Can simulated consultations be authentic?

Authentic consultations as a model for simulated doctor consultations: Managing uncertainty of the activity in (setting the agenda, or: the opening sequence) when participating in simulated consultations. This paper is concerned with the opening sequences in simulated consultations between doctor students and real patients, and what impact establishing the agenda has on the rest of the interaction. In the simulated consultations the students learn how to interact with patients in real consultations. The students in the medical programme use a consultation map developed by Pendleton et al (1984) in communication skills teaching when they interact with patients. This map covers some general tasks or phases that the students navigate throughout the interaction. The key task in the opening sequence is to establish contact with the patient and let them define the agenda. According to communicative ideals the students are instructed to act as dialogue-centred doctors and ask open-ended questions in order to let the patients set the agenda. The patients however are asked to take part in a dialogue with a student and are expected to talk about his/her health problem(s). The data illustrates that doctor-like agenda questions, which is a way of asking for the patient’s reason for seeing the doctor, create situations where the doctor students have to manage uncertainty at different levels. There is uncertainty or confusion related to whether the role-play should be perceived as authentic consultation which seems to be the student’s aspiration, or whether it is a training situation which seems to be the patient’s perception. In the dialogue this asymmetry of expectations and uncertainty becomes evident especially in the opening sequence and in the conclusion of the interaction. This is both activity-specific uncertainty concerning status, role, task and purpose as well as knowledge-based uncertainty concerning level of competence. The focus in this paper will be on how the parties are managing the uncertainty of the activity in the opening sequence. What are the resources when the parties are managing uncertainty in the way of setting the agenda? In opening sequences negotiation of frames may lead to what Sarangi (2001) call hybrid interactional incidents. Interactional hybridity surface in these phases of the interaction as moments of frame ambiguity as well as frame shifts. Keying and layering can be referred to as different types of framing an event. Keying is referred to as framing in an explicit manner and layering concerns framing in a rather implicit manner. As we will see the student doctors negotiations of frame are rather implicit, ambiguous and multi-layered whereas the patients negotiates or keys the general frame(s) for the conversation and changes of frame(s) in a more explicit manner. Keywords: Simulated consultations, authentic consultations, opening sequence (setting agenda), managing uncertainty, activity type, hybridity, framing, keying, layering.