Medicine and Health Sciences Commons^™

Look Who’S Talking: Teaching And Learning Using The Genre Of Medical Case Presentations, Marlee Spafford, Catherine Schryer, Marcellina Mian, Lorelei Lingard

Lorelei Lingard

In a pediatric teaching hospital, the authors examined 16 novice medical case presentations that were classified as instances of a hybrid apprenticeship genre. In contrast to strict school and workplace genres, an apprenticeship genre results from the sometimes competing activity systems of student education and patient care. The authors examined these novice case presentations for the amount and patterns of time devoted to student learning and expert teaching, the difficulties created for participants, the sometimes misunderstood implicit messages delivered by experts, and the opportunities to address educational objectives. This study offers professional communication researchers a model that combines quantitative and …

What Do We Mean By "Relevance"? A Clinical And Rhetorical Definition With Implications For Teaching And Learning The Case-Presentation Format, Lorelei Lingard, R. Haber

Lorelei Lingard

No abstract provided.

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 …

Junior Faculty Experiences With Informal Mentoring, Karen Leslie, Lorelei Lingard, Sarah Whyte

Lorelei Lingard

Mentoring is one way in which new faculty can acquire the skills needed for a successful academic career. Little is known about how informal mentoring is operationalized in an academic setting. This study had two main objectives: (1) to determine if junior faculty identify as having an informal mentor(s) and to describe their informal mentoring relationships; and (2) to identify the areas in which these faculty seek career assistance and advice. The study employed a grounded theory approach. Subjects were recruited from the clinical teaching faculty and were 3-7 years into their first faculty position. Theoretical sampling was employed in …

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 …

Clinical Oversight: Conceptualizing The Relationship Between Supervision And Safety, Tara Kennedy, Lorelei Lingard, G. Baker, Lisa Kitchen, Glenn Regehr

Lorelei Lingard

BACKGROUND: Concern about the link between clinical supervision and safe, quality health care has led to widespread increases in the supervision of medical trainees. The effects of increased supervision on patient care and trainee education are not known, primarily because the current multifacted and poorly operationalized concept of clinical supervision limits the potential for evaluation.

OBJECTIVE: To develop a conceptual model of clinical supervision to inform and guide policy and research.

DESIGN, SETTING, AND PARTICIPANTS: Observational fieldwork and interviews were conducted in the Emergency Department and General Internal Medicine in-patient teaching wards of two academic health sciences centers associated with …

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 …

Team Communications In The Operating Room: Talk Patterns, Sites Of Tension, And Implications For Novices, Lorelei Lingard, Richard Reznick, Sherry Espin, Glenn Regehr, Isabella Devito

Lorelei Lingard

PURPOSE: Although the communication that occurs within health care teams is important to both team function and the socialization of novices, the nature of team communication and its educational influence are not well documented. This study explored the nature of communications among operating room (OR) team members from surgery, nursing, and anesthesia to identify common communicative patterns, sites of tension, and their impact on novices.

METHOD: Paired researchers observed 128 hours of OR interactions during 35 procedures from four surgical divisions at one teaching hospital. Brief, unstructured interviews were conducted following each observation. Field notes were independently read by each …

Progressive Independence In Clinical Training: A Tradition Worth Defending?, Tara Kennedy, Glenn Regehr, G. Baker, Lorelei Lingard

Lorelei Lingard

BACKGROUND: Progressive independence is a traditional premise of clinical training. Recently, issues such as managed care, work hours limitation, and patient safety have begun to impact the degree of autonomy afforded to clinical trainees. This article reviews empirical evidence and theory pertaining to the role of progressive autonomy in clinical learning. METHOD: A computerized literature search was performed using Medline, PsycINFO, Social Sciences Citation Index, and Educational Resources Information Center. This article presents a synthetic review of relevant empirical and theoretical concepts from the domains of medicine, psychology, education, kinesiology, and sociology. RESULTS: The clinical psychology and medical education literatures …

Teaching And Learning Communication In Medicine: A Rhetorical Approach, Lorelei Lingard, R. Haber

Lorelei Lingard

The language people use both makes possible and constrains the thoughts they can have. More than just a vehicle for ideas, language shapes ideas--and the practices that follow from them. Thus, in medical education, teaching students how to talk about medical cases also teaches them how to think about patients and medical work, and how to define their relationships to both. Without a theoretical model, however, teaching efforts in this domain tend to be implicit and ad hoc, which can lead to serious problems. Rhetoric is one science that can deepen understanding of communication and improve teaching of this clinical …

'You Learn Better Under The Gun': Intimidation And Harassment In Surgical Education, Laura Musselman, Helen Macrae, Richard Reznick, Lorelei Lingard

Lorelei Lingard

BACKGROUND: Medical literature has documented a high prevalence of intimidation and harassment in the educational context. However, the research has failed to adequately delineate the nature of these phenomena as well as the different ways in which diverse actors perceive the behaviours in question.

METHODS: Based on qualitative methodology anchored in a social constructionism framework, how teachers (staff surgeons) and learners (surgical residents) define intimidation and harassment were documented and compared. In addition, teachers' and learners' perceptions of the impact of these behaviours on the learning environment, including their effects on the socialisation of surgeons in training, were examined.

FINDINGS: …

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 …

The Rhetorical 'Turn' In Medical Education: What Have We Learned And Where Are We Going?, Lorelei Lingard

Lorelei Lingard

This paper presents a critical reflection on the contributions and challenges associated with one rhetorical approach to studying teaching and learning communication in health professions education. A rhetorical approach treats language as a social act, and attends to the role of language in establishing professional identities and relationships. The research has produced insights into the use of standard communication formats to teach novices, the nature of socialization on clinical teams, and the relationship between communication patterns and patient safety. Challenges and emerging questions include the problem of accounting for the material dimensions of communication in a rhetorical model, grappling with …

Technical Skills In Paediatrics: A Qualitative Study Of Acquisition, Attitudes And Assumptions In The Neonatal Intensive Care Unit, Susan Bannister, Robert Hilliard, Glenn Regehr, Lorelei Lingard

Lorelei Lingard

PURPOSE: While the effective acquisition of technical skills is essential for excellent paediatric care, little is known about how technical skills are learned in the paediatric setting. This study sought to describe and theorise the variables influencing technical skills acquisition in a tertiary care neonatal intensive care unit (NICU) inpatient setting. METHODOLOGY: Using non-participant field methodology, paediatric residents and their teachers (nurses, respiratory therapists, neonatal staff and fellows) were observed at various times in the NICU for 8 weeks. Thirteen semistructured interviews with these teachers and learners and 1 focus group of additional learners were conducted and used to triangulate …

'Is That Normal?' Pre-Clerkship Students' Approaches To Professional Dilemmas, Shiphra Ginsburg, Lorelei Lingard

Lorelei Lingard

OBJECTIVES: Context has been recognised as a key variable in studies of medical student professionalism, yet the effect of students' stage of training has not been well explored, despite growing recognition that medical students begin to form their professional ethos from their earliest medical school experiences. The purpose of this study, which builds on previous research involving clinical clerks, was to explore the decision-making processes of pre-clerkship medical students in the face of standardised professional dilemmas.

METHODS: Structured interviews were conducted with 30 pre-clerkship (Years 1 and 2) medical students at one institution. During the interviews, students were asked to …