‘Let’s talk more about this’: An analysis of how experts engage novice physicians in pedagogical dialogue

Abstract

This exploratory study examines conversations between faculty physician preceptors and resident physicians to identify communicative actions that encourage pedagogical dialogue. Using a modified grounded theory approach, this study considers resident-preceptor conversations at the levels of the conversational exchange and the clause. Four categories of exchanges emerged from the analysis: presenting the case, teaching clinical concepts, initiating clinical discussion, and offering/requesting direct instruction. Focusing on the latter two categories, this study identifies common communicative actions in the clauses of speakers' conversational turns. I contend that clinical-discussion exchanges best support the academic goal of these conversations by engaging novices with open-ended, interpretation-focused questions, proposals, and assessments; in contrast, direct-instruction exchanges support the workplace objective of treating patients through imperative proposals and procedure-focused questions and assessments. This analysis offers communication scholars insight into how expert-novice conversations support professionalization and provides preceptors with an understanding of communicative actions that may facilitate pedagogical dialogue.