Questioning Competence: A Discourse Analysis of Attending Physicians’ Use of Questions to Assess Trainee Competence

Abstract

Attending physicians (APs) must constantly assess trainees' competence to act independently, to promote learning while ensuring quality of care. This study aimed to explore, through discourse analysis of case presentations, the process of competence assessment for case-specific clinical independence. Twenty-six case presentations in emergency medicine were observed and audiorecorded. A discourse analysis was conducted, focusing on APs' use of questioning strategies. Questioning strategies involved clarifying questions (to ensure APs' understanding of the case), probing questions (to probe trainees' understanding of a case or their underlying knowledge), and challenging questions (to challenge presuppositions). Case-related probing questions and challenging questions were found to be linguistic features of APs' assessments of trainees' competence. The identification of specific linguistic features of the process of competence assessment by APs provides a framework for faculty development and future study of the function and effects of such discourse patterns.