This book reports the results of a linguistic analysis of reflective written texts, produced during medical education or practice. It explores the topics and communication skills the authors write about, how the narratives develop, how these texts are shaped, what genres influence their composition, how relational work surfaces in them and how the writers linguistically create their identities as experts or novices. It is clear that both experienced and trainee medics grapple with the place of emotions in their communicative acts, and with the idea of what it means to be a doctor. The book makes a valuable contribution to genre analysis, interpersonal pragmatics and the study of linguistic identity construction, and will be essential reading for those involved in teaching doctor–patient communication skills.
This book reports the results of a linguistic analysis of reflective written texts, produced during medical education or practice. It explores the topics and communication skills the authors write about, how the narratives develop, how these texts are shaped, what genres influence their composition, how relational work surfaces in them and how the writers linguistically create their identities as experts or novices. It is clear that both experienced and trainee medics grapple with the place of emotions in their communicative acts, and with the idea of what it means to be a doctor. The book makes a valuable contribution to genre analysis, interpersonal pragmatics and the study of linguistic identity construction, and will be essential reading for those involved in teaching doctor–patient communication skills.
Reflective Writing in Medical Practice: A Linguistic Perspective
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Overview
This book reports the results of a linguistic analysis of reflective written texts, produced during medical education or practice. It explores the topics and communication skills the authors write about, how the narratives develop, how these texts are shaped, what genres influence their composition, how relational work surfaces in them and how the writers linguistically create their identities as experts or novices. It is clear that both experienced and trainee medics grapple with the place of emotions in their communicative acts, and with the idea of what it means to be a doctor. The book makes a valuable contribution to genre analysis, interpersonal pragmatics and the study of linguistic identity construction, and will be essential reading for those involved in teaching doctor–patient communication skills.
Product Details
| ISBN-13: | 9781783098255 |
|---|---|
| Publisher: | Multilingual Matters Ltd. |
| Publication date: | 06/05/2017 |
| Series: | Language at Work , #2 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 224 |
| File size: | 3 MB |
About the Author
Miriam A. Locher is Professor of the Linguistics of English, University of Basel, Switzerland. She is co-editor (with Franziska Gygax) of Narrative Matters in Medical Contexts across Disciplines (2015, John Benjamins) and co-editor (with Andreas H. Jucker) of Pragmatics of Fiction (2017, de Gruyter).
Miriam A. Locher is Professor of the Linguistics of English, University of Basel, Switzerland. She is co-editor (with Franziska Gygax) of Narrative Matters in Medical Contexts across Disciplines (2015, John Benjamins) and co-editor (with Andreas H. Jucker) of Pragmatics of Fiction (2017, de Gruyter).
Read an Excerpt
Reflective Writing in Medical Practice
A Linguistic Perspective
By Miriam A. Locher
Multilingual Matters
Copyright © 2017 Miriam A. LocherAll rights reserved.
ISBN: 978-1-78309-825-5
CHAPTER 1
Reflective Writing in Medical Practice
1.1 Rationale for this Book
This book is about the linguistic analysis of written reflective writing texts that were produced in the context of medical education or medical practice. The texts were collected from medical students from the University of Basel and the University of Nottingham, and are supplemented by a corpus of texts written by doctors for columns published in medical journals. We explore what topics and communication skills the authors write about, how the narratives develop, how these texts are shaped, what genres influence their composition, how relational work surfaces in them and how the writers linguistically create their identities as experts or novices. We offer our analysis as a contribution to linguistic theory as well as to teaching in medicine.
