Culture, Medicine, and Psychiatry

, Volume 35, Issue 2, pp 134–162 | Cite as

The Moral Aesthetics of Simulated Suffering in Standardized Patient Performances



Standardized patient (SP) performances are staged clinical encounters between health-professional students and people who specialize in role-playing the part of patients. Such performances have in recent years become increasingly central to the teaching and assessment of clinical skills in U.S. medical schools. SP performances are valued for being both “real” (in that they involve interaction with a real person, unlike written examinations) and “not real” (in that the SP does not actually suffer from the condition portrayed, unlike an actual patient). This article considers how people involved in creating SP performances reconcile a moral commitment to avoid suffering (to keep it “not real”), with an aesthetic commitment to realistically portray it (to keep it “real”). The term “moral aesthetic” is proposed, to indicate a sensibility that combines ideas about what is morally right with ideas about what is aesthetically compelling. Drawing on ethnographic research among SPs and SP program staff and medical faculty who work closely with them, this article argues that their work of creating “realism” in simulated clinical encounters encompasses multiple different (and sometimes conflicting) understandings and practices of realism, informed by three different moral aesthetics: (1) a moral aesthetic of induction, in which an accurate portrayal with a well-documented provenance serves to introduce experientially distant forms of suffering; (2) a moral aesthetic of inoculation, in which the authenticity and emotional impact of a performance are meant to inoculate students against the impact of future encounters with suffering; (3) a moral aesthetic of presence, generating forms of voice and care that are born out of the embodied presence of suffering individuals in a clinical space. All are premised on the assumption that risk and suffering can be banished from SP performances. This article suggests, however, that SP performances necessarily raise the same difficult, important, fundamentally ethical questions that are always involved in learning from and on human beings who are capable of suffering, and who need and deserve recognition and respect as well as care.


Standardized patient (SP) performance Moral aesthetics Simulation Realism Emotional labor 



My sincere thanks are due to the many people working in the field of SP simulation and medical education, who have generously shared with me their time and knowledge. For their encouragement of this project from its earliest stages, I am grateful to Brian Hodges, Nancy McNaughton, Lorna Rhodes, Lesley Sharp, Susan Shaw, and Jennie Struijck—though I would stress that they may not agree with my analysis, and are certainly in no way responsible for any errors or shortcomings it may contain. For helpful comment on earlier versions of this essay, my thanks to Nancy McNaughton, Uta Poiger, Jeannette Pols, Priti Ramamurthy, Michele Rivkin-Fish, Lesley Sharp, and Lynn Thomas, as well as Lochlann Jain and others who attended a public presentation of this argument in the Department of Anthropology at Stanford University. Sincere appreciation to the editors and anonymous reviewers of Culture, Medicine and Pyschiatry, and especially to Scott Stonington, Seth Holmes, and Angela Jenks as guest-editors of this special issue.


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.University of WashingtonSeattleUSA

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