Tidsskrift for Forskning i Sygdom og Samfund, 2010
This paper investigates how the concept of motivation functions in health promotion practice. It ... more This paper investigates how the concept of motivation functions in health promotion practice. It provides an analysis of the understandings and articulations of motivation at the levels of the state, health professionals, and citizens. It finds that motivation takes on different meanings and functions depending on the perspective; thus the general agreement on the importance of motivation in health promotion does not correspond to a mutual understanding of what motivation actually is: motivation works variously as technology, a statistically created collective informed consent, and a moral imperative. It is conceived of as an instrumentalized psychological entity but also expressed as a complex and context-bound phenomenon. The paper concludes by arguing that motivation must be seen as the latter: a relational concept, relating to concrete social and situational contexts rather than an instrumental psychological entity within the individual.
MedieKultur: Journal of media and communication research, 2021
In this article, we explore e-mail consultation platforms that allow digital and written asynchro... more In this article, we explore e-mail consultation platforms that allow digital and written asynchronous communication between patients and general practioners (GPs). Research has suggested that doctor-patient e-mail communication has the potential to transform the sphere of responsibility of health matters, leaving the patient with more responsibility than in other forms of communication. Th erefore, we ask whether the e-mail consultation platform provides opportunities for patients to be active and responsible biological citizens, and if so, in what way. To explore this, we analyzed 646 e-mail consultation instances from 38 patients from 4 Danish GP practices. We found four ways the platform provides opportunities for patients to satisfy the expectation of biological citizenship: specifi cally, by affi rming their own responsibility in healthcare; making suggestions to the GP; making requests of the GP; and questioning aspects of healthcare. In conclusion, we argue that the platform provides patients with new ways of satisfying the expectations of biological citizenship.
A recurring challenge in health promotion and prevention practice is the phenomenon of people cho... more A recurring challenge in health promotion and prevention practice is the phenomenon of people choosing not to follow the health advice given by professionals, the people who appear to be 'non-motivated' for a healthy lifestyle. This phenomenon is the subject of this article. Based on the concepts of akrasia (weakness of the will) (with an inspiration from Martha C. Nussbaum and Alaisdair MacIntyre) and rationality of des-interest, (as proposed by Sam Paldanius) it unfolds a theoretical and philosophical framework for understanding the rationales that lie behind not following recommended health guidelines. Through an empirical analysis of the case of Poul, a diabetes2patient that refuses to change his lifestyle, the article shows how not choosing the healthy lifestyle must not be understood as only an irrational lack of motivation. The concepts akrasia and des-interest contribute to an understanding of how human reflections on the 'right choice' is an ongoing and time...
Editorial. Qualitative Health Communication: What can a new journal dedicated to qualitative heal... more Editorial. Qualitative Health Communication: What can a new journal dedicated to qualitative health communication offer? Welcome to Qualitative Health Communication (QHC). What can a new journal dedicated to qualitative health communication offer? In this editorial, we will offer some answers to this question. Let us start with an anecdote. A few years ago, two of the editors submitted a qualitative article to a leading health communication journal that stated that it welcomed both quantitative and qualitative research. Interestingly, the qualitative article received a desk rejection which was legitimised using quantitatively oriented terminology and approaches ("science of interventions", "subjective ratings", "outcome measures"). It was further suggested that instead of qualitative focus groups, "objective observations of communication behaviour" should be used in "a pre-test post-test control group design" as it would "provide much stronger evidence". (We want to underline here that a desk rejection might have been warranted, but it should have occurred on the right terms). We suspect this is a situation in which other qualitative health communication researchers may have found themselves, i.e. having their work assessed against inappropriate conceptualisations, methodological frameworks and criteria for validity. In QHC, quality will be assessed through a qualitative lens rather than applying a quantitative framework.
In their article ‘Delineating the Field of Medical Education: Bibliometric Research Approach (es)... more In their article ‘Delineating the Field of Medical Education: Bibliometric Research Approach (es)’, Maggio at al. present a list of 24 Medical Education Journals (MEJ-24) identified through a bibliometric approach. The list is suggested as a starting point for a conversation among medical education stakeholders aimed at defining ‘a working consensus on the scope of the field’. Their reason for engaging in this task is to ‘facilitate conducting bibliometric studies and other research designs (e.g., systematic reviews) and to enable individuals to identify themselves as ‘medical education researchers’. As medical educators and researchers, we find this approach interesting and agree that discussions about how we understand and delineate the field of medical education are crucial. In addition, medical education research needs bibliometric analyses to provide a statistically based overview, for example, of the value of writing systematic reviews or to scrutinise dominant forms of knowledge in the field.
