"I Guess I Didn't Like That Word Unfortunately": Standardized Patients' Unscripted Techniques for Training Medical Students.

INTRODUCTION: This article explores tacit techniques embedded in standardized patients' (SPs) unscripted dialog in a context of breaking bad news (BBN) education. It identifies a technique in which the SP explicitly repeats 1 or more of the medical student's words and analyzes the function and impact of this technique. METHODS: This film-based ethnographic inquiry used conversation analysis to examine so-called echo utterances, through which the SP repeats all or part of what the student has said. The data set includes 9 student encounters with 2 female SPs who specialize in the BBN simulation. RESULTS: The authors identified a technique of "repair request" used by the SPs to provide an opportunity for the student to reformulate their utterance in character. Repair requests emerged from 4 main types of student speech: speculative language, inappropriate utterances, awkward timing, and medical jargon. CONCLUSIONS: The technique of repair request is used to heighten the student's language sensitivity and foster the ability to respond to criticism or misunderstanding in character. Discovery of the tacit, unscripted technique of repair request in this study provides an opportunity to disseminate this technique in SP training for BBN and other simulation scenarios. These findings suggest the need for further research to identify additional tacit techniques used by SPs to improve medical education

Ambiguity and uncertainty in 'breaking bad news' simulation: lessons from standardized patients' different personality type

Introduction: Ambiguity and uncertainty are intrinsic aspects of contemporary medicine, and there is a need for methods to train medical students to tolerate them better. This article distinguishes the ways that different standardized patient (SP) personality types provide opportunities for medical students to practice tolerating ambiguity and uncertainty associated with breaking bad news (BBN). Methods: This ethnographic study draws data from nine student encounters with two female SPs who specialize in the BBN simulation. It utilizes the literary concepts of “unfinalizability” and parallel “time zones” to reflect upon manifestations of uncertainty and ambiguity in SP performances. Results: The SPs challenged the linear progression of the BBN encounter by including shifts between different time zones in the patient’s mental-experiential continuum. The study identified seven main forms of resistance in the SP performance, all geared toward challenging the linear and complete conduct of the student performance: resisting being considered a patient, resisting decision-making, resisting authority, resisting here-and-now, resisting being seated, resisting closure, and resisting death/life. Discussion: The SPs’ distinct personality types have the potential to improve students’ ability to respond to individuals with different temporal orientations, and support them to tolerate encounters with various kinds of open endings

Digital Medical Humanities: An Applied Media Studies Community of Practice

Presentation for the 2016 Digital Frontiers Annual Conference. In this presentation, Kirsten Ostherr draws on examples from the Medical Media Arts Lab to show how digital medical humanities cultivates 21st century communication skills for future health professionals

Privacy, Data Mining, and Digital Profiling in Online Patient Narratives

Practices of health datafication and inadequate privacy policies are redefining the meaning of online patient narratives. This article compares patient-driven illness narratives and clinic-driven illness narratives to uncover a set of unrecognized assumptions about trust and privacy in health discourses. Specifically, I show how the open sharing of patient stories in social media, blogs, and other public domains collides with privacy regulations and normative assumptions in the US health care system that prevent integration of those stories into electronic health record (EHR) systems. I argue that publicly told stories based on personal experiences of illness are valuable sources of health care information in part because they are subjective, richly detailed, and open ended. Yet, precisely because of their public nature, these patient stories are unprotected sources of data that are barred from integration into health care data ecologies where clinical action takes place. Consequently, an impermeable barrier exists between the officially sanctioned accounts in the clinical record and the contextual richness of patient stories on the social web. The tensions between these two approaches to narrative and data create an opening for exploitative digital profiling practices that can ─ and already do ─ harm patients. Examples are drawn from Hugo Campos and Medtronic, PatientsLikeMe, Apple Health Records, Google Health, Microsoft Health Vault, IBM Watson Health, and OpenNotes

Death in the digital age: A systematic review of information and communication technologies in end-of-life care

