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This paper is concerned with simulated consultations between medical students and real patients, focusing in particular on multiple framings as they lead to activity-specific ambiguities. In these simulated consultations the misalignment of expectations between medical students and patients becomes evident in the opening and closing sequences in particular, which provides the rationale for focusing on these phases of the encounter. Transcribed video recordings were drawn from a Norwegian empirical study of simulated consultations in medical education. The analytic framework derives from a dynamic notion of activity type in conjunction with framing and hybridity. The data illustrate that agenda questions, targeted at the patient's reason for seeing the doctor, frame situations where the students had to manage ambiguities at different levels. While the medical students strive to negotiate the multi-layered frames at an implicit level, the patients negotiate the frames in a more explicit manner. There is uncertainty as to whether the role-play should be perceived as an authentic consultation, which seems to be the student's aspiration, or whether it is to be regarded as a training situation, which appears to be the patient's perception. The paper concludes by raising some issues about the role of role-play in medical education, with particular reference to communication skills training.

BackgroundCommunication errors can reduce patient safety, especially in emergency situations that require rapid responses by experts in a number of medical specialties. Talking to each other is crucial for utilizing the collective expertise of the team. Here we explored the functions of “team talk” (talking between team members) with an emphasis on the talk-work relationship in interdisciplinary emergency teams.MethodsFive interdisciplinary medical emergency teams were observed and videotaped during in situ simulations at an emergency department at a university hospital in Norway. Team talk and simultaneous actions were transcribed and analysed. We used qualitative discourse analysis to perform structural mapping of the team talk and to analyse the function of online commentaries (real-time observations and assessments of observations based on relevant cues in the clinical situation).ResultsStructural mapping revealed recurring and diverse patterns. Team expansion stood out as a critical phase in the teamwork. Online commentaries that occurred during the critical phase served several functions and demonstrated the inextricable interconnections between team talk and actions.DiscussionDiscourse analysis allowed us to capture the dynamics and complexity of team talk during a simulated emergency situation. Even though the team talk did not follow a predefined structure, the team members managed to manoeuvre safely within the complex situation. Our results support that online commentaries contributes to shared team situation awareness.ConclusionsDiscourse analysis reveals naturally occurring communication strategies that trigger actions relevant for safe practice and thus provides supplemental insights into what comprises “good” team communication in medical emergencies.

ObjectivesExplore the function of three specific modes of talk (discourse types) in decision-making processes.DesignTen real-life admissions of patients with critical illness were audio/video recorded and transcribed. Activity-type analysis (a qualitative discourse analytical method) was applied.SettingInterdisciplinary emergency teams admitting patients with critical illness in a Norwegian university hospital emergency department (ED).ParticipantsAll emergency teams consisted of at least two internal medicine physicians, two ED nurses, one anaesthetist and one nurse anaesthetist. The number of healthcare professionals involved in each emergency team varied between 11 and 20, and some individuals were involved with more than one team.ResultsThe three discourse types played significant roles in team decision-making processes when negotiating meaning. Online commentaries (ONC) and metacommentaries (MC) created progression while offline commentaries (OFC) temporarily placed decisions on hold. Both ONC and MC triggered action and distributed tasks, resources and responsibility in the team. OFC sought mutual understanding and created a broader base for decisions.ConclusionA discourse analytical perspective on team talk in medical emergencies illuminates both the dynamics and complexity of teamwork. Here, we draw attention to the way specific modes of talk function in negotiating mutual understanding and distributing tasks and responsibilities in non-algorithm-driven activities. The analysis uncovers a need for an enhanced focus on how language can trigger safe team practice and integrate this knowledge in teamwork training to improve communication skills in ad hoc emergency teams.

SAMMENDRAGMøter mellom Nav-veileder og bruker er viktige både for samfunnets mål om flest mulig i arbeid, og for den enkelte bruker som har behov for veiledning, økonomisk eller praktisk hjelp. Gjennom FOU-satsingen «Interaksjon med brukere» legger Nav vekt på brukermøtene og hvordan kvaliteten i disse henger sammen med målene om aktivisering og brukermedvirkning.Denne metodologiske artikkelen bruker norsk og internasjonal forskning om samtaler i arbeids-og velferdssektoren som empirisk grunnlag for å diskutere hvordan ulike metoder er egna til å belyse ulike problemstillinger. Detaljert analyse av samarbeidet og samspillet i faktiske brukermøter er en lite brukt metode i forskning om Nav. I denne artikkelen diskuterer vi derfor hva som kan oppnås gjennom å gjøre naerstudier av interaksjonen i brukermøter med utgangspunkt i lyd-/bildeopptak og med verktøy fra samtaleforskning. Vi gir eksempler på hvordan analyse av samtaledata kan gi grunnlag for å nyansere standardiserte råd om kommunikasjon og belyse hvordan brukermøtets interaksjonelle forløp skaper vilkår for deltakelse i samtalen.Å vaere samtaleleder i brukermøter er en viktig del av Nav-veilederes jobb. Denne artikkelen bidrar med en forskningsbasert begrunnelse for hvorfor bevisstgjøring om samtalens dynamikk i brukermøtene bør vaere del av fagutviklingen i Nav. NøkkelordNav, brukermøter, brukermedvirkning, samtaledata, interaksjon med brukere ABSTRACT Meetings between service users and counsellors in the Norwegian Labour and Welfare Administration (NAV) are vital both for achieving the goals of increased employment in the labour and welfare sector and for the individual service user with needs for counselling or economic assistance. Detailed analysis of interaction in service user meetings, based on audio/video recordings of authentic meetings, is a method that is rarely used in research on social work. In this methodological paper, we discuss what can be achieved by studying interactional data with micro-analytic tools. This paper gives a research-based motivation for why detailed analysis of interaction can create awareness and insights into the dynamics of service user meetings and provide a foundation for professional development in NAV.Keywords NAV, service user involvement, interaction, service user meetings, micro-analysis Veiledere i Nav tilbringer mye tid i møter med brukere av offentlige tjenester. Brukerne har ulike behov, ønsker og livssituasjoner, og Nav tilbyr et bredt spekter av tjenester innafor rammene av offentlige budsjetter, lover og forskrifter og statlige og kommunale mål for tjenestene. Felles for alle disse ulike brukermøtene er etatens mål om flest mulig i arbeid og