ERIC Number: EJ861374
Record Type: Journal
Publication Date: 2009-Dec
Abstractor: As Provided
Reference Count: N/A
Attending to Audience: Comparing Optometry Student Talk "with" and "about" Patients
Hildebrand, Jenna M.; Spafford, Marlee M.; Schryer, Catherine F.
Advances in Health Sciences Education, v14 n5 p777-789 Dec 2009
We explored mediating concepts that affect clinical novices shifting between their talk "with" patients in eye examinations and their talk "about" patients in case presentations (nCPs). In a Canadian optometry teaching clinic, patient "chief concern or request", "illness experience", and "management" utterances were observed in ten eye examinations and nCPs. Twenty-three participants (8 students, 5 instructors, and 10 patients) were observed; 22 were subsequently interviewed. Of 10 nCPs, the "chief concern or request' was absent in four, the "illness experience" was incomplete or absent in 9 and 5 of 19 (35.7%) "management" topics were not discussed with patients. During eye exams, 17 of 31 (54.8%) "management" discussions with patients were not discussed with instructors during nCPs. Instructional "scaffolding" (Bruner and Sherwood in "Play: its role in development and evolution", p. 280, 1976) appeared limited regarding talk "with" and "about" patients. The limited and recontextualized reporting of patient concerns and experiences in nCPs represented lost opportunities to provide and learn patient-centered care. While Goffman's ("The presentation of the self in everyday life", p. 114, 1969) "front stage" performances and Mishler's ("The discourse of medicine: dialectics of medical interviews", p. 14, 1984) healthcare "voices" suggest separate worlds of talk before patients and instructors, we found these worlds were not wholly separate for neophyte speakers. Mediating concepts that influence clinical novices shifting their performances before their audiences, included: (1) pedagogical inconsistencies, (2) incompatible values associated with talk, (3) discordance between patient care and student education, (4) time limitations for teaching, and (5) insufficient instructional "scaffolding" about talk.
Descriptors: Classroom Communication, Optometry, Patients, Interpersonal Communication, Allied Health Occupations Education, Clinical Teaching (Health Professions), Practicums, Medical Evaluation, Clinical Diagnosis, Educational Strategies, Foreign Countries, Vision Tests, College Students
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Publication Type: Journal Articles; Reports - Evaluative
Education Level: Higher Education; Postsecondary Education
Authoring Institution: N/A
Identifiers - Location: Canada