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Metadiscourse in Simulation: Reflexivity of/as Communication Skills Learning.

Grace Peters1

  • 1Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA.

Teaching and Learning in Medicine
|February 1, 2022
PubMed
Summary

This study analyzes communication skills training, revealing tensions between individual skills and group dynamics. Incorporating reflexive dialogues can enhance training by promoting mutual understanding and patient-centered care.

Keywords:
communication skillsdiscourse practicesreflexivitysimulated patientssimulation-based learning

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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.