Techne or Artful Science and the Genre of Case Presentations in Healthcare Settings

Schryer, Catherine F.; Lingard, Lorelei; Spafford, Marlee M.

doi:10.1080/03637750500120485

Cited by 33 publications

(34 citation statements)

References 21 publications

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“…Of note is the student's candor about his uncertainty with his supervisor who will ultimately evaluate him. This candor contrasts sharply with results from our earlier study of medical students performing case presentations (Lingard et al 2003a;Schryer et al 2005).…”

Section: Introductioncontrasting

confidence: 84%

“…The attitudes toward clinical uncertainty displayed by these optometry students were consistent with those displayed in interviews with medical students in our earlier study (Lingard et al 2003a;Schryer et al 2005). Students in optometry and medicine consider clinical uncertainty in the case presentation to be dangerous and something that should be avoided if at all possible.…”

Section: 'Well It Wouldn't Be-i Don't Think It Would Be [Disease X]' supporting

confidence: 73%

“…The opening excerpt reveals an optometry student who is quite explicit with his supervisor about his personal knowledge deficits. This openness was not characteristic of medical students who saw uncertainty as a negative personal statement about themselves and thereby sought to minimize their deficits in front of their supervisors (Lingard et al 2003a;Schryer et al 2005). We wondered whether this di¤er-ence in disclosure represented an interprofessional di¤erence in socialization regarding uncertainty and sought other instances where uncertainty arose in the optometry novice case presentation.…”

Section: Case Presentationsmentioning

confidence: 92%

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What healthcare students do with what they don't know: The socializing power of 'uncertainty' in the case presentation

Spafford¹,

Schryer²,

Lingard³

et al. 2006

Communication Medicine

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Healthcare students learn to manage clinical uncertainty amid the tensions that emerge between clinical omniscience and the 'truth for now' realities of the knowledge explosion in healthcare. The case presentation provides a portal to viewing the practitioner's ability to manage uncertainty. We examined the communicative features of uncertainty in 31 novice optometry case presentations and considered how these features contributed to the development of professional identity in optometry students. We also reflected on how these features compared with our earlier study of medical students' case presentations. Optometry students, like their counterparts in medicine, displayed a novice rhetoric of uncertainty that focused on personal deficits in knowledge. While optometry and medical students shared aspects of this rhetoric (seeking guidance and deflecting criticism), optometry students displayed instances of owning limits while medical students displayed instances of proving competence. We found that the nature of this novice rhetoric was shaped by professional identity (a tendency to assume an attitude of moral authority or defer to a higher authority) and the clinical setting (inpatient versus outpatient settings). More explicit discussions regarding uncertainty may help the novice unlock the code of contextual forces that cue the savvy member of the community to sanctioned discursive strategies.

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Section: Introductioncontrasting

confidence: 84%

Section: 'Well It Wouldn't Be-i Don't Think It Would Be [Disease X]' supporting

confidence: 73%

Section: Case Presentationsmentioning

confidence: 92%

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What healthcare students do with what they don't know: The socializing power of 'uncertainty' in the case presentation

Spafford¹,

Schryer²,

Lingard³

et al. 2006

Communication Medicine

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“…We have found that the novice case presentation-during which patient information is presented by students to their instructors-is a complex discursive process, interwoven with the intentions of caring for the immediate patient while attending to the process of teaching and learning (e.g., Lingard et al 2003a, b;Schryer et al 2003Schryer et al , 2005Schryer et al , 2007Spafford et al 2004Spafford et al , 2005Spafford et al , 2006aSpafford et al , b, 2007. Through this work, we have noted that the problems associated with the tension of this balancing act increase when patients face potentially serious threats to their health.…”

Section: Introductionmentioning

confidence: 97%

Balancing patient care and student education: Learning to deliver bad news in an optometry teaching clinic

Spafford

Schryer

Creutz

2008

Adv in Health Sci Educ

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Learning to counsel patients in a teaching clinic or hospital occurs in the presence of the competing agendas of patient care and student education. We wondered about the challenges that these tensions create for clinical novices learning to deliver bad news to patients. In this preliminary study, we audio-taped and transcribed the interviews of seven senior optometry students and six optometrist instructors at a Canadian optometry teaching clinic. The participants described their experiences in learning to deliver bad news. Using a grounded theory approach, our analysis was informed by situated learning and activity theory. Optometry students received formal classroom training regarding how to deliver bad news, including exposure to the medically-based six-step SPIKES protocol (Baile et al. The Oncologist, 5, 302-311, 2000). Yet, application of this protocol to the teaching clinic was limited by the lack of exposure most instructors had received to this strategy. Determinants of the students' complex learning process during their clinical apprenticeship, included: (i) knowing one's place, (ii) knowing one's audience, (iii) knowing through feedback, and (iv) knowing who speaks. The experiences of these participants pointed toward the need for: (1) more instructional "scaffolding" (Bruner and Sherwood Play: Its role in development and evolution, p. 280, 1976) in the clinical setting when the learning task is complex, and (2) explicit discussions about the impacts that unfold when the activities of patient care and student education overlap. We reflect on the possible consequences to student education and patient care in the absence of these changes.

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“…This articulation sets the stage for the communication activities that CID typically supports such as speaking, writing, and working in teams. Activities such as writing (e.g., Bazerman, 1988;Berkenkotter & Huckin, 1995;Ding, 2008) and speaking (e.g., Dannels, 2000;Schryer, Lingard, & Spafford, 2005;Schryer & Spoel, 2005) represent vehicles for socialization into a discipline. These activities are also practices and spaces where social actors are saying and doing gender (Martin, 2003).…”

mentioning

confidence: 99%

(Re)Situating Communication in the Disciplines: Taking Gender into Account

Sullivan¹,

Kedrowicz

2011

Communication Education

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Communication in the disciplines (CID) is a model of situated pedagogy that prepares students for the communication demands of their professional work. A defining feature of CID is its ''situatedness.'' Communication is meant to uphold, not disrupt, disciplinary norms surrounding communication outcomes, genres, and assessment. However, by upholding rather than critically examining and shifting disciplinary norms, CID runs the risk of being an unwitting ally in the maintenance of gendered inequities in the disciplines and professions. We argue that CID, as both situated and representative of contradiction, can highlight tensions internal to disciplinary activities, thus positioning CID to be an agent of expansion. We draw from feminist theory and socialization and genre research to show how CID instructors and instruction can facilitate engagement with the contradictions and tensions characterizing the CID classroom to promote a more inclusive community of practice.Communication in the disciplines (CID) is a unique educational approach where disciplines collaborate for the purpose of enhancing and aligning students' communication competence with the perceived needs of their discipline and future professions. In part, CID socializes students through preparing them for the demands of their professional work. A defining feature of CID is its ''situatedness.'' Communication is meant to uphold, not disrupt, disciplinary norms surrounding communication outcomes, genres, and assessment (Dannels, 2002(Dannels, , 2005a, allowing CID practitioners to be responsive to industries' needs. However, disciplines and professions are gendered. Given this, several gendered contradictions emerge when adopting the tenets of CID. Yet

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Techne or Artful Science and the Genre of Case Presentations in Healthcare Settings

Cited by 33 publications

References 21 publications

What healthcare students do with what they don't know: The socializing power of 'uncertainty' in the case presentation

What healthcare students do with what they don't know: The socializing power of 'uncertainty' in the case presentation

Balancing patient care and student education: Learning to deliver bad news in an optometry teaching clinic

(Re)Situating Communication in the Disciplines: Taking Gender into Account

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