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

Sarah J White

doi:10.15694/mep.2019.000224.1

Abstract

This article was migrated. The article was marked as recommended. 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. 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.

Highlights

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 curricula
Such training is valuable (Rotthoff et al, 2011), 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
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

Summary

Introduction

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 curricula. The preparation work is focused on two readings, one of which covers consultation skills (Silverman, Kurtz and Draper, 2013 Ch. 1) and the other which delves into the conversation analytic evidence on history taking in medicine (Heritage and Clayman, 2010, Ch. 10) Using these chapters, the students participate in an online discussion forum where they choose an evidence-based motivation for improving clinical communication and briefly describe why it is important to them, further developing their own approach to communication. The class is wrapped up with a small group activity where the students work to identify how small changes to a description of a patient in a history taking scenario would alter their approach, with reference to their preparation material This debrief about the application of theoretical knowledge, relating to interactional structures and practices, is extended to understanding their participation within the role play paradigm.

Conclusions

Notes On Contributors