How student healthcare providers in a communication skills course respond to standardized patient resistance

• Published in: Social science & medicine (1982) 2023-11, Vol.337, p.116309-116309, Article 116309
• Main Authors: Paulus, Trena M., Grubbs, Heather, Rice-Moran, Renee, Lester, Jessica N.
• Format: Article
• Language: English
• Subjects: Communication; Delivery of Health Care; Discourse analysis; Epistemics; Health communication; Health Personnel; Humans; Interprofessional education; Medical education; Patient resistance; Standardized patients; Students
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2023.116309

Encountering and responding to patient resistance can be especially challenging for student healthcare providers. Navigating who ultimately holds the authority to know and understand a health concern, make recommendations for a course of action, and accept or resist these recommendations are all part of how epistemic authority is negotiated in medical settings. The purpose of this paper is to systematically examine how student providers enrolled in a communication skills course at an American university responded to standardized patient resistance. The data for this study were 121 video-recorded and transcribed final objective structured clinical examinations from the fall 2019 course. We used discourse analysis informed by principles of conversation analysis to identify several discursive strategies used by the students, including: 1) asking for clarification; 2) expressing uncertainty and offering to gather additional resources; 3) aligning with and offering an account for the resistance; 4) recommending a new course of action; and 5) confronting the resistance. Our findings point to the value of including instruction for both student healthcare providers and standardized patients on how to respond to resistance they encounter in ways that may help improve healthcare outcomes. •Standardized patient resistance presents an epistemic dilemma for student healthcare providers.•Five strategies were used by student providers to align with either the patient or the doctor.•Strategies for navigating patient resistance should be included in communication skills courses.