Attending to audience: comparing optometry student talk with and about patients

Abstract

We explored mediating concepts that affect clinical novices shifting between their talk with patients in eye examinations and their talk about patients in case presentations (nCPs). In a Canadian optometry teaching clinic, patient 'chief concern or request', 'illness experience', and 'management' utterances were observed in ten eye examinations and nCPs. Twenty-three participants (8 students, 5 instructors, and 10 patients) were observed; 22 were subsequently interviewed. Of 10 nCPs, the 'chief concern or request' was absent in four, the 'illness experience' was incomplete or absent in 9 and 5 of 19 (35.7%) 'management' topics were not discussed with patients. During eye exams, 17 of 31 (54.8%) 'management' discussions with patients were not discussed with instructors during nCPs. Instructional 'scaffolding' (Bruner and Sherwood in Play: its role in development and evolution, p. 280, 1976) appeared limited regarding talk with and about patients. The limited and recontextualized reporting of patient concerns and experiences in nCPs represented lost opportunities to provide and learn patient-centered care. While Goffman's (The presentation of the self in everyday life, p. 114, 1969) 'front stage' performances and Mishler's (The discourse of medicine: dialectics of medical interviews, p. 14, 1984) healthcare 'voices' suggest separate worlds of talk before patients and instructors, we found these worlds were not wholly separate for neophyte speakers. Mediating concepts that influence clinical novices shifting their performances before their audiences, included: (1) pedagogical inconsistencies, (2) incompatible values associated with talk, (3) discordance between patient care and student education, (4) time limitations for teaching, and (5) insufficient instructional 'scaffolding' about talk.

At the boundary of school: Continuity and discontinuity in learning across contexts

“…In recognition of this, supporting students in being able to cross boundaries independently is discussed in the reviewed studies. For instance, different authors discuss the importance of learning how different rules apply to different settings (e.g., Bonotto, 2005;Hildebrand, Spafford, & Schryer, 2009). The reviewed studies show that teachers can also demonstrate an ability to act as broker in school, supporting students in learning across contexts.…”

Optometrists' perspectives on cross‐cultural encounters in clinical practice: a pilot study

“…Previously quantitative research methods have been used more widely to study patient–practitioner communication and interactions; however, in recent times researchers in this field have adopted qualitative methods. Findings from studies using qualitative methods 5,21–23 indicate that they are useful in helping us understand the multi‐faceted nature and complexities of the patient–practitioner relationship; however, this is a developing area of research. A stronger evidence base is necessary to design strategies and frameworks to instruct and prepare health practitioners, such as optometrists, to work in culturally diverse communities.…”

Rethinking Soft Skills Through Front-Stage and Back-Stage Genres

“…But, when talking with a patient in the front stage, the doctors usually avoided discussion about prognosis. Similarly, Hildebrand et al (2009) researched what concepts affected clinical novices (i.e., optometry students) to shift talk about patients in case presentations to their faculty. In other words, when students would talk to their supervisors or practitioners, they would need to reconstruct their talk with patients into profession-sanctioned discourse, which was adjusted to the front stage.…”