Medical school is a formative time when future physicians learn what it means to care for patients and how to practice medicine in complex health systems. As students progress through school, they encounter significant challenges, risks, and expectations. Guided by a narrative perspective, I explore one experiential component of the professional education of medical students in the U.S.—standardized patient labs. Standardized patients are hired by medical schools to follow scripts and act as patients with various ailments and health problems. Medical students interact with standardized patients to practice diagnostic skills and prepare for clinical interactions beyond medical school. In this dissertation, I observe and analyze ways that standardized patient interactions prepare students for the narrative nature of clinical work. I also identify and interpret value sets that are maintained and disrupted through standardized patient interactions.
I outline a rationale for the project in Chapter One by exploring contemporary challenges facing the health care industry and medical educators. In Chapter Two, I illustrate the theoretical importance of the project by situating the project within scholarly literature on the narrative nature of medicine and the experience of uncertainty in medicine. I detail my inquiry practices in Chapter Three, a research design that crystallized data gathered through multiple methods including observations, in-depth interviews, and the collection of documents. Chapters Four and Five offer complementary analytic representations of the SP lab at the Ohio University Heritage College of Osteopathic Medicine (OUHCOM). To begin, I take readers through a creative narrative vignette representing a typical and realistic medical student encounter in a SP lab. This story offers readers an ethnographic glimpse of the communication processes composing this pedagogy. Then, in Chapter Five, I present a traditional thematic representation developed through a constant comparative analysis of the data. Across both chapters, I position the SP labs as narrative-based pedagogies that prepare students for the narrative nature of clinical work in inescapably uncertain circumstances. Finally, in Chapter Six, I re-visit my initial research questions in light of the knowledge claims offered in Chapters Four and Five. I discuss theoretical and practical implications of my interpretations as well as recommendations for future directions.