BackgroundCommunication skills learned in the classroom do not transfer easily into clinical prac... more BackgroundCommunication skills learned in the classroom do not transfer easily into clinical practice because they are not reinforced by teachers in the workplace setting and because lack of faculty training restricts the transfer of communication skills in real patient encounters. Trained university-based communication skills teachers often work simultaneously as doctors in clinics. This study explored if and how the skills of these teachers play a role in communication skills training in the clinical workplace.MethodsWe used an exploratory sequential design: a mixed method approach that combined a survey with communication skills teachers, and qualitative individual interviews with these teachers and their educational leaders in clinical departments. The questionnaire was analysed using descriptive statistics. The interviews were analysed using content analysis.ResultsThe response rate was 34 %. A majority (93 %) used their communication skills when communicating with patients and...
In recent years and throughout the developed world, policymakers have encouraged the implementati... more In recent years and throughout the developed world, policymakers have encouraged the implementation of digital patient-clinician interaction. Our focus is on the Danish general practice setting where email consultations were implemented as a mandatory service in 2009 and now constitute 21% of all consultations in general practice. Drawing upon strong structuration theory (SST), our analysis sets out to explore how email consultations are represented in structures on macro, meso and micro-levels and how the interplay between structures and agents plays out with respect to possible alignments, tensions and adjustments. We analyze data from policy documents on the macro and meso-levels, data from clinics' websites (meso-level) and data from interviews with GPs and patients (micro-level) (n = 53). Our findings show that the introduction of email consultation as a new health technology is a key site for development in email consultation practice, professional boundary setting and adjustments within the doctor-patient relationship. Our findings thus demonstrate that email consultation can be considered a dynamic component of a socio-technical network rather than a static medium for simple health transactions or information delivery. Based on these findings, we recommend that, for future implementation of patient-clinician digital communication it is important to investigate the multiple sources of influence on telecare practices and to see its intended users as agents who actively shape their own care motivated by opinions, relationships and values.
Catalan Journal of Communication & Cultural Studies, 2021
It is well-known that non-verbal cues are essential in doctor‐patient communication. As doctor‐pa... more It is well-known that non-verbal cues are essential in doctor‐patient communication. As doctor‐patient communication is turning increasingly digital and written, it becomes relevant to explore the role of non-verbal cues in such communication genres. One more recent genre is the doctor‐patient e-mail consultation. Research has found that while patients like e-mail consultations, they also miss facial expressions, eye contact, etc. In this study, we explored the different ways in which Danish GPs use non-verbal cues in e-mail consultations. We analysed 633 e-mail consultations written by 22 GPs. We applied the concept oforalization, which includes the use of emoticons and non-standard use of grammar and spatial arrangement. We found that the dominant types of oralizations were non-corrected spelling errors and lack of attention to capitalization. Overall, GPs used a limited number of other non-verbal cues. We discuss how these findings relate to norms of formality and professional co...
Denne artikel beskriver udviklingen af et narrativt digitalt læringsobjekt: Det sund-hedsprofessi... more Denne artikel beskriver udviklingen af et narrativt digitalt læringsobjekt: Det sund-hedsprofessionelle kommunikationshjul. Dette læringsobjekt er udviklet på Aarhus Universitets adjunktpædagogikums Educational IT-modul med henblik på at indgå i kommunikationsundervisning for sundhedsfagsstuderende og sundhedsprofessionelle under efter- og videreefteruddannelse. Hjulet er blevet udviklet i samspil mellem kommunikationsundervisere og educational IT-ekspertise. Det bidrager til at løse en didaktisk udfordring ved at visualisere et komplementært forhold mellem sundhedskommunikation som færdighed på den ene side og som kontekstbundet kompleksitet på den anden. Kommunikationshjulet er implementeret på videreuddannelseskurser for yngre læger i Region Midtjylland og har gjort det muligt at erstatte en række ppt-oplæg med mere deltageraktiverende øvelser. Dog er modellens potentiale for egentlige ’blended learning’-aktiviteter endnu ikke udfoldet, og artiklen diskuterer, hvordan dette frema...