As linguists, we are interested in spoken and written texts of all shapes and with all kinds of functions. We therefore could not resist when, in 2008, Alexander Kiss, one of the medical faculty members who teaches communication skills to medical students at the University of Basel (Switzerland), approached my colleague Franziska Gygax (literary and cultural studies) with a corpus of texts he thought could be of analytical interest to scholars in the humanities. Kiss was referring to a task that all students had to fulfil in order to gain credit for their communication skills course: they had to write a text about an encounter/conversation with a patient that they had met during their internship at a general practitioner (GP) practice and who had made an impression on them. Reflective writing – texts written to critically examine one's own practice, conduct or position – has been recognized as a valuable tool in teaching in the discipline of medicine for some time, but is still not widely used according to Branch and Paranjape (2002: 1185). For example, it is argued that introspection leads to greater awareness of what one has learnt (in this case, the communication skills strategies) and allows students to shape their analytical powers. Students are thus encouraged to use reflection to understand their new community of practice. Wald (2015) adapts Sandars' (2009) definition of reflection, which captures this aspect of learning and future application:
Reflection is a metacognitive process including connecting with feelings that occurs before, during, and after situations with the purpose of developing greater awareness and understanding of self, other, and situation, so that future encounters with the situation including ways of being, relating, and doing are informed from previous encounters. (Wald, 2015: 697; Wald added the italicized words to Sandars' 2009 definition)
Since both Alexander Kiss and Franziska Gygax were longstanding members of a committee in charge of organizing medical humanities events at the University of Basel, the potential of these texts for linguistic analysis quickly became apparent. The linguists joined the team and we decided to explore these texts in detail in order to learn from them for the development of teaching modules, and because the texts are interesting in their own right from a linguistic perspective. Locher, Kiss and Gygax designed an interdisciplinary project entitled 'Life (Beyond) Writing': Illness Narratives that combines literary analysis of life writing texts (autobiographies/novels), analysis of medical reflective writing texts as described above, and the transfer of these findings to teaching in the medical field. The Swiss National Science Foundation (SNSF) funded the project for four years from 2009 to 2013. This endeavour is outlined in greater detail in Chapter 2. This book is about the linguistic branch of the project and reports on the results of the analysis of the reflective writing texts.
The corpus for this study consists of texts from three sources. The first is the Basel corpus which consists of reflective writing texts written in German by students at the University of Basel. We were fortunate to find a research collaborator in Victoria Tischler, who led the communication skills courses for medical students at the University of Nottingham, and who also included the reflective writing task in her curriculum. This resulted in a parallel corpus of reflective writing texts written in English by medical students at the University of Nottingham. These student texts are supplemented by a selection of texts published by doctors in the journal columns 'A Piece of My Mind' (the Journal of the American Medical Association, JAMA) and 'On Being a Doctor' (the Annals of Internal Medicine, AIM). The chosen texts fulfil the requirement of being reflective and about an encounter with a patient who made an impression on the writer. It is important to point out that none of the texts in our corpus was explicitly written for linguistic analysis; their function is either fundamentally educational or to invite professional introspection. This means that we have a corpus of naturally occurring data and can contribute to the study of language in use.
1.2 Aim and Scope
We position our study within the field of medical humanities and – generally speaking – within the linguistic area of discourse analysis, which draws on genre analysis and corpus linguistics. It is worthwhile taking the time to set out this interface. According to the extensive description published on the website of the Centre for Medical Humanities at Durham University in the UK (accessed 22 November 2012), the medical humanities can be defined as follows:
'Medical humanities' is the name given to a so-far rather diverse field of enquiry. Its object is medicine as a human practice and, by implication, human health and illness, and the enquirers are, basically, people working from the perspectives of humanities disciplines. Thus 'medical humanities' denotes humanities looking at medicine, looking at patients, and – crucially – looking at medicine looking at patients. The way medicine conceives and represents patients shows up in the way that it treats patients.
Therefore 'medical humanities' isn't the name of a further humanities discipline, but is simply the name of a field of enquiry, albeit a very significant and intriguing one. The disciplines actually involved in it are familiar humanities and social sciences disciplines, having in common both an interest in individual experience (which in this context means individuals' experiences of health, illness, disability, diagnosis, treatment and care), and a recognition that subjective experience can be a legitimate source of knowledge.
