Clinical communication training for the general practice of medicine – A case for including discourse analytical findings from real-world practice

Abstract

Communication is central to the clinical training of doctors preparing for Fellowship of the Royal Australian College of General Practitioners. Currently, medical educators use a comprehensive problem-solving methodology that includes engaging registrars in role-plays of consultations as a means for reflection on practice. To date, however, this interactive training has made little use of the evidence from real-life clinical encounters that discourse analysis affords. This paper presents a case for the use of discourse analytical findings to complement existing training processes. Drawing from ethnographic observations of clinical communication training and focusing particularly on the development of empathic communication, the paper looks closely at current training practice. Turning to discourse analytical findings from real-life practice, and focusing on moments of empathic opportunity, the paper brings to light the impact of a doctor's selective empathic formulations on the direction and outcomes of the consultation, in order to make visible what constitutes clinically ineffective empathy. The paper goes on to suggest a training approach that deploys such discourse analytical findings as a means to enhance clinical communication training and to support processes of critical reflection on practice.