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UBC Theses and Dissertations

What are we saying and what are they learning : how language implies "competence" and professional identity in clinical medical education Schrewe, Brett Michael


Gee (2005) notes that in enacting a socially recognizable identity, people integrate “language, actions, interactions, ways of thinking, believing, and valuing”. In order to do this, however, medical students must learn how to interpret broad swaths of information and grasp which “language, actions, interactions, ways of thinking, believing, and valuing” are considered relevant to their emerging professional identities. Although ethnographies of medical student learning have been previously undertaken, they have not studied how identity is emergent through everyday recurrent conversational interactions. An activity theory stance was used to conceptualize medical student learning on a paediatric clinical teaching unit as socially elaborated and continuously produced. Preceptor beliefs concerning desirable student qualities, case presentation content, and teaching practices were developed from thematic analysis of semi-structured interviews. Using these findings as a contextual frame, a microethnography was conducted to observe and record student case presentations and signover participation. Through a conversation analysis lens, these events were transcribed and read to understand how students’ language use changed regarding information organization and the degree and detail to which information was included. During early clinical training, medical students accommodate rapidly to normative speaking practices through repeated interactions with their preceptors. These enable them to “do being” a novice professional in legitimated ways and manifest the beginnings of professional communicative competence. Far from a faithful reproduction of professional competencies, however, performances of competence are critically dependent upon relationships and contexts. How students learn to talk about sick persons as patients in contextually relevant ways is not superficial mimicry of a certain vocabulary but rather a broader adoption of practices and participation in shared understandings enabling them to talk in certain ways. In so doing, they reproduce cultures of biomedical practice that foreground patients as problems to be solved, struggle to contextualize sickness in the wider lived experience of families, and may unintentionally dilute effects of initiatives such as family-centred rounds. Articulating how students learn to participate in sociocultural norms through language use is a critical first step towards deeper curricular reforms seeking to establish a more harmonious balance between practices of patient care and clinical medical education.

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