Luminary Learning Gastrointestinal Disorder- Issue 1

54  • LUMINARY LEARNING: GASTROINTESTINAL DISORDERS shift in modern societies away from “manual work to discourse work” (Scheeres, 2003, p. 332) in which talking has become one of the main components of the work (Iedema and Scheeres, 2003). Thus, although talk has always played a role in the work of healthcare, rather than a supporting role, we argue here that talk, as discourse, now plays a central role since it is a core activity in learning and in caring for patients. Oral case presentations are a prominent example of healthcare talk through which medical students legitimately participate in patient care. During oral presentations, medical learners verbally summarize and present information gathered through interviewing patients/families, examining patients, and—importantly—interpret what it means in terms of diagnosis and/or management. In general, giving an oral case presentation to colleagues represents a fundamental communication skill for all physicians, not only to report key findings of patient assessments and diagnostic evaluations, but also to demonstrate an ability to process, prioritize, and synthe- size information, formulate possible diagnoses, and outline steps in patient management. The key is to include only what is relevant to the listener in a given setting. Haber and colleagues used rhetorical analysis to explore how medical students learn oral case presentation skills (Haber and Lingard, 2001). Students struggle to tailor presentations to the context, in contrast to more experienced physicians who view the rhetoric of their presentations as fluid and dependent on patient, time, and situational factors (Haber and Lingard, 2001). In short, physicians must master oral case presentations. Lingard and colleagues (2003) note that socialization involves learning to speak like other community members, both learning to talk with and about patients (Lingard, Schryer, Garwood, and Spafford, 2003). Indeed, professional identities are “constructed and co- constructed through talk” (p. 40) (Monrouxe, 2010). In addition to demonstrating an ability to synthesize and integrate patient information, medical students shape their professional identi- fies though oral case presentations, particularly in learning to deal with and convey uncertainty (Lingard, Garwood, Schryer, and Spafford, 2003). For example, students observe more experi- enced doctors using modal auxiliaries (e.g. can, could, may, might must, shall, etc.) and adverbs (e.g. perhaps, maybe, etc.) in oral case presentations to manage uncertainty in a skilful manner (Lingard, Garwood, et al., 2003). Thus, oral case presentations represent a textual form of talk that comprises a significant form of work for many physicians, one that has important implications for both learning and patient care in all career phases. The discourse of clinical teaching is, like case presentations, an important example of talk in medicine for which learning is an explicit goal. Supervising or attending physicians are more experienced and fully qualified doctors who oversee medical trainees and are ultimately account- able for patients’ care. These more senior physicians often use questions to assess trainee com- petence during oral case presentations (Kennedy and Lingard, 2007). For example, supervising physicians often pose clarifying questions to support their own understanding of the case. In addition, three other forms of question help assess trainee competence: (a) case-related probing questions to explore the trainee’s understanding of diagnostic decision-making or management plans, (b) knowledge-related probing questions to assess medical knowledge, and (c) challenging