Exile Vol. XXIII No. 2

PROSE The End of East by Libby Thomas 3-12 Lilt by Andrew Calabrese 13 The Egg Lady by Nancy Jones 14-20 The International Man by Chip Finefrock 21-31 MUSIC Theme and Variations Op.2, No 1. by J. J. Fuerst 32-38 POETRY Thrown Out Of The Game by Herberto Padilla to Yannis Ritzos in a Greek jail (Translated from the Spanish by José de Armas) 39 Plumb-Creek In Late Sunlight by Lenore Mayhew 40 untitled by Sharon Singleton 41 untitled by Sharon Singleton 42 A Dance Of Stones by Lawrence Weber 43-44 Carp and Crane by William McNaughton 45 Mountain Ash by Dawn Patnode 46-49 untitled by Mary de Rachewiltz 50 Kai Gar Onar Ek Dios Estin by William McNaughton 51 acute angles by Gay Parks 52 Annihilating All Made To A Thought by Tony Stoneburner 53 Dead Fish by Deneise Deter 54 Changing by Deb Allbery 54 Finish Lines by David A. Goldblatt 55 Malinche\u27s Sister by Tona Dickerson 56 Tarde en el hospital by Carlos Peoza Veliz 57 Afternoon in the Hospital by Carlos Peoza Veliz (Tanslated from the Spanish by Joan Straub) 57 Cuadrados Y Angulos by Alfonaina Storni 58 Squares and Angles by Alfonaina Storni (Translated from the Spanish by Joan Straub) 58 INK DRAWINGS untitled by Susan Hoagman 2 Self-Portrait or Darla by Julia Weatherford 59 untitled by Katy Booth 70 ESSAYS On As For Poets by Gary Snyder 60-61 Joseph Heller\u27s Something Happened and the Problem of Community in Modern America by Jack Kirby 62-68 EDITOR\u27S NOTE by Lawrence Weber 69-70 CONTRIBUTORS 71-72 The cover ink drawing by Cathy Ries is entitled, Exercise In Exaggerated Contours

Key challenges in simulated patient programs: An international comparative case study

<p>Abstract</p> <p>Background</p> <p>The literature on simulated or standardized patient (SP) methodology is expanding. However, at the level of the program, there are several gaps in the literature. We seek to fill this gap through documenting experiences from four programs in Australia, Canada, Switzerland and the United Kingdom. We focused on challenges in SP methodology, faculty, organisational structure and quality assurance.</p> <p>Methods</p> <p>We used a multiple case study method with cross-case synthesis. Over eighteen months during a series of informal and formal interactions (focused meetings and conference presentations) we documented key characteristics of programs and drew on secondary document sources.</p> <p>Results</p> <p>Although programs shared challenges in SP methodology they also experienced differences. Key challenges common to programs included systematic quality assurance and the opportunity for research. There were differences in the terminology used to describe SPs, in their recruitment and training. Other differences reflected local conditions and demands in organisational structure, funding relationships with the host institution and national trends, especially in assessments.</p> <p>Conclusion</p> <p>This international case study reveals similarities and differences in SP methodology. Programs were highly contextualised and have emerged in response to local, institutional, profession/discipline and national conditions. Broader trends in healthcare education have also influenced development. Each of the programs experienced challenges in the same themes but the nature of the challenges often varied widely.</p

A Theoretical Analysis of the Field of Human Simulation and the Role of Emotion and Affect in the Work of Standardized Patients

Standardized Patients (SPs) are lay persons who are employed extensively within health professional education to help teach and assess a range of clinical skills. Individuals trained to take on the physical, historical and emotional aspects of patient stories are integral to the dissemination of collective attitudes, values, and beliefs about what it means to be a competent health professional. As an embodied affective presence literally in front of and often in physical contact with health professionals SPs are a fertile site of knowledge production as well as transformative learning. Their unique contribution is a corollary of both their location as non-clinicians and their pedagogical facility with embodied emotions and affect. SPs in medical education teach about emotion and affect, engage affectively in the presentation of clinical material and as a professionalizing group have developed an educational methodology for facilitating understanding and experience of emotion and affect. In this thesis I examine the field of human simulation and the work of standardized patients (SPs) through critical theoretical perspectives seeking to broaden our understanding of their contributions as a present and future force in health professional education, specifically medical education. Central to my examination is the constitutive role of emotion and affect as they are conceived both within medical education and engaged by standardized patients as media through which different knowledges are produced. My analysis is shaped by poststructuralist feminist writers on emotion, Michel Foucault’s genealogical historical approach, and principally Gilles Deleuze and Felix Guattari’s alternative nomadology as theorized in a thousand plateaus (1987). I intend an alternative reading of the advent of SPs in medical education through a process of mapping rhizomatic networks that include acting, emotion, affect, medicine, and the place of women patients and standardized patients in medical arenas. I have located the current study within an ongoing project of embodied ethical practice and nomadic subjectivity within education specific to human simulation and standardized patients.Ph

Effects of Portraying Psychologically and Emotionally Complex Standardized Patient Roles

Background: The use of standardized patients (SPs) to portray emotionally intense roles has stimulated inquiry into the effects such roles might have on the actors. Purpose: Our study endeavored to obtain a rich description of the consequences of highly affective psychiatric roles on SPs. We wanted to find out what conditions made these consequences worse or better and what countermeasures, if any, SPs had evolved to address the effects of case simulation. Methods: In a pilot phase, 16 SPs completed a survey exploring the extent to which they were affected by playing emotionally intense roles. Based on these surveys, questions were developed for subsequent focus groups examining these effects. Four focus groups of 9 SPs each (N = 36) were taped, transcribed, and coded by 2 independent raters. Results: In the pilot survey, 11 of 16 SPs (69%) described residual psychophysiological effects. In the focus groups, all SPs reported some effect of portraying emotional roles, sometimes lasting several days. Several variables appeared to increase or mitigate the likelihood of such residual effects. Conclusions: Understanding the ways in which SPs are affected by portraying emotionally intense roles, and the personal and situational variables that increase or mitigate these effects, can lead to improved recruitment, training, and performance