Medical Education & Sociology
University of Illinois at Chicago 

Making the Subjective, Objective?: Examining Standardized Patients’ Decision-Making and Assessment of Medical Trainees’ Communication Skills

Standardized and simulated patients (SPs) are frequently used to teach medical communication. One key aspect of SPs’ work is the use of checklists and rating scales to provide a standardized format for evaluating medical trainees’ performances. While numerous studies have been conducted to validate the use of SPs, little is known about how SPs make decisions about how to rate trainees’ performances. This is of particular interest given that certain aspects of medical communication, such as displaying empathy, rely upon subjective feelings experienced by the SPs. We draw on data from qualitative interviews with 27 SPs employed at a large, Midwestern medical school in the U.S. to ask, “how do SPs maintain standardized forms of evaluation and assessment?”  Though our participants highlighted the rigorous training they received and the standardization of the checklists they used, they also acknowledged the subjective nature of their work. Three main themes emerged: 1) interactional dynamics which cannot be named; 2) the interjection of "gut feelings" in the assessment of interactions and 3) how personal reactions and feelings must be tabled to "fairly" assess students. Our findings highlight the strategies and techniques utilized by SPs as they worked to transform their subjective assessments into objective evaluations in line with the values of standardized medical science and training. We argue that SPs perform underexplored forms of emotional labor in order to create or produce standardization in these types of educational encounters.