The role of role-play: Managing activity ambiguities in simulated doctor consultation in medical education

Abstract

This paper is concerned with simulated consultations between medical students and real patients, focusing in particular on multiple framings as they lead to activity-specific ambiguities. In these simulated consultations the misalignment of expectations between medical students and patients becomes evident in the opening and closing sequences in particular, which provides the rationale for focusing on these phases of the encounter. Transcribed video recordings were drawn from a Norwegian empirical study of simulated consultations in medical education. The analytic framework derives from a dynamic notion of activity type in conjunction with framing and hybridity. The data illustrate that agenda questions, targeted at the patient's reason for seeing the doctor, frame situations where the students had to manage ambiguities at different levels. While the medical students strive to negotiate the multi-layered frames at an implicit level, the patients negotiate the frames in a more explicit manner. There is uncertainty as to whether the role-play should be perceived as an authentic consultation, which seems to be the student's aspiration, or whether it is to be regarded as a training situation, which appears to be the patient's perception. The paper concludes by raising some issues about the role of role-play in medical education, with particular reference to communication skills training.