Chapter 3. The reciprocal nature of trust in bedside teaching encounters

Elsey, Christopher; Monrouxe, Lynn V.; Grant, Andrew

doi:10.1075/dapsac.56.03els

Cited by 9 publications

(15 citation statements)

References 30 publications

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“…As part of our steering group activities, we are also asking BTE participants (clinical teachers, students and patients) which issues within their BTEs they would like us to explore. Indeed, if we are serious about espousing a model of power sharing among BTE participants, we also need to consider the sharing of power between the researcher and the researched 36,45,46 …”

Section: Discussionmentioning

confidence: 99%

The construction of power in family medicine bedside teaching: a video observation study

2013

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INTRODUCTION Bedside teaching is essential for helping students develop skills, reasoning and professionalism, and involves the learning triad of student, patient and clinical teacher. Although current rhetoric espouses the sharing of power, the medical workplace is imbued with power asymmetries. Power is context-specific and although previous research has explored some elements of the enactment and resistance of power within bedside teaching, this exploration has been conducted within hospital rather than general practice settings. Furthermore, previous research has employed audio-recorded rather than video-recorded observation and has therefore focused on language and para-language at the expense of non-verbal communication and humanmaterial interaction.METHODS A qualitative design was adopted employing video-and audio-recorded observations of seven bedside teaching encounters (BTEs), followed by short individual interviews with students, patients and clinical teachers. Thematic and discourse analyses of BTEs were conducted.RESULTS Power is constructed by students, patients and clinical teachers throughout different BTE activities through the use of linguistic, para-linguistic and non-verbal communication. In terms of language, participants construct power through the use of questions, orders, advice, pronouns and medical ⁄ health belief talk. With reference to paralanguage, participants construct power through the use of interruption and laughter. In terms of non-verbal communication, participants construct power through physical positioning and the possession or control of medical materials such as the stethoscope.CONCLUSIONS Using this paper as a trigger for discussion, we encourage students and clinical teachers to reflect critically on how their verbal and non-verbal communication constructs power in bedside teaching. Students and clinical teachers need to develop their awareness of what power is, how it can be constructed and shared, and what it means for the student-patient-doctor relationship within bedside teaching.power in education

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Section: Discussionmentioning

confidence: 99%

The construction of power in family medicine bedside teaching: a video observation study

2013

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“…Our study bridges this gap by exploring feedback mechanisms found within interactions occurring during BTEs (involving the doctor–patient–student). Building upon an expanding body of research conducted by the present authors investigating BTEs, we uniquely explore feedback in action by examining the scope and character of correction sequences during BTEs.…”

Section: Methodsmentioning

confidence: 99%

Feedback in action within bedside teaching encounters: a video ethnographic study

et al. 2014

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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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“…This triadic doctor – patient – student interaction within bedside teaching encounters (BTEs) serves the dual purpose of patient care and medical student learning (Celenza and Rogers 2006; Chacko et al 2007; Wang-Cheng et al 1989). This dual purpose, however, makes it difficult for educators to marry the two for the benefit of all (Elsey et al 2014; Hindmarsh 2010): sometimes student learning presides, resulting in patients being objectified, marginalised or side-lined from their own medical consultations (Elsey et al 2014; Monrouxe et al 2009; Spencer and McKimm 2010). Such marginalisation runs counter to calls for more active involvement of patients in medical education, where students learn in conjunction with patients rather than merely in their presence (Rees et al 2007).…”

Section: Introductionmentioning

confidence: 99%

“…More recently, using a social constructionist framework viewing power, roles and identities as interactionally constructed, researchers have begun to examine interactional nuances within BTEs (Ajjawi et al 2015 ; Elsey et al 2014 ; Monrouxe et al 2009 ; Rees et al 2013 ; Rees and Monrouxe 2008 , 2010 ; Rizan et al 2014 ). For example, utilising a dramaturgy analysis of audio data, Monrouxe et al ( 2009 ) examined the extent to which patients were part of the teaching team within hospital based BTEs.…”

Section: Introductionmentioning

confidence: 99%

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Patients embodied and as-a-body within bedside teaching encounters: a video ethnographic study

Elsey

Challinor

Monrouxe

2016

Adv in Health Sci Educ

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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.Electronic supplementary materialThe online version of this article (doi:10.1007/s10459-016-9688-3) contains supplementary material, which is available to authorized users.

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Chapter 3. The reciprocal nature of trust in bedside teaching encounters

Cited by 9 publications

References 30 publications

The construction of power in family medicine bedside teaching: a video observation study

The construction of power in family medicine bedside teaching: a video observation study

Feedback in action within bedside teaching encounters: a video ethnographic study

Patients embodied and as-a-body within bedside teaching encounters: a video ethnographic study

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