Practitioners’ Noticing and Know-How in Multi-Activity Practice of Patient Care And Teaching and Learning

Abstract

Developing a sound ability of noticing is a crucial competency for both teachers and medical professionals in the respective professional and disciplinary communities. In this article, we investigate noticing in practice-how members of a professional community in the high-tech modern medicine specialty of Advanced Heart Failure use this ability towards developing and sustaining what it means to be a competent practitioner and what counts as a relevant practice of noticing in their moment-to-moment training. A multimodal analysis of videotaped practice is conducted on professionals' interactions who are simultaneously engaged in multiple activities: patient care and teaching and learning in graduate medical education. Toward this end, we expand the concept of noticing to 1) include a relational aspect, attending to and caring for the Other (students, patients); and 2) shift the analytic focus from an observer's interpretation of a scene to a concerted production of the scenic features to make sense of noticing in practice.

‘Noticing’ in health professions education: Time to pay attention?

“…However, such expert behaviour typically starts off as slow and effortful, only becoming flowing and effortless through practice. New health professions students' ability to notice is particularly compromised when the tasks asked of them are demanding, or the clinical placement settings are ‘noisy’, because little of what they ‘do’ is automatic 34 …”

“…Unless ‘incidents’ are marked as salient at the time, and subsequently recorded, they are likely to be lost. Health professionals also need the ability to recognise the ‘in‐the‐moment’ situations that they have primed themselves to notice in order to have the possibility of acting differently, expressed as the ability to ‘notice in context’ 3 or ‘notice in practice’ 34 . Like the other Intentional Noticing stages, this ability requires deliberate approaches to practice as it requires some disruption of the automatic processing that characterises the work of competent health professionals 24 …”

“…New health professions students' ability to notice is particularly compromised when the tasks asked of them are demanding, or the clinical placement settings are 'noisy', because little of what they 'do' is automatic. 34 As these processes of noticing, sensemaking and responding are closely linked, it has led to the aforementioned differing conceptualisations of noticing. Some authors have defined noticing exclusively as that to which people attend to.…”

What is that’s going on here? A multidimensional time concept is foundational to framing for decision making in situations of uncertainty

“…Dr. D does the same. The apparent competition for the lead fast resolves in organized teamwork: Dr. D talks to Mr. Spencer and his family in what Goffman (1974) defined as a frontstage, while Dr. S organizes the plan in backstage, where Mr. Spencer and his family have no auditory access, a common division of space in medical care (Raia & Smith, 2020). A sudden change of a situation, from urgent to emergency, requires multiple rapid adjustments.…”

Using the Skill of Noticing to Support Empathy for Third-Year Medical Students in Family Medicine

“…5,6 By noticing patient clues, doctors are more engaged with and better able to care for patients. 7 Other studies focused on empathy decline have largely been quantitative studies and self-reports. [8][9][10] This qualitative study addressed the following question: How can a focused noticing tool encourage empathetic moments during the patient interview for third-year medical students?…”