At present, history, literature studies, theology, anthropology and philosophy are prominent among the disciplines that engage in medical humanities. If they act separately and in isolation from one another, then 'medical humanities' is just a list. But it becomes far more interesting when these disciplines' perspectives are combined [in] a genuinely interdisciplinary way.
[A paragraph on medical ethics has been omitted].
In medical ethics, other humanities disciplines joined philosophy in looking for a richer way of tackling normative questions about what doctors ought to do. Similarly in 'medical humanities' a range of humanities disciplines join together in looking for more richly-textured ways of understanding medicine as a practice, and understanding health, illness and medical care in relation to individual subjective experience. One of the most interesting challenges in terms of interdisciplinarity will be to embrace biological scientists in co-enquiry with us as humanities scholars. Taking embodied human nature seriously in the medical context requires aspects of scientific literacy as well as existential literacy, and it requires bringing them together creatively.
This is a challenging task but one that is worthwhile and important in the search for more realistic expectations of the contribution of medicine to human flourishing.
Source: HME, March 2009.
The important points we can take from this description of the medical humanities are as follows: (1) it brings the perspective of disciplines from the humanities to medical practice as an object of study; (2) it calls for interdisciplinarity; and (3) despite extensive publications on the language of medical practice, the 2009 definition does not yet mention the discipline of linguistics.
As Davis (2010) points out, there is indeed a longstanding tradition of looking at language and communication in doctor–patient or caretaker–patient interaction. Davis (2010) identifies four distinct groups of researchers who study language use in medical contexts:
Linguists who study health discourse [...]
Clinical linguists are interested in understanding language so that they can more effectively treat those with language disorders. They form a branch of linguistics which can incorporate pragmatics, discourse, or sociolinguistic perspectives. They are medically-trained clinicians who work with people in the role of patient or client, seeking to remedy or ameliorate a particular language condition or disorder. Many clinical linguists are speech pathologists or audiologists who want to focus on the study of language qua language as well as on patient applications.
Health communications studies specialists research the ways that language is used in (real-world) clinical settings from the disciplinary perspective of Communications Studies. They focus on both communications within healthcare and also about healthcare, targeting a range of audiences, which can include patients, healthcare and medical personnel, community members and policy makers.
Finally, clinicians (medical practitioners such as doctors, nurses, etc.) form a fourth group. They include persons who are trained in clinical practice in medicine, nursing, dentistry, pharmacology, and the like and they study language in order to enact more effective care and achieve more favorable patient outcomes as a result of better communication. (Davis, 2010: 382, emphasis in original)
Davis (2010: 382) goes on to say that, '[d]espite the fact that each of these groups studies language use in medical settings, the differences in their foci and ultimate research goals make the distinctions between them important'. At the same time, there is a lack of awareness of research results from the other disciplines. If we take this point up and add it to the research desideratum of interdisciplinarity quoted in the extensive definition of medical humanities above, it becomes apparent that the study of the linguistic aspect of medical practice that we will endeavour to explore in this book can only benefit from drawing on different research traditions.
For our study of naturally occurring written data, we can eclectically draw on the traditions pursued in health communication studies, interpersonal pragmatics, discourse analysis, genre studies and stylistics, the study of narrative in various disciplines, and corpus linguistics (seeFigure 1.1). Furthermore, it is important to acknowledge that the literature in linguistics that focuses on the study of face-to-face interaction and naturally occurring data has a long tradition of drawing on sociology and anthropology as propagated by conversation analysis and discourse analysis, and as developed in interactional sociolinguistics.