NEW TECHNOLOGIES HAVE FACILITATED DOCTOR–PATIENT EMAIL CONSULTATIONS (E-CONSULTATIONS). GUIDELINE... more NEW TECHNOLOGIES HAVE FACILITATED DOCTOR–PATIENT EMAIL CONSULTATIONS (E-CONSULTATIONS). GUIDELINES FOR E-CONSULTATION USE IN DENMARK STATE THAT THEY SHOULD BE USED FOR SIMPLE, CONCRETE AND NON-URGENT QUERIES; HOWEVER, A SMALL-SCALE DANISH STUDY SUGGESTED THAT DOCTORS ENCOUNTER E-CONSULTATIONS THAT DO NOT MATCH THE GUIDELINES. THE PURPOSE OF THIS ARTICLE IS TO EXPLORE WHETHER E-CONSULTATIONS IN DENMARK REFLECT RECOMMENDATIONS THAT THEY SHOULD BE SIMPLE, SHORT, CONCRETE AND WELL DEFINED, AND IF NOT, WHAT FORMS OF COMPLEXITY ARE EVIDENT. WE INDUCTIVELY ANALYSED 1,671 E-CONSULTATIONS FROM 38 PATIENTS AGED 21–91 YEARS COMMUNICATING WITH 28 DOCTORS, 6 NURSES, 1 MEDICAL STUDENT AND 8 SECRETARIES. RESULTS SHOWED BOTH QUANTITATIVE COMPLEXITY IN TERMS OF NUMBER OF INTERACTION TURNS, COMMUNICATIVE PARTICIPANTS, AND QUESTIONS ASKED, AND QUALITATIVE COMPLEXITY RELATING TO PATIENTS’ PSYCHOSOCIAL CONTEXTS AND GPS’ BIOMEDICAL DISEASE PERSPECTIVE. THUS, DESPITE EXISTING GUIDELINES AND THE LEANNESS A...
Over the past decades, the use of qualitative methodologies has increased in medical education re... more Over the past decades, the use of qualitative methodologies has increased in medical education research. This includes ethnographic approaches which have been used to explore complex cultural norms and phenomena by way of long-term engagement in the field of research. Often, however, medical education consists of short-term episodes that are not bound to single sites, but take place in a myriad of locations and contexts such as classrooms, exam stations, clinical settings, and online. This calls for methodologies that allows us to grasp what is at stake in an increasingly multi-faceted and diverse field. Methods In this article, we direct attention to focused ethnography which has emerged as a useful, suitable, and feasible applied qualitative research approach, that uses adapted classic ethnographic methods, such as direct observation, to gain new insights and nuanced understandings of distinct phenomena, themes, and interactions in specific settings in medical education, e.g. the learning potential of ward rounds, or how hierarchical positions affect learning situations. We introduce methodological key features of focused ethnography to give insights into how to use the approach, and we offer examples of how the method has been used in medical education research to show how it has contributed in different ways to the field of medical education research. Furthermore, some of the main challenges and limitations of the approach are addressed and discussed. Conclusions Accepted Article This article is protected by copyright. All rights reserved Focused ethnography offers a methodological approach that sheds light over limited and welldefined social episodes and interactions. Exactly because the field of medical education to a large degree consists of such fragmented interactions, focused ethnography can be seen as being methodology tailored to these characteristics and should become an integrated part of the toolkit of medical education research.
ObjectiveThis article investigated residents’ narratives to gain their understandings of which pa... more ObjectiveThis article investigated residents’ narratives to gain their understandings of which patterns are challenging in doctor–patient conversations.DesignQualitative narratological framework.ParticipantsWe analysed 259 narratives from 138 residents’ oral recounts of communication with patients in which they had felt challenged.ResultsThe analysis identified an ideal narrative for the doctor–patient encounter with the resident as protagonist pursuing the object of helping the patient with his health problem. Disruptions of this ideal narrative were at play when challenges occurred. Regardless of medical setting, challenges were often related to the establishment of a common object, and the communication actants had to go through negotiations, disagreements or even battles when trying to reach a common object. Challenges also occurred when actants which in the ideal narrative should act as helpers become opponents. We find narratives where patients, relatives and colleagues become...
