Browsing by Author "Monrouxe, Lynn V."

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    Feedback-in-action within bedside teaching encounters: a video ethnographic study
    (Wiley, 2014-08-11) Rizan, Chantelle; Elsey, Christopher; Lemon, Thomas; Grant, Andrew; Monrouxe, Lynn V.
    Context Feedback associated with teaching activities is often synonymous with reflection on action, which comprises the evaluative assessment of performance out of its original context. Feedback in action (as correction during clinical encounters) is an underexplored, complementary resource facilitating students' understanding and learning. Objectives The purpose of this study was to explore the interactional patterns and correction modalities utilised in feedback sequences between doctors and students within general practice-based bedside teaching encounters (BTEs). Methods A qualitative video ethnographic approach was used. Participants were recorded in their natural settings to allow interactional practices to be contextually explored. We examined 12 BTEs recorded across four general practices and involving 12 patients, four general practitioners and four medical students (209 minutes and 20 seconds of data) taken from a larger corpus. Data analysis was facilitated by Transana video analysis software and informed by previous conversation analysis research in ordinary conversation, classrooms and health care settings. Results A range of correction strategies across a spectrum of underlying explicitness were identified. Correction strategies classified at extreme poles of this scale (high or low explicitness) were believed to be less interactionally effective. For example, those using abrupt closing of topics (high explicitness) or interactional ambiguity (low explicitness) were thought to be less effective than embedded correction strategies that enabled the student to reach the correct answer with support. Conclusions We believe that educators who are explicitly taught linguistic strategies for how to manage feedback in BTEs might manage learning more effectively. For example, clinicians might maximise learning moments during BTEs by avoiding abrupt or ambiguous feedback practices. Embedded correction strategies can enhance student participation by guiding students towards the correct answer. Clinician corrections can sensitively manage student face-saving by minimising the exposure of student error to patients. Furthermore, we believe that the effective practices highlighted by our analysis might facilitate successful transformation of feedback in action into feedback for action.
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    Patients embodied and as-a-body within bedside teaching encounters: A video ethnographic study
    (Springer, 2016-05-31) Elsey, Christopher; Challinor, Alexander; Monrouxe, Lynn V.
    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.
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    The reciprocal nature of trust in bedside teaching encounters
    (John Benjamins, 2014-07-24) Elsey, Christopher; Monrouxe, Lynn V.; Grant, A. J.
    The objective of this chapter is to explore a broad and liberal conception of trust as manifest in bedside teaching encounters (BTEs) in which medical students learn with, from and about patients. Adopting an ethnomethodological conception of trust, it is postulated that trust, as a practical phenomenon, revolves around parties within a clinical setting sharing a mutual intelligibility of action and orienting to a world-known-in-common that provides the interactional resources to enable the mutual accomplishment of the medical encounter (Garfinkel 1963; 1967; Watson 2009; Schegloff 1992; Sacks 1995). The standard medical encounter between doctor and patient constitutes an experience that they routinely and recurrently enact. As a result it is reasonable to postulate that on any given instance of a medical interaction the different parties have a shared understanding as to the social roles that are being fulfilled by themselves and others. However, the presence of a medical student is not necessarily an intrinsic feature of medical encounters. Therefore a fruitful avenue of analysis is to explore how the triadic interaction between doctor-patient-student involves a modification of the interactional format and organisation of medical encounters. It is also critical to consider how the expectations and roles of the participants are negotiated, enacted and transformed, in the midst of the pursuit of patient health and wellbeing. The primary mode of enquiry has been video ethnography in conjunction with a linguistic ethnographic analytic mentality (Heath et al. 2010; Pink 2007). In short our data consists of video recordings of bedside teaching encounters (n=34, ongoing; mean average per encounter 23 minutes; approximate total recording time 788 minutes) in a variety of clinical settings (e.g. general practice surgeries, hospital wards, outpatient clinics) encompassing a range of clinical specialties (e.g. GP, paediatrics, geriatrics, and general surgery and medicine). The thrust of the analytic interests reside in understanding the dynamics that are constituted within the triadic interactions between doctor-patient-student and focalises the pivotal role that the student plays within BTEs whether as an observer or active participant.