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The display and negotiation of expertise and uncertainty in problem-based tutorials in medicine: a discourse analytic approach

Storey, Anne M. 2012. The display and negotiation of expertise and uncertainty in problem-based tutorials in medicine: a discourse analytic approach. PhD Thesis, Cardiff University.
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Abstract

This dissertation examines interaction in a hybrid educational and clinical medical context, specifically how students and tutors negotiate and display expertise and uncertainty in problem-based learning (PBL) tutorials in the final years of an undergraduate medical curriculum. I take a broad view of expertise and uncertainty, one which includes scientific knowledge, evidence-based explanations, warrants for uncertainty, personal experience and communicative performance. Taking a discourse analytic approach, I analyse what constitutes expertise in this tutorial setting and how it is negotiated and displayed through the participating students’ and tutors’ interactional dynamics. I examine the nature of the various tutorial activities, the educational and clinical context, and how factors associated with the ethos and approaches of both PBL and traditional clinical curricula influence the display and negotiation of expertise and uncertainty. The data were collected during 2008 in two teaching hospitals in Hong Kong. Participants were selected by convenience sampling. Eight tutorials were video or audio recorded, and the interactions were transcribed. The discourse analytical approach (activity analysis, Sarangi 2010a) is based on the notions of activity types (Levinson, 1992[1979]) and discourse types (Sarangi, 2000) as well as notions of participant structure, roles, frames, and alignment. The analysis is conducted in three stages. First, the structural mapping indicates that the tutorials were composed of three main elements – presenting a patient history, presenting clinical reasoning, and presentation of the findings of the physical examination and that these were recursive. Second, the interactional mapping shows that the dominant participants were the presenter of the patient history and the tutor, and that the main discursive device is questioning. Third, the thematic mapping shows that implicit throughout the interaction is the display of expertise through role performance, and the hybrid clinical and educational frames associated with these roles. Role, frame and activity characteristics interact to contribute to a complex setting within which participants could display degrees of expertise and uncertainty.

Item Type: Thesis (PhD)
Status: Unpublished
Schools: English, Communication and Philosophy
Subjects: L Education > LB Theory and practice of education > LB2300 Higher Education
R Medicine > R Medicine (General)
Date of First Compliant Deposit: 30 March 2016
Last Modified: 19 Mar 2016 23:15
URI: http://orca.cardiff.ac.uk/id/eprint/44885

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