Metadiscourse in Simulation: Reflexivity of/as Communication Skills Learning

Area of Science:

• Medical Education
• Communication Studies
• Discourse Analysis

Background:

• Simulation-based training is widely used for teaching communication skills to medical students.
• Existing training models often focus on communication as an individual skill, overlooking its dynamic and relational aspects.
• Tensions exist between conceptualizing communication as information exchange versus mutual accountability.

Purpose of the Study:

• To examine simulation-based communication skills training as a practice of metadiscourse (talk about talk).
• To explicate tensions in conceptualizing communication as an individual skill versus a distributed dynamic.
• To analyze the purposes of communication skills training in relation to institutional outcomes and multifacetd communication goals.

Main Methods:

• Discourse-analytic approaches were used to reflexively analyze communication skills training practices.
• Data were collected from a communication-skills practice exam involving third-year medical students and simulated patients.
• Analysis focused on question-and-answer sequences, repairs, and orientations to institutional protocols.

Main Results:

• Communication as an individual skill offers structured teaching frameworks but may limit focus on joint communication dynamics.
• Simulated patients communicate differently than actual patients, potentially impacting assessment validity.
• Viewing communication skills as acquired knowledge risks oversimplifying complex interactions and essentializing individuals.

Conclusions:

• Metadiscursive tensions in communication skills training present both affordances and constraints.
• Video-based reflexive dialogues are proposed as a method to enhance simulation-based learning by fostering reflexivity.
• Promoting reflexivity as a meta-skill can equip learners to collaborate with patients towards shared health goals.