Introduction: Studies suggest that the workplace is a key to understanding how clinical communica... more Introduction: Studies suggest that the workplace is a key to understanding how clinical communication skills learning takes place and that medical communication skills need to be reinforced over time in order not to deteriorate. This study explored the perceptions of doctors in four hospital departments who participated in a workplace-based communication training project. Its specific focus was the relationship between collegial relations and learning communication skills. Methods: The study applied a qualitative design using an ethnographic methodology, i.e. interviews and observations. Positioning theory was used as the theoretical framework. Results: Training communication skills with colleagues in the actual workplace setting was valued by the participants who experienced more sharing of communication challenges, previously understood as something private one would not share with colleagues. However, collegial relations were also barriers for providing critical feedback, especially from junior doctors to their seniors. Conclusion: The position as "colleague" both reinforced the communication skills training and hindered it. The communication skills educational model had a flat, non-hierarchical structure which disturbed the hierarchical structure of the workplace, and its related positions. Practice points Workplace communication skills' training is a valuable contribution to continuing professional development. Situating communication training in the workplace enable doctors to share challenges otherwise understood as something too private to share with colleagues. The position as "colleague" both reinforces the communication skills training and hinders feedback. Educational models with a flat, non-hierarchical structure disturbs the hierarchical structure of the workplace.
In this paper we describe and discuss communication skills training in Denmark - it has come a lo... more In this paper we describe and discuss communication skills training in Denmark - it has come a long way. After a short review of current research we outline the history of communication training in Denmark and describe the case of communication training at Aarhus University, which illustrates how the Danish universities have radically changed their communication training in the last decade. Finally, we discuss communication models and teaching methods and recommend an attempt to reach a national consensus on communication training.
This qualitative study presents results from a development project of clinical communication skil... more This qualitative study presents results from a development project of clinical communication skills training for physicians in a paediatric ward. Overall, the doctors express that the training positively supports their clinical work and that it provides a model for discussing communication challenges with colleagues. Challenges, however, are time constraints and overcoming conventional hierarchical structures. Prerequisites for ward-based communication training thus are: a suitable timeframe, use of a structured feedback model, managerial backup, and support from external expertise.
Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 2011
The article investigates the role of the social in medicine through an empirical study of social ... more The article investigates the role of the social in medicine through an empirical study of social technologies in Diabetes 2 and COPD patient education in Denmark. It demonstrates how the social at the same time is the cause of disease but also functions as a solution to the problem. Furthermore it suggests that the patient groups have an ambiguous role in medicine; they appear to be organized as communities of empowerment, critical of the individualizing effects of medicine, but at the same time these groups are embedded in medical practices, transferring responsibility for illness and health to the level of the citizens. The article provides an empirical analysis of how the social in patient education works. The empirical analysis challenges an existing understanding that patient groups automatically support healthy lifestyle changes. We point out the multiple ways in which the social works.
Over the last 15-20 years, the scope of medical education has broadened to include disciplines ot... more Over the last 15-20 years, the scope of medical education has broadened to include disciplines other than the biomedical. Many educators from the humanities and social sciences are thus currently teaching in the faculty of medicine. But how should we understand and communicate the position from which we - as 'non-doctors' - teach in this field? This article provides a reflection on how both doctors and 'non-doctors' in medical education seem to confirm and reproduce an underlying norm, namely that doctors are the most suitable teachers in medical education. I argue that these norms could and should be challenged. I provide examples of how a 'gaze from the outside' is fruitful and may be necessary in medical education, and highlight the potential strength of cross-disciplinary teaching that involves medical educators 'within and outside' medicine.
Tidsskrift for Forskning i Sygdom og Samfund, 2010
This paper investigates how the concept of motivation functions in health promotion practice. It ... more This paper investigates how the concept of motivation functions in health promotion practice. It provides an analysis of the understandings and articulations of motivation at the levels of the state, health professionals, and citizens. It finds that motivation takes on different meanings and functions depending on the perspective; thus the general agreement on the importance of motivation in health promotion does not correspond to a mutual understanding of what motivation actually is: motivation works variously as technology, a statistically created collective informed consent, and a moral imperative. It is conceived of as an instrumentalized psychological entity but also expressed as a complex and context-bound phenomenon. The paper concludes by arguing that motivation must be seen as the latter: a relational concept, relating to concrete social and situational contexts rather than an instrumental psychological entity within the individual.
