ABSTRACT
This chapter focuses on many students’ perception that real patients respond in unexpected ways to clinical interviews. They find them very different from their experiences interviewing simulated patients or fellow students. Potential unintended consequences of the early use of simulation to teach students about clinical communication are discussed. When students talk about their clinical encounters, they often use metaphors characterising patients’ accounts as deviating from an expected path or track. One student’s story about how to respond when this happens reveals her creative struggle to integrate established and emerging identities. A history-taking interview between a student and patient is analysed to show how the patient interweaves story fragments about his life through the medical history. As a result, parallel narratives of disease, illness experience and identity work can be distinguished. Autobiographical stories offer insights into a patient’s needs and preferences but are typically excluded when their accounts are transformed into a clinical case presentation. This chapter shows that identity construction is integral to interactive learning and that despite contextual and cultural influences, it is an active process that results in the construction of additional identities rather than a transformation or substitution of new for old.
