ERIC Number: EJ1130084
Record Type: Journal
Publication Date: 2017-Mar
Abstractor: As Provided
Reference Count: 63
Patients "Embodied" and "As-a-Body" within Bedside Teaching Encounters: A Video Ethnographic Study
Elsey, Christopher; Challinor, Alexander; Monrouxe, Lynn V.
Advances in Health Sciences Education, v22 n1 p123-146 Mar 2017
Bedside teaching encounters (BTEs) involve doctor-patient-student interactions, providing opportunities for students to learn with, from and about patients. How the differing concerns of patient care and student education are balanced in situ remains largely unknown and undefined. This video ethnographic study explores "patient involvement" during a largely "student-centric" activity: "feedback sequences" where students learn clinical and practical skills. Drawing on a data subset from a multi-site study, we used Conversation Analysis to investigate verbal and non-verbal interactional practices to examine patients' inclusion and exclusion from teaching activities across 25 BTEs in General Practice and General Surgery and Medicine with 50 participants. Through analysis, we identified two representations of the patient: the patient "embodied" (where patients are actively involved) and the "patient as-a-body" (when they are used primarily as a prop for learning). Overall, patients were excluded more during physical examination than talk-based activities. Exclusion occurred through physical positioning of doctor-patient-student, and through doctors and students talking "about", rather than "to", patients using medical jargon and online commentaries. Patients' exclusion was visibly noticeable through eye gaze: patients' middle-distance gaze coincided with medical terminology or complex wording. Inclusory activities maintained the "patient embodied" during teaching activities through doctors' skilful embedding of teaching within their care: including vocalising clinical reasoning processes through students, providing patients with a "warrant to listen", allocating turns-at-talk for them and eye-contact. This study uniquely demonstrates the visible nature patient exclusion, providing firm evidence of how this affects patient empowerment and engagement within educational activities for tomorrow's doctors.
Descriptors: Clinical Teaching (Health Professions), Patients, Medical Students, Video Technology, Ethnography, Participation, Physicians, Eye Movements, Feedback (Response), Foreign Countries
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Publication Type: Journal Articles; Reports - Research
Education Level: Higher Education; Postsecondary Education
Authoring Institution: N/A
Identifiers - Location: United Kingdom