UC San Diego

This dissertation studies human patient simulation in medical and nursing education, specifically, the use of “Standardized Patient” (SP) performers portraying a patient with a disease. It demonstrates how SP performers and educators in the simulation laboratory draw on multiple practices and heterogeneous techniques to produce an institutionally configured medical standard. Examining the training of the SP’s subjectivity to become a reliable training and testing instrument this project shows the process of inscribing the bodies of performers with clinical standards of care.

Examining SP simulations within the operational logic of a teaching event in the laboratory, I argue that patient simulation cannot be analyzed merely as a representation – the imitation of the clinical reality – but as the practice of designing, performing, enacting and sustaining the clinical standard in practice. Each chapter examines a facet of the SP simulation: historical and cultural configurations; the simulation laboratory as the material site for action; clinical scripts, checklists, and rating scales in their use; the training of the performer’s subjectivity; and the performance of disease. Together, these standardization practices compose, perform and sustain the standard in the body of the SP performer, one that is lived, discoursed, and articulated both culturally and socially, intersubjectively co-constructed, and materially co-constituted.

This interdisciplinary project, which considers the central role of multimodality in situated human action and interaction, alongside ethnographic approaches to studying practices of standardization and quantification, is situated at the intersection of communication studies, medical visualizations of the body in science and technology studies (STS), and medical humanities. Drawing on feminist epistemologies in STS and medical humanities I propose to de-trivialize forms of behavior educators see as nonscientific excess in patient simulation training, a field today largely driven by quantification, quality measurement, and tenets of objectivity. Considering the role of cultural inheritance in patient simulation today my discussion examines mechanisms through which standards become officially established through the exclusion of cultural values that do not cohere with scientific rationality in medical and nursing education.