MedieKultur: Journal of media and communication research, 2021
In this article, we explore e-mail consultation platforms that allow digital and written asynchro... more In this article, we explore e-mail consultation platforms that allow digital and written asynchronous communication between patients and general practioners (GPs). Research has suggested that doctor-patient e-mail communication has the potential to transform the sphere of responsibility of health matters, leaving the patient with more responsibility than in other forms of communication. Th erefore, we ask whether the e-mail consultation platform provides opportunities for patients to be active and responsible biological citizens, and if so, in what way. To explore this, we analyzed 646 e-mail consultation instances from 38 patients from 4 Danish GP practices. We found four ways the platform provides opportunities for patients to satisfy the expectation of biological citizenship: specifi cally, by affi rming their own responsibility in healthcare; making suggestions to the GP; making requests of the GP; and questioning aspects of healthcare. In conclusion, we argue that the platform provides patients with new ways of satisfying the expectations of biological citizenship.
A recurring challenge in health promotion and prevention practice is the phenomenon of people cho... more A recurring challenge in health promotion and prevention practice is the phenomenon of people choosing not to follow the health advice given by professionals, the people who appear to be 'non-motivated' for a healthy lifestyle. This phenomenon is the subject of this article. Based on the concepts of akrasia (weakness of the will) (with an inspiration from Martha C. Nussbaum and Alaisdair MacIntyre) and rationality of des-interest, (as proposed by Sam Paldanius) it unfolds a theoretical and philosophical framework for understanding the rationales that lie behind not following recommended health guidelines. Through an empirical analysis of the case of Poul, a diabetes2patient that refuses to change his lifestyle, the article shows how not choosing the healthy lifestyle must not be understood as only an irrational lack of motivation. The concepts akrasia and des-interest contribute to an understanding of how human reflections on the 'right choice' is an ongoing and time...
Editorial. Qualitative Health Communication: What can a new journal dedicated to qualitative heal... more Editorial. Qualitative Health Communication: What can a new journal dedicated to qualitative health communication offer? Welcome to Qualitative Health Communication (QHC). What can a new journal dedicated to qualitative health communication offer? In this editorial, we will offer some answers to this question. Let us start with an anecdote. A few years ago, two of the editors submitted a qualitative article to a leading health communication journal that stated that it welcomed both quantitative and qualitative research. Interestingly, the qualitative article received a desk rejection which was legitimised using quantitatively oriented terminology and approaches ("science of interventions", "subjective ratings", "outcome measures"). It was further suggested that instead of qualitative focus groups, "objective observations of communication behaviour" should be used in "a pre-test post-test control group design" as it would "provide much stronger evidence". (We want to underline here that a desk rejection might have been warranted, but it should have occurred on the right terms). We suspect this is a situation in which other qualitative health communication researchers may have found themselves, i.e. having their work assessed against inappropriate conceptualisations, methodological frameworks and criteria for validity. In QHC, quality will be assessed through a qualitative lens rather than applying a quantitative framework.
In their article ‘Delineating the Field of Medical Education: Bibliometric Research Approach (es)... more In their article ‘Delineating the Field of Medical Education: Bibliometric Research Approach (es)’, Maggio at al. present a list of 24 Medical Education Journals (MEJ-24) identified through a bibliometric approach. The list is suggested as a starting point for a conversation among medical education stakeholders aimed at defining ‘a working consensus on the scope of the field’. Their reason for engaging in this task is to ‘facilitate conducting bibliometric studies and other research designs (e.g., systematic reviews) and to enable individuals to identify themselves as ‘medical education researchers’. As medical educators and researchers, we find this approach interesting and agree that discussions about how we understand and delineate the field of medical education are crucial. In addition, medical education research needs bibliometric analyses to provide a statistically based overview, for example, of the value of writing systematic reviews or to scrutinise dominant forms of knowledge in the field.
BackgroundCommunication skills learned in the classroom do not transfer easily into clinical prac... more BackgroundCommunication skills learned in the classroom do not transfer easily into clinical practice because they are not reinforced by teachers in the workplace setting and because lack of faculty training restricts the transfer of communication skills in real patient encounters. Trained university-based communication skills teachers often work simultaneously as doctors in clinics. This study explored if and how the skills of these teachers play a role in communication skills training in the clinical workplace.MethodsWe used an exploratory sequential design: a mixed method approach that combined a survey with communication skills teachers, and qualitative individual interviews with these teachers and their educational leaders in clinical departments. The questionnaire was analysed using descriptive statistics. The interviews were analysed using content analysis.ResultsThe response rate was 34 %. A majority (93 %) used their communication skills when communicating with patients and...
