title: The simulation game: an analysis of interactions between students and simulated patients.
abstract: BACKGROUND
  Institutional interactions are often asymmetrical in that the professional has more control over the conversation. It is difficult to say who the professional is in simulated consultations between simulated patients (SPs) and medical students because these feature a real (educational) institutional context and a simulated (medical) institutional context. This study describes this asymmetry and makes educational recommendations based on the description.
  
  
  METHODS
  One hundred assessed conversations between SPs and Year 3 students were transcribed and analysed using discourse analysis (DA). We aimed to find linguistic patterns in predefined parts of the conversations (questions, topic initiations, openings, closings) that might suggest conversational dominance.
  
  
  RESULTS
  The SP is conversationally more dominant, despite performing the role of the patient, in that he or she asks more direct questions, is more likely to initiate topics, is more likely not to follow topic changes by students, and closes the consultation. The student is likely to follow topics initiated by the SP and to seek permission to pre-close the consultation.
  
  
  CONCLUSIONS
  The apparently greater dominance of the SP indicates that the simulated consultation differs from the doctor-patient consultation in certain key aspects. It is in that sense unrealistic. We argue, however, that 'realism' ought not to be a goal of simulated consultation and that what matters is that such consultations are sufficiently realistic for their educational purpose. We discuss the educational implications that follow from this.
authors.affiliation: Department of Medical Psychology and Psychotherapy, Erasmus University Medical Centre, Rotterdam, The Netherlands. a.delacroix@erasmusmc.nl
authors.forename: Anne
authors.initials: A
authors.lastname: de la Croix
authors.forename: John
authors.initials: J
authors.lastname: Skelton
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D004504:Education, Medical, Undergraduate / Q000379:methods* / Q000592:standards; D004521:Educational Measurement / Q000379:methods*; D004739:England; D006801:Humans; D007802:Language; D016544:Patient Simulation; D013337:Students, Medical / Q000523:psychology*