Access Type

Open Access Dissertation

Date of Award

January 2016

Degree Type


Degree Name




First Advisor

Julie M. Novak


Patient-centered Communication (PCC) is the gold standard in effective clinical communication. Feedback from Standardized Patients (SPs) provides one strategy to teach PCC. SP feedback is highly valued, but little is understood about its quality, nature, and the form in which it is actually delivered. Methods: Using the meta-method of crystallization (Ellingson, 2009), I conducted three unique studies, content analysis, iterative thematic analysis, and narrative analysis of SP feedback. These analyses were conducted using transcribed SP feedback from a multi-station, residency-based Objective Structured Clinical Exam (OSCE). SPs in this OSCE were trained using the adapted version of the Kalamazoo Essential Elements of Communication Checklist (KEECC-A). Findings: In the content analysis, I identified that most SP feedback was positive, in nature. Additionally, the KEECC-A communication competencies and sub-competencies most referenced by SPs, related to building a deeper, more meaningful relationship with the resident, particularly with regard to achieving a mutual understanding of a treatment plan. In the thematic analysis, I identified five emergent themes: (a) Active Listening; (b) Enhanced Autonomy; (c) Culture; (d) Empathy; and (e) Communication as Comfort. In the final study, I found through narrative analysis, that the form of SP feedback is a storied process, adhering to five inherent elements of narrative, as defined by Charon (2006). Discussion: Looking at these findings through the meta-method of Crystallization (Ellingson, 2009) reveals that analyzing complex phenomena through one methodology inherently limits the depth of knowledge gained; specific to this research, whereas the content analysis provided me with a descriptive understanding of ‘what’ elements of the KEECC-A were being used, the thematic analysis provided a deeper context of meaning – the ‘why’ the elements were used, and the narrative analysis provided the ‘how’ feedback was being delivered (i.e., narratively). Furthermore this research extends current understandings of those elements in the KEECC-A that are most salient, as well as opportunities for enhancing or extending the KEECC-A to be more reflective of ‘lifeworld’ voices (Mishler, 1984). Future Research: Future research should continue to explore SP feedback with more diverse groups of SPs, enhanced versions of the KEECC-A and/or, new communication assessment tools, more reflective of lifeworld voices could be piloted. This is the first known study to extend the boundaries of crystallization beyond the qualitative spectrum into the post-positive realm; communication scholars and others committed to interpretive, multiple means for exploring phenomena should continue to embrace and challenge crystallization, seeking out new and dynamic methods for robust and meaningful scholarship.