Date of Award
Open Access Thesis
Medical Doctor (MD)
Patient simulation has been used in medical education to provide a safe and supportive learning environment for learners to practice clinical and interpersonal skills. However, simulation involving pediatric medicine and child psychiatry is rare and generally does not reflect the child-caregiver dyad or the longitudinal aspects of this care and does not provide learners an opportunity to engage with and reflect on these dynamics. We organized a series of 7 observed patient simulation sessions with a cohort of 7 senior child and adolescent psychiatry fellows as an educational opportunity. In these sessions, we utilized the previously described co-constructive patient simulation model to create the simulation cases. We included the use of at least two patient actors in almost all sessions, and two of the case narratives were longitudinally followed across multiple simulation sessions. We conducted a thematic analysis of the data collected from the debriefing sessions after each simulation case via a symbolic interactionist approach. Using the data from the debriefing sessions, I first analyzed the reflections on the simulation experience via a dramaturgical perspective. I then developed the following themes based on a symbolic interactionist approach to the debriefing data: (1) centering the child, allying with the parent, and treating the family system, (2) reflecting on dyadic challenges: role reversal and individuation, (3) ambivalence in and about the parent-child dyad, (4) accepting uncertainty and the unknown and focusing on the here and now, and (5) longitudinal narratives and changing contexts. The depth of participant reflections during the debriefing sessions suggested the emotional authenticity and interpersonal complexity of the simulation cases. The emotional experience of the simulations, for interviews and observers alike, provided an opportunity to reflect on personal and professional experiences and triggered meaningful insights and connections between participants. I then examined the questions of whether we truly simulated the parent-child dyad and whether we truly created a safe space. I explored how CCPS reproduces emotional authenticity and emotional labor. In discussing emotional authenticity, I interrogated the concept of “authenticity” further, explored authentic performance via Stanislavski’s system, and examined how Medical Education Empowered by Theater (MEET) harnesses the power of performance to create emotionally authentic experiences that lead to personal and professional growth. In discussing emotional labor, I turned to Hochschild’s The Managed Heart and complicated the notion of emotional labor in child and adolescent psychiatry. I then examined dyadic relationships as holding environments. I outlined Winnicott’s conceptualization of the mother-infant dyad as the first holding environment and how therapeutic dyads can function as holding environments. I then considered the debriefing session as a holding environment between learners and for the instructor-learner dyad.
Thomas, Isaiah, "Family Dyads, Emotional Labor, And The Theater Of The Clinical Encounter: Co-Constructive Patient Simulation As A Reflective Tool In Child And Adolescent Psychiatry Training" (2023). Yale Medicine Thesis Digital Library. 4163.
This Article is Open Access