Marlee M. Spafford

'Talking the talk': school and workplace genre tension in clerkship case presentations

Background  Socialisation into a community involves learning sanctioned ways of talking. This study investigates the case presentation genre as a site of socialisation into the clinical community of practice.

Representing complexity well: a story about teamwork, with implications for how we teach collaboration

Medical Education 2012: 46: 869–877

Look Who’s Talking: Teaching and Learning Using the Genre of Medical Case Presentations

In a pediatric teaching hospital, the authors examined 16 novice medical case presentations that were classified as instances of a hybrid apprenticeship genre. In contrast to strict school and workplace genres, an apprenticeship genre results from the sometimes competing activity systems of student education and patient care. The authors examined these novice case presentations for the amount and patterns of time devoted to student learning and expert teaching, the difficulties created for participants, the sometimes misunderstood implicit messages delivered by experts, and the opportunities to address educational objectives. This study offers professional communication researchers a model that combines quantitative and qualitative methodologies to assess the effects of competing activity systems in the development of communication expertise.

Techne or Artful Science and the Genre of Case Presentations in Healthcare Settings

This paper presents a qualitative study that investigated the role of case presentations in the socialization of medical and optometry students. Using the debate from classical rhetoric around the term techne (art or science), we observed that genre theory helps explain the way case presentations mediate the development of professional identity through the interaction of certain knowledge (techne 1), “savvy” knowledge (techne 2), and ethical reflection (phronesis). We noted that these mediated scenes of learning are necessary but problematic because they can lead students to yearn for certainty and to exclude outsiders (other healthcare providers, patients). Finally, our research challenges the binary opposition that exists between art and science especially for professions that bring their disciplinary knowledge into practice.

Tensions in the field: teaching standards of practice in optometry case presentations.

Purpose. Professional identity formation and its relationship to case presentations were studied in an optometry school’s onsite clinic. Methods. Eight optometry students and six faculty optometrists were audio-recorded during 31 oral case presentations and the teaching exchanges related to them. Using convenience sampling, interviews were audio-recorded of four of the students and four of the optometrists from the field observations. After transcribing these audio-recordings, the research team members applied a grounded theory method to identify, test, and revise emergent themes. The theme reported herein pertains to communicating standards of practice. Results. Faculty optometrists demonstrated three ways of communicating standards of practice to optometry students during case presentations: Official Way, Our Way, and My Way. Although there were differences between these standards, the rationale for the disparities was rarely explicitly articulated by the instructors to the students. Without this information, the incongruity among the standards was left to the students to interpret on their own. Conclusions. The risk created by faculty not articulating the rationale underlying standards of practice was that students misinterpreted the optometrists’ ways as idiosyncratic. Thus, opportunities were missed in the educational setting to assist students in making responsible decisions, locating their position in practice, and shaping their professional identity. Competing responsibilities of patient care and student education left instructors with little time to articulate rationale for standards of practice. Therefore, educators must reflect on innovative ways to bring into relief the logic behind their actions when working with novices.

Struggling to Maintain Occupation While Dealing With Risk: The Experiences of Older Adults With Low Vision

The primary aim of this descriptive phenomenological study was to describe the core aspects of living with low vision in later life among older adults (aged 70 years and older) who had not accessed rehabilitation services for low vision. Thirty-four older adults from urban and rural areas participated in a semi-structured qualitative interview and a telephone follow-up. Drawing on an occupational science perspective and using Giorgi and Giorgis (2003) method of analysis, the essence of the experience of living with low vision was identified as struggling to maintain valued and necessary occupations while dealing with risk. Additional themes included enhanced sense of risk, striving for independence, and shrinking physical and social life spaces. Findings are interpreted in relation to occupational adaptation and environmental influences on occupation, and implications for the role of occupational therapists are discussed.

Towards Embracing Clinical Uncertainty Lessons from Social Work, Optometry and Medicine

• Summary: The oral transmission and transformation of client information in an apprenticeship setting provides a rich environment in which to observe students and their expert supervisors managing uncertainty. In this Canadian-based study, we examined the communicative features of 12 social work supervisions involving social work students and their supervisors and enriched our observations with subsequent interviews of the participants. • Findings: Social work students viewed the acknowledgement and examination of uncertainty as a touchstone of competent social work. This observation contrasted with our past study of medical and optometry students who focused on personal deficit and a distrust of acknowledging uncertainty. Our observations and interviews revealed a unique professional signature to the novice rhetoric of uncertainty (seeking guidance, deflecting criticism, owning limits, showing competence) that suggests differing professional identities and contextual settings. • Applications : An attitudinal shift toward accepting and trusting uncertainty in medicine and optometry may facilitate an enriched educational environment for students and a more open dialogue with patients about uncertainty. The unique professional signatures of this rhetoric offer insights into how professional identity shapes attitudes and behaviors toward uncertainty and suggest a source of tension within interdisciplinary healthcare teams.

Clinical evaluation of ocular and visual functions in insulin-dependent juvenile diabetics.

ABSTRACT Ocular and visual functions were evaluated in 30 insulin‐dependent diabetics, aged 12 to 20 years, and 30 age‐ and sex‐matched nondiabetics. The test and control groups were compared in terms of visual resolution, accommodative ability, color discrimination, functional retinal reserve, and afferent optic nerve function. These results were considered along with the blood‐glucose level, crystalline lens, fundus appearance, level of diabetic control, and disease duration. No widespread differences in ocular or visual function were found between the test and control groups. Measures of accommodative ability, functional retinal reserve (photostress recovery time), and blood‐glucose level best differentiated the two groups. This study suggests that in‐office evaluation of accommodation and functional retinal reserve may be sensitive indicators of early visual functional deficits in the presence of minimal anatomical changes associated with diabetes.

When Self-Presentation Trumps Access: Why Older Adults with Low Vision Go without Low Vision Services

Reasons were sought for low-vision service nonuse in a group of Canadian seniors with self-reported low vision. Audio-recorded semistructured interviews were completed with 34 seniors with low vision: age range (70 to 94 years; mean: 82 years); 16 urban dwellers (12 women); 18 rural dwellers (14 women). Qualitative content analysis and template analytic techniques were applied to transcriptions. Informant nonuse of low-vision services involved: insufficient knowledge, managing for now, and practitioner behavior (inadequate rehabilitation education and management). Underlying seniors’ attitudes that shaped their self-presentation and service nonuse included a strong need for independence, a contextualization of vision loss relative to other losses, and an acceptance of vision loss in life. Service delivery strategies should consider not only knowledge access and healthcare practitioner behavior but also senior self-presentation strategies (e.g., viewing aids as counterproductive to independence). Subtle rural-urban attitudinal differences may further delay access for rural seniors; further research is advised.

Seeing and Listening A Visual and Social Analysis of Optometric Record-Keeping Practices

This article investigates the contribution visual rhetoric and rhetorical genre studies (RGS) can make to health care education and communication genres. Through a visual rhetorical analysis of a patient record used in an optometry teaching clinic, this article illustrates that a genres visual representations provide significant insights into the social action of that genre. These insights are deepened by an insider analysis of the patient record that highlights how content analyses of visual designs need to be elaborated by contextual considerations. A combined visual rhetoric and RGS analysis shows that clinical novices learn to interpret the records visual cues to safely traverse the complex requirements of this apprenticeship genre. The article demonstrates that visual rhetoric research can meaningfully contribute to the understanding of genres by presenting an enriched contextual analysis achieved by consulting with context insiders.