In recent years and throughout the developed world, policymakers have encouraged the implementati... more In recent years and throughout the developed world, policymakers have encouraged the implementation of digital patient-clinician interaction. Our focus is on the Danish general practice setting where email consultations were implemented as a mandatory service in 2009 and now constitute 21% of all consultations in general practice. Drawing upon strong structuration theory (SST), our analysis sets out to explore how email consultations are represented in structures on macro, meso and micro-levels and how the interplay between structures and agents plays out with respect to possible alignments, tensions and adjustments. We analyze data from policy documents on the macro and meso-levels, data from clinics' websites (meso-level) and data from interviews with GPs and patients (micro-level) (n = 53). Our findings show that the introduction of email consultation as a new health technology is a key site for development in email consultation practice, professional boundary setting and adjustments within the doctor-patient relationship. Our findings thus demonstrate that email consultation can be considered a dynamic component of a socio-technical network rather than a static medium for simple health transactions or information delivery. Based on these findings, we recommend that, for future implementation of patient-clinician digital communication it is important to investigate the multiple sources of influence on telecare practices and to see its intended users as agents who actively shape their own care motivated by opinions, relationships and values.
Catalan Journal of Communication & Cultural Studies, 2021
It is well-known that non-verbal cues are essential in doctor‐patient communication. As doctor‐pa... more It is well-known that non-verbal cues are essential in doctor‐patient communication. As doctor‐patient communication is turning increasingly digital and written, it becomes relevant to explore the role of non-verbal cues in such communication genres. One more recent genre is the doctor‐patient e-mail consultation. Research has found that while patients like e-mail consultations, they also miss facial expressions, eye contact, etc. In this study, we explored the different ways in which Danish GPs use non-verbal cues in e-mail consultations. We analysed 633 e-mail consultations written by 22 GPs. We applied the concept oforalization, which includes the use of emoticons and non-standard use of grammar and spatial arrangement. We found that the dominant types of oralizations were non-corrected spelling errors and lack of attention to capitalization. Overall, GPs used a limited number of other non-verbal cues. We discuss how these findings relate to norms of formality and professional co...
Denne artikel beskriver udviklingen af et narrativt digitalt læringsobjekt: Det sund-hedsprofessi... more Denne artikel beskriver udviklingen af et narrativt digitalt læringsobjekt: Det sund-hedsprofessionelle kommunikationshjul. Dette læringsobjekt er udviklet på Aarhus Universitets adjunktpædagogikums Educational IT-modul med henblik på at indgå i kommunikationsundervisning for sundhedsfagsstuderende og sundhedsprofessionelle under efter- og videreefteruddannelse. Hjulet er blevet udviklet i samspil mellem kommunikationsundervisere og educational IT-ekspertise. Det bidrager til at løse en didaktisk udfordring ved at visualisere et komplementært forhold mellem sundhedskommunikation som færdighed på den ene side og som kontekstbundet kompleksitet på den anden. Kommunikationshjulet er implementeret på videreuddannelseskurser for yngre læger i Region Midtjylland og har gjort det muligt at erstatte en række ppt-oplæg med mere deltageraktiverende øvelser. Dog er modellens potentiale for egentlige ’blended learning’-aktiviteter endnu ikke udfoldet, og artiklen diskuterer, hvordan dette frema...
