Health Services Research Commons^™

Techne Or Artful Science And The Genre Of Case Presentations In Healthcare Settings, Catherine Schryer, Lorelei Lingard, Marlee Spafford

Lorelei Lingard

This paper presents a qualitative study that investigated the role of case presentations in the socialization of medical and optometry students. Using the debate from classical rhetoric around the term techne (art or science), we observed that genre theory helps explain the way case presentations mediate the development of professional identity through the interaction of certain knowledge (techne 1), “savvy” knowledge (techne 2), and ethical reflection (phronesis). We noted that these mediated scenes of learning are necessary but problematic because they can lead students to yearn for certainty and to exclude outsiders (other healthcare providers, patients). Finally, our research challenges …

What Healthcare Students Do With What They Don't Know: The Socializing Power Of 'Uncertainty' In The Case Presentation, Marlee Spafford, Catherine Schryer, Lorelei Lingard, Patricia Hrynchak

Lorelei Lingard

Healthcare students learn to manage clinical uncertainty amid the tensions that emerge between clinical omniscience and the 'truth for now' realities of the knowledge explosion in healthcare. The case presentation provides a portal to viewing the practitioner's ability to manage uncertainty. We examined the communicative features of uncertainty in 31 novice optometry case presentations and considered how these features contributed to the development of professional identity in optometry students. We also reflected on how these features compared with our earlier study of medical students' case presentations. Optometry students, like their counterparts in medicine, displayed a novice rhetoric of uncertainty that …

Tensions In The Field: Teaching Standards Of Practice In Optometry Case Presentations, Marlee Spafford, Lorelei Lingard, Catherine Schryer, Patricia Hrynchak

Lorelei Lingard

PURPOSE: Professional identity formation and its relationship to case presentations were studied in an optometry school's onsite clinic. METHODS: Eight optometry students and six faculty optometrists were audio-recorded during 31 oral case presentations and the teaching exchanges related to them. Using convenience sampling, interviews were audio-recorded of four of the students and four of the optometrists from the field observations. After transcribing these audio-recordings, the research team members applied a grounded theory method to identify, test, and revise emergent themes. The theme reported herein pertains to communicating standards of practice. RESULTS: Faculty optometrists demonstrated three ways of communicating standards of …

Teaching The Balancing Act: Integrating Patient And Professional Agendas In Optometry, Marlee Spafford, Lorelei Lingard, Catherine Schryer, Patricia Hrynchak

Lorelei Lingard

PURPOSE: We observed novice case presentations to identify the opportunities optometry students have to learn about balancing patient and professional agendas. METHODS: Eight optometry students and 6 faculty optometrists were audio-recorded during 31 case presentations. Four students and 4 optometrists from the field observations were interviewed. We analyzed the data using a grounded theory method. RESULTS: Students encountered patient and professional agendas that were both compatible (these instances typically involved appointment purpose and treatment options) and incompatible (these instances typically involved patient consent and 'guideline adherence). CONCLUSIONS: Ideally through explicit instruction, optometrists facilitated the student's ability to negotiate these tensions …

Towards Embracing Clinical Uncertainty: Lessons From Social Work, Optometry And Medicine, Marlee Spafford, Catherine Schryer, Sandra Campbell, Lorelei Lingard

Lorelei Lingard

Summary: The oral transmission and transformation of client information in an apprenticeship setting provides a rich environment in which to observe students and their expert supervisors managing uncertainty. In this Canadian-based study, we examined the communicative features of 12 social work supervisions involving social work students and their supervisors and enriched our observations with subsequent interviews of the participants.

Findings: Social work students viewed the acknowledgement and examination of uncertainty as a touchstone of competent social work. This observation contrasted with our past study of medical and optometry students who focused on personal deficit and a distrust of …