In this project, we are of course dealing with written texts produced in a particular context. We look at the texts as a fixed product (in the sense that we do not witness their genesis), but are aware that the text itself is in dialogue with what came before and what comes afterwards. The student texts are triggered within an educational context and are explicitly about the past (i.e. an encounter with a patient in the context of an internship and the communication skills course) and are (at least in part) written for the communication skills instructor or GP. The expert texts also report on a past interaction and reflect on it for a professional peer audience. In addition, the subject the students and doctors write about is interactive and they are invited to reflect on communication skills. This allows us to draw not only on the literature on interaction and the negotiation of meaning in interaction, but also on traditions that deal with teaching communication skills in medical practice, with written narratives and with genre. We draw on the study of text types and genres in order to establish how best to classify the essence of reflective writing texts, acknowledging the contribution of corpus linguistics and cognitive linguistics for this field, and the influence of discursive psychology in the framework that is our inspiration for working on linguistic identity construction.
We will elaborate in detail on the theoretical background and methodological steps in the individual chapters that deal with particular research questions. At this stage, we will simply say that our methodology is qualitative, in that the categories we work with (e.g. topic choice, identity categories, elements of narratives) are primarily interpretative and functional rather than formal and structural. In order to best capture the nature of our corpora, we use quantification whenever we can gain further understanding from this process, and we use traditional corpus linguistics methods whenever appropriate. Finally, we discuss our results and their potential for transfer to teaching with our collaborators Victoria Tischler (for the Nottingham data) and Alexander Kiss (for the Basel data).
Since we are dealing with texts written by students and doctors on doctor–patient communication, our data might lead to false expectations. We should point out from the start that we are not concerned with the following list of issues, either because they are not our focus of study or because our data cannot answer them.
This book is not about:
• establishing whether students have poor English or poor German;
• establishing whether students write good or bad texts;
• establishing whether doctors can write aesthetically pleasing texts of literary quality;
• researching doctor–patient interaction by looking at the texts written by the students and doctors.
The first two points about the use and level of English and German are valid points of interest for applied linguists, but are not the focus of this study. Nor do we explore the more literary question of aesthetics. With respect to the last point, we should stress that we will identify the topics of the texts, but we will not take the rendition of events in the texts at face value as reports on 'what really happened'. If we had wanted to study doctor–patient interaction in itself, we would have had to use an entirely different research design and, for example, use video-tapes and observations of the interactions as they unfold. In other words, the reported interactions of the present study cannot be used to establish how doctor–patient interaction works but rather how the writers reflect on interaction. This will offer valuable insights in itself.
We strongly believe that the texts available to us for research deserve to be studied in their own right from a linguistic perspective. We will systematically explore the areas mentioned in Figure 1.2, all of which we wish to contribute to on both a descriptive and theoretical level.
This book is about:
• Genre analysis: In order to better understand the reflective writing texts, we will explore how we can best describe the function and form of these texts by drawing on a number of text types that might have influenced their production. Since 'narrative' is such a fundamental discourse unit for both medicine and daily life, we will pay special attention to highlighting the narrative elements in the texts.
• Interpersonal pragmatics: As suggested in Locher and Graham (2010b: 2), interpersonal pragmatics is especially interested in studying the interpersonal side of communication in situ. Working in particular with the concept of 'relational work', i.e. the work individuals invest in 'the construction, maintenance, reproduction and transformation of interpersonal relationships among those engaged in social practice' (Locher & Watts, 2008: 96), we are interested to see how the writers evoke norms of conduct and appropriateness and frames of expectations when describing the doctor–patient encounters.
• Linguistic identity construction: With first-person narratives in particular and reflective writing texts in general, writers have to position themselves within their texts vis-à-vis others. We are interested in how writers creatively employ language to create identities and in how they deal with the challenges this task poses. This research focus combines insights from genre analysis and the study of interpersonal processes, and thus constitutes a link between the research fields.
(Continues...)
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Table of Contents
1. Reflective Writing in Medical Practice
2. Context and Data
3. The Choice of Themes: On Communication Strategies and Challenging Situations
4. Communication Skills in Action: From Keeping Eye Contact to Creating Rapport
5. Reflective Writing as Genre: A Text Linguistic Perspective
6. Interpersonal Pragmatics in Reflective Writing
7. Interpersonal Pragmatics and Identity Construction
8. Conclusions
Appendices
References
Subject Index
Author Index
Bionote