NEW TECHNOLOGIES HAVE FACILITATED DOCTOR–PATIENT EMAIL CONSULTATIONS (E-CONSULTATIONS). GUIDELINE... more NEW TECHNOLOGIES HAVE FACILITATED DOCTOR–PATIENT EMAIL CONSULTATIONS (E-CONSULTATIONS). GUIDELINES FOR E-CONSULTATION USE IN DENMARK STATE THAT THEY SHOULD BE USED FOR SIMPLE, CONCRETE AND NON-URGENT QUERIES; HOWEVER, A SMALL-SCALE DANISH STUDY SUGGESTED THAT DOCTORS ENCOUNTER E-CONSULTATIONS THAT DO NOT MATCH THE GUIDELINES. THE PURPOSE OF THIS ARTICLE IS TO EXPLORE WHETHER E-CONSULTATIONS IN DENMARK REFLECT RECOMMENDATIONS THAT THEY SHOULD BE SIMPLE, SHORT, CONCRETE AND WELL DEFINED, AND IF NOT, WHAT FORMS OF COMPLEXITY ARE EVIDENT. WE INDUCTIVELY ANALYSED 1,671 E-CONSULTATIONS FROM 38 PATIENTS AGED 21–91 YEARS COMMUNICATING WITH 28 DOCTORS, 6 NURSES, 1 MEDICAL STUDENT AND 8 SECRETARIES. RESULTS SHOWED BOTH QUANTITATIVE COMPLEXITY IN TERMS OF NUMBER OF INTERACTION TURNS, COMMUNICATIVE PARTICIPANTS, AND QUESTIONS ASKED, AND QUALITATIVE COMPLEXITY RELATING TO PATIENTS’ PSYCHOSOCIAL CONTEXTS AND GPS’ BIOMEDICAL DISEASE PERSPECTIVE. THUS, DESPITE EXISTING GUIDELINES AND THE LEANNESS A...
Over the past decades, the use of qualitative methodologies has increased in medical education re... more Over the past decades, the use of qualitative methodologies has increased in medical education research. This includes ethnographic approaches which have been used to explore complex cultural norms and phenomena by way of long-term engagement in the field of research. Often, however, medical education consists of short-term episodes that are not bound to single sites, but take place in a myriad of locations and contexts such as classrooms, exam stations, clinical settings, and online. This calls for methodologies that allows us to grasp what is at stake in an increasingly multi-faceted and diverse field. Methods In this article, we direct attention to focused ethnography which has emerged as a useful, suitable, and feasible applied qualitative research approach, that uses adapted classic ethnographic methods, such as direct observation, to gain new insights and nuanced understandings of distinct phenomena, themes, and interactions in specific settings in medical education, e.g. the learning potential of ward rounds, or how hierarchical positions affect learning situations. We introduce methodological key features of focused ethnography to give insights into how to use the approach, and we offer examples of how the method has been used in medical education research to show how it has contributed in different ways to the field of medical education research. Furthermore, some of the main challenges and limitations of the approach are addressed and discussed. Conclusions Accepted Article This article is protected by copyright. All rights reserved Focused ethnography offers a methodological approach that sheds light over limited and welldefined social episodes and interactions. Exactly because the field of medical education to a large degree consists of such fragmented interactions, focused ethnography can be seen as being methodology tailored to these characteristics and should become an integrated part of the toolkit of medical education research.
ObjectiveThis article investigated residents’ narratives to gain their understandings of which pa... more ObjectiveThis article investigated residents’ narratives to gain their understandings of which patterns are challenging in doctor–patient conversations.DesignQualitative narratological framework.ParticipantsWe analysed 259 narratives from 138 residents’ oral recounts of communication with patients in which they had felt challenged.ResultsThe analysis identified an ideal narrative for the doctor–patient encounter with the resident as protagonist pursuing the object of helping the patient with his health problem. Disruptions of this ideal narrative were at play when challenges occurred. Regardless of medical setting, challenges were often related to the establishment of a common object, and the communication actants had to go through negotiations, disagreements or even battles when trying to reach a common object. Challenges also occurred when actants which in the ideal narrative should act as helpers become opponents. We find narratives where patients, relatives and colleagues become...
Introduction: Studies suggest that the workplace is a key to understanding how clinical communica... more Introduction: Studies suggest that the workplace is a key to understanding how clinical communication skills learning takes place and that medical communication skills need to be reinforced over time in order not to deteriorate. This study explored the perceptions of doctors in four hospital departments who participated in a workplace-based communication training project. Its specific focus was the relationship between collegial relations and learning communication skills. Methods: The study applied a qualitative design using an ethnographic methodology, i.e. interviews and observations. Positioning theory was used as the theoretical framework. Results: Training communication skills with colleagues in the actual workplace setting was valued by the participants who experienced more sharing of communication challenges, previously understood as something private one would not share with colleagues. However, collegial relations were also barriers for providing critical feedback, especially from junior doctors to their seniors. Conclusion: The position as "colleