Seeking Narrative Coherence: Doctors' Elicitations and Patients' Narratives in Medical Encounters

<p>This thesis presents research on how doctors and patients negotiate meaning through interaction, focusing on the role of narrative in the medical encounter. Within sociolinguistics, most previous studies using discourse analysis to analyze patients’ narratives have adopted the canonical (Labovian) framework. This thesis adds more recent approaches to narrative analysis, within an interactional sociolinguistics (IS) framework in order to examine the relationship between doctor elicitations and patient narratives. The analysis also explores the clinical approach of Narrative Medicine (NM), which offers patients “space” in which to construct their narratives, to create an interdisciplinary lens for exploring data. The data comprised 69 videotaped medical interviews, amounting to 18 hours of naturally occurring medical interactions, plus evaluative feedback from questionnaires and interviews with 12 doctors. All interactions were initially analyzed for canonical narrative components. Twelve interactions were then selected for more detailed analysis on the basis of the frequency of doctors’ elicitations, which represent medical interview approaches. The analysis of these interactions demonstrates how and to what extent participant roles and identities frame the co-construction of patient narratives. Evaluations of three of the interactions by 12 doctors provided information on how aspects of patient narratives are perceived by clinicians, particularly with respect to the types and amounts of patient information considered necessary for making diagnostic decisions. Key findings demonstrate that both patients and doctors seek to construct narrative coherence. The analysis shows how the frame of developing narrative coherence offers insights on the interactional narratives as they are co-constructed by participants. Patients living with chronic illness may have difficulty constructing coherent narratives, and thus, strategies for developing narrative coherence are important for both patients and doctors when managing patients’ chronic illnesses. Additionally, in constructing narrative coherence, patients present important aspects of their identities potentially offering important information related to their illness and intervention. Evaluating doctors’ also engaged in using this frame which offers insight into one way doctors develop their professional identities and perhaps indicates the strength of the role of narrative in our lives. This research represents a first attempt to use both interactional sociolinguistics and NM to contribute to the understanding of doctor-patient interaction. Overall, the research indicates that narrative plays an important part in constructing relevant meanings in medical interactions between doctor and patient. Patients strive to create a coherent narrative as they present their medical problem to their doctor. Although this analysis provides further evidence of the relevance of the power asymmetry in medical interviews, it also suggests ways in which patients can shape their narratives to construct themselves as active agents to their benefit in medical interactions.</p>

Seeking Narrative Coherence: Doctors' Elicitations and Patients' Narratives in Medical Encounters

<p>This thesis presents research on how doctors and patients negotiate meaning through interaction, focusing on the role of narrative in the medical encounter. Within sociolinguistics, most previous studies using discourse analysis to analyze patients’ narratives have adopted the canonical (Labovian) framework. This thesis adds more recent approaches to narrative analysis, within an interactional sociolinguistics (IS) framework in order to examine the relationship between doctor elicitations and patient narratives. The analysis also explores the clinical approach of Narrative Medicine (NM), which offers patients “space” in which to construct their narratives, to create an interdisciplinary lens for exploring data. The data comprised 69 videotaped medical interviews, amounting to 18 hours of naturally occurring medical interactions, plus evaluative feedback from questionnaires and interviews with 12 doctors. All interactions were initially analyzed for canonical narrative components. Twelve interactions were then selected for more detailed analysis on the basis of the frequency of doctors’ elicitations, which represent medical interview approaches. The analysis of these interactions demonstrates how and to what extent participant roles and identities frame the co-construction of patient narratives. Evaluations of three of the interactions by 12 doctors provided information on how aspects of patient narratives are perceived by clinicians, particularly with respect to the types and amounts of patient information considered necessary for making diagnostic decisions. Key findings demonstrate that both patients and doctors seek to construct narrative coherence. The analysis shows how the frame of developing narrative coherence offers insights on the interactional narratives as they are co-constructed by participants. Patients living with chronic illness may have difficulty constructing coherent narratives, and thus, strategies for developing narrative coherence are important for both patients and doctors when managing patients’ chronic illnesses. Additionally, in constructing narrative coherence, patients present important aspects of their identities potentially offering important information related to their illness and intervention. Evaluating doctors’ also engaged in using this frame which offers insight into one way doctors develop their professional identities and perhaps indicates the strength of the role of narrative in our lives. This research represents a first attempt to use both interactional sociolinguistics and NM to contribute to the understanding of doctor-patient interaction. Overall, the research indicates that narrative plays an important part in constructing relevant meanings in medical interactions between doctor and patient. Patients strive to create a coherent narrative as they present their medical problem to their doctor. Although this analysis provides further evidence of the relevance of the power asymmetry in medical interviews, it also suggests ways in which patients can shape their narratives to construct themselves as active agents to their benefit in medical interactions.</p>

How does a move towards a coaching approach impact the delivery of written feedback in undergraduate clinical education?

Feedback uptake relies on interactions between learners and educators Winstone (Educ Psychol 52: 17–37, 2017). Feedback that coaches using a feedforward approach, is considered to be more personal and emotionally literate Bussey (Bull R Coll Surg Engl 99: 180–182, 2017), Hattie (Rev Educ Res 77: 81–112, 2007). Many modes of feedback are employed in clinical teaching environments, however, written feedback is particularly important, as a component of feedback discourse, as significant time may elapse before a similar clinical situation is encountered. In practice, time constraints often result in brief or descriptive written feedback rather than longer coaching feedback. This study aimed to explore whether a change in ethos and staff development would encourage clinical dental tutors to utilise a coaching approach in their written feedback. Across two time-points, written feedback was categorised into either descriptive, evaluative or coaching approaches. Cross-sections of data from 2017 to 2019 were examined to determine whether changes in practice were noted and whether there were any alterations in the affective nature of the language used. Feedback moved significantly towards coaching and away from a descriptive approach. A shift towards the use of more positive language was seen overall, although this was solely driven by a change in the evaluative feedback category. Descriptive feedback generally used neutral language with coaching feedback using marginally more positive language. Both categories employed significantly lower levels of affective language than evaluative feedback. These data indicate a move towards feedback approaches and language that may support increased uptake and utilisation of feedback.

Let’s Talk About Each Other: Neural Responses to Dissenting Personality Evaluations Based on Real Dyadic Interactions

Dyadic interactions are associated with the exchange of personality-related messages, which can be congruent or incongruent with one’s self-view. In the current preregistered study ( N = 52), we investigated event-related potentials (ERPs) toward real social evaluations in order to uncover the neural mechanisms underlying the processing of congruent and incongruent evaluative feedback. Participants interacted first, and then during an electroencephalogram (EEG) session, they received evaluations from their interaction partner that were either congruent or incongruent with their own ratings. Findings show potentiated processing of self-related incongruent negative evaluations at early time points (N1) followed by increased processing of both incongruent negative and positive evaluations at midlatency time windows (early posterior negativity) and a prioritized processing of self-related incongruent positive evaluations at late time points (feedback-related P3, late positive potential). These findings reveal that, after real social interactions, evaluative feedback about oneself that violates one’s self-view modulates all processing stages with an early negativity and a late positivity bias.

Artificial intelligence adaptive learning tools

This paper explores the field of Artificial Intelligence applied to Education, focusing on the English Language Teaching. It outlines concepts and uses of Artificial Intelligence, and appraises the functionalities of adaptive tools, bringing evaluative feedback on their use by American school teachers, and highlighting the importance of additional research on the matter. It was observed that the tools are valid media options to complement teaching, especially concerning adaptive learning. They offer students more inclusive opportunities: they maximize learning by tailoring instruction to address students ‘needs, and helping students become more responsible for their own schooling. As for teachers, their testimonials highlight the benefits of dedicating more class time to the students’ most pressing weaker areas. Drawbacks might include the need to provide teachers with autonomy to override recommendations so as to help them find other ways to teach a skill that seems to be more effective for a specific student.

ESL Learners’ Sense of Alienation: An Exploratory Mixed Method Research on the Role of ESL Teachers’ Remarking Practices

The study attempts to highlight a major cause of learners&rsquo; detachment and low performance in ESL classrooms at graduation levels in Bahawalpur City, Punjab, Pakistan. In this connection, this study tries to focus on the role of teachers&rsquo; feedback remarks as a major cause of either instilling or accelerating sense of alienation among ESL learners. This study underpinned exploratory sequential mixed method research design to prove its hypotheses. The qualitative data shows that ESL learners receive evaluative remarks from their teachers in the form of &#39;face-threatening acts&#39; more than &lsquo;face-saving acts&rsquo; during classroom activities. Resultantly, they experience a sense of alienation from the language-related tasks and try to avoid the classroom situation feeling it a threat. The quantitative analysis shows the average range of sense of alienation experienced by learners which are highest in oral activities, lower in written tasks and lowest in comprehension-based activities. ESL teachers&#39; evaluative feedback either instils or accelerates the sense of alienation among learners during various classroom activities. The type of alienation experienced more was an accelerated sense of alienation. This is why the majority of learners avoid getting engaged in the activities in which they find chances of losing self-image. Keeping the results in view, training sessions on &lsquo;Face Wants, Politeness theory, and Speech Acts&rsquo; are recommended for ESL teachers to enhance their follow-up remarking practices. Moreover, there is a need to develop an anxiety-free classroom atmosphere to strengthen learners&#39; autonomy and linguistic self-concept.

Spatiotemporal dissociation of fMRI activity in the caudate nucleus underlies human de novo motor skill learning

Motor skill learning involves a complex process of generating novel movement patterns guided by evaluative feedback, such as a reward. Previous literature has suggested anteroposteriorly separated circuits in the striatum to be implicated in early goal-directed and later automatic stages of motor skill learning, respectively. However, the involvement of these circuits has not been well elucidated in human de novomotor skill learning, which requires learning arbitrary action–outcome associations and value-based action selection. To investigate this issue, we conducted a human functional MRI (fMRI) experiment in which participants learned to control a computer cursor by manipulating their right fingers. We discovered a double dissociation of fMRI activity in the anterior and posterior caudate nucleus, which was associated with performance in the early and late learning stages. Moreover, cognitive and sensorimotor cortico-caudate interactions predicted individual learning performance. Our results suggest parallel cortico-caudate networks operating in different stages of human de novomotor skill learning.