Background: The first baby boomers turned 65 in the year 2011. As this population ages and approaches death, it will place increasing demands on an overburdened healthcare system that already provides inadequate end-of-life care to many patients. Information and communication technologies (ICTs) may offer a means to address the needs of this generation, particularly for the growing numbers of tech-savvy seniors who are already accustomed to using smartphones, the internet and other digital devices as part of their daily lives. However, few resources exist to guide the use of ICTs in end-of-life care. Methods: A systematic review of the literature was conducted using Medline, PubMed PsycINFO, Sociological Abstracts, Communication Abstracts, CINAHL, and Embase. Cross-sectional, case-control, cohort studies, and clinical trials were included. Only articles published in English between the dates of 1997 and 2013 were included in the final review. Concepts that made up the search included end-of-life, doctor-patient communication, and technology. Aims: The primary aim was to identify the information and communication technologies being used in end-of-life communication. The secondary aim was to compare the effectiveness of different information and communication technologies being used in end-of-life communication. Results: Two thousand two hundred and forty eight (2248) publications were identified, twenty-nine of which met the inclusion criteria for the review. Fifteen of the studies were randomized, controlled trials, thirteen were quasi-experimental pre-intervention post-intervention studies, and one was an interrupted time series study. The study populations were approximately evenly distributed between two primary patient groups: 48% were cancer patients (n=14) and 52% were non-cancer patients (n=15). Eight different types of technology were identified: the majority (59%, n=17) used video as the intervention technology; 14% (n=4) developed a prototype website; 14% (n=4) used a telephone; and the remaining technologies—videoconferencing, email prompt, telemonitoring, Internet search, and Compact Disc (CD)—were used once each. Of the twenty-nine studies included in this review, 45% ( n=13) were published between 2011-2013, with 28% (n=8) published in the year 2013 alone. Eight different purposes of ICT use were identified. The most common purposes for using technology in these interventions were to provide information/education and to serve as decision aids, followed by promoting Advance Care Planning (ACP), and relieving physical symptom distress. Conclusions: The use of ICTs in end-of-life care is a small, but growing, field of research. Early results show promise for further applications, but additional research is needed to adapt older, analogue technologies for use in the digital age. Many of the interventions discussed in this review do not take full advantage of the affordances of mobile, connected health ICTs. The growing evidence base for mHealth and eHealth applications in related fields should guide future interventions in end-of-life care

Trust and privacy in the context of user-generated health data

This study identifies and explores evolving concepts of trust and privacy in the context of user-generated health data. We define “user-generated health data” as data captured through devices or software (whether purpose built or commercially available) and used outside of traditional clinical settings for tracking personal health data. The investigators conducted qualitative research through semistructured interviews (n = 32) with researchers, health technology start-up companies, and members of the general public to inquire why and how they interact with and understand the value of user-generated health data. We found significant results concerning new attitudes toward trust, privacy, and sharing of health data outside of clinical settings that conflict with regulations governing health data within clinical settings. Members of the general public expressed little concern about sharing health data with the companies that sold the devices or apps they used, and indicated that they rarely read the “terms and conditions” detailing how their data may be exploited by the company or third-party affiliates before consenting to them. In contrast, interviews with researchers revealed significant resistance among potential research participants to sharing their user-generated health data for purposes of scientific study. The widespread rhetoric of personalization and social sharing in “user-generated culture” appears to facilitate an understanding of user-generated health data that deemphasizes the risk of exploitation in favor of loosely defined benefits to individual and social well-being. We recommend clarification and greater transparency of regulations governing data sharing related to health

Foundations of Applied Media Studies

Each of the collaboratively authored chapters of Applied Media Studies was produced through a series of interview-style questions that I, as editor, developed and circulated to the contributors. Through a dialogic process that took place in a deliberately conversational tone, I asked each contributor to answer questions related to a set of themes in the book as a whole, ranging from logistical concerns to methodological and theoretical problems. In this foundational chapter, I asked, “What does applied media studies mean to you? How and why did you start doing applied media studies? In your view, what is the theoretical, historical, and/or political rationale for reimagining humanistic media studies as an applied practice?” In addition to their written responses, contributors created short videos for a web-based companion to the book, hosted on the open-access Scalar platform (http://scalar.usc.edu/works/applied-media-studies/index)

Unintended Consequences

This chapter addresses the complex, sometimes unintended—but also potentially very rewarding—consequences of intervening into practices that are more commonly studied from a distance, and the political and ethical implications of this work. The case studies for this chapter explore what happens when media scholars become actively involved in the reshaping of media experiences and infrastructures, and in some sense become part of the very processes they seek to critique. Contributors were asked, has your applied media studies work ever produced truly unexpected results that raised unintended ethical or legal issues you had to address? How have you managed issues relating to Intellectual Property regulations with open, collaborative work online? Have you discovered any novel ethical challenges or responsibilities from putting work online—including objects created by people, living and deceased, from cultures that are different than your own? Have you ever been unexpectedly drawn into an applied media studies project as a participant in ways that redefined your understanding of your role as scholar, or expert, or lead investigator? How did you respond, and has this changed the way you work now