The science of talk in clinical science: using a conversation analytic approach as a foundation for communication skills training [Version 2]

Sarah J White
2019 MedEdPublish  
Additional information was provided in the introduction around the methodology of conversation analysis as well as clarification about the context of communication learning and focus of the curriculum. Abstract Communication skills are considered a central part of medical and health professional curricula. The focus for both theoretical knowledge and practical skills in these curricula is often, necessarily, on that which is directly relevant to consultations and other clinical activities.
more » ... al activities. Prior to engaging in this more specific and often experiential learning, it is arguable that the inclusion of foundational learning around how interaction works to adequately scaffold more specific, clinically-contextualised learning, building through the zone of proximal development. In this paper, I describe a conversation analysis-informed curriculum for communication skills in an undergraduate pre-clinical science degree which is designed to enhance the ability to critically and constructively reflect on their own communication. Clinical communication skills are taught in a variety of ways at all levels of training (Kurtz et al., 2003; Stewart et al., 2013; Silverman, Kurtz and Draper, 2013) and form an important part of medical and health professional White S MedEdPublish https://doi.org/10.15694/mep.2019.000224.2 Page | 2 curricula. This teaching involves varying degrees of input from communication and language sciences (Bachmann et al., 2013; Silverman, Kurtz and Draper, 2013) , often with a focus on theory specifically related to clinical communication and applying these skills in a context through experiential learning activities. Such training is valuable (Rotthoff et al., 2011) , however there are ways to improve the scaffolding of such learning, as described by Street and De Haes (2013) , who argue for the inclusion for a theoretical framework within such curricula. This is particularly relevant to undergraduate students for whom learning more foundational aspects of interaction may be closer to their actual level of development, in line with Podolskiy's description of zone of proximal development (2012). With that in mind, and in the context of a broader core stream on professional practice, we integrated a foundational communication curriculum into a pre-clinical program. While conversation analysis (CA) and other forms of interaction analysis have been used in communication training within clinical professions and in other industries (Antaki, 2011; Stokoe, 2011) , the building of a foundational, CA-informed curriculum for communication skills in the pre-clinical years is yet to be described in the literature. The purpose of this paper is to describe this curriculum, providing a rationale for including interaction theory in the introductory phases on clinical communication training. Communication skills training involves introducing students to the skills for effectively communicating in consultations, with colleagues, and beyond (Bachmann et al., 2013; Makoul, 2001; Noble et al., 2018) . In the recent Consensus statement on an updated core communication curriculum for UK undergraduate medical education, the authors maintain that "an appreciation of conceptual frameworks and research evidence" (Noble et al., 2018 (Noble et al., , p. 1715) is at the core of communication curriculum. This approach, however, focuses on frameworks and evidence relating specifically to communication in clinical settings and does not explicitly suggest that scaffolding learning with more introductory information on communication is also of merit. series of units focussed on professional practice. The course is designed to be taken prior to applying for postgraduate studies in a range of areas, such as medicine, physiotherapy, or public health, or moving into the health workforce in another capacity. The professional practice units are designed to make explicit the core skills for students pursuing careers in health and medicine, whether as clinicians, researchers, or other professionals. This includes communication. In developing the communication curriculum, the aim was to create a cohesive and authentic journey from the basics of how interaction works to introducing students to effective communication in clinical settings. As there is a lot of ground to cover on these topics, ensuring the fundamentals were covered in a clear but appropriately contextualised way, was a key focus of curriculum design. The curriculum is designed for students in the aforementioned undergraduate course. The focus is on how people communicate and the social function of interaction with an emphasis is on face-to-face interaction and, although aspects of written professional and academic communication are taught and assessed throughout the entire course, they are not the specific focus of this stream of the curriculum. Nor are more specific aspects of clinical communication that are more appropriate in further studies, with the communication curricula in those courses tailored to the needs of the professions for which students are training. The aim is to assist students in developing knowledge and skill around how interaction works as a social institution itself, how it shapes and is shaped by the institutional goals, tasks, and identities in healthcare, and how it can be analysed, all while touching on different examples and scenarios to help contextualise the learning and building a strong foundation for future, more specific learning. These units generally follow a flipped model, with students preparing with readings and recorded talks prior to a two-hour tutorial. Across the professional practice units, communication is also covered within the context of both teamwork and broader society, exploring culture, gender, and privilege in the latter. Communication is explicitly covered in seven weeks (out of 39 weeks of professional practice units) under the following topics: Block 1 -first year level unit Communication as action Nonverbal communication Analysing communication Block 2 -third year level unit Communication in the workplace Managing uncertainty in communication Clinical communication Clinical handover In the most recent iteration of the degree, the first unit is core while the second is elective, so students have a minimum of three weeks of explicit communication learning. The following is a brief description of the preparation work and in-class activities for each of the seven weeks. Communication as action Learning objectives: Define core concepts of communication; Identify key skills required for effective communication The first three weeks on communication occur early within the degree and are about foundations of understanding Communication in the workplace White S MedEdPublish
doi:10.15694/mep.2019.000224.2 fatcat:5prniwzhyvh5xgvlc46qpu2fma