LAUSR

Background Simulated participants (SPs) play an increasing role in Health Professions Education (HPE) in simulated learning environments.1Whilst some are actively involved in teaching intimate examinations in some parts of the world2, most SPs are involved in more ‘mundane’ or everyday simulated examinations. We argue that even these ‘mundane’ examinations, such as a chest examination in a female patient, may also be perceived as intrusive and involve unacknowledged sexual undercurrents. We were interested in power dynamics in such simulated encounters which unlike in clinical contexts with patients, are less well known. This research looked at SPs’ perceptions of boundary crossing in all examinations on the intimacy continuum, particularly where power dynamics led to subjugation of SPs to clinical tools. Methods Data was collected from 22 SPs in five focus groups and analysed using thematic analysis, sensitised by Foucault’s concept of the clinical gaze. Data collection and analysis continued iteratively under themes were fully developed, with input from the research team. Results As students and SPs navigated boundary crossing simulated examinations, issues of power were apparent. The simulated learning environment permitted SPs themselves, perhaps unintentionally to further propagate the clinical gaze. Discourses of sexuality were prominent, exemplified by the strong sexual metaphors that the SPs often called on to reflect their feelings of subjugation and even, at times, violation. Discussion and conclusion In simulated learning environments, the clinical gaze and power dynamics are very important with potentially detrimental consequences. Any simulated examination, however mundane, can be considered ‘intimate’; underpinned by discourses of sexuality. SPs have an important role in guiding students to reflectively navigate the blurred lines between contact that is caring and contact that is sexual, and to acknowledge power relations in such encounters. Simulated learning spaces must no longer permit enactment of the clinical gaze. References Lewis KL, Bohnert CA, Gammon WL, Hölzer H, Lyman L, Smith C, Thompson TM, Wallace A and Gliva-McConvey G. The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP). Advances in Simulation 2017 2:10 Grankvista O, Olofssonb AD, Isakssonc RM. Can physicians be replaced with gynaecological teaching women to train medical students in their first pelvic examination? A pilot study from Northern Sweden. Patient Education and Counselling. 2014;96 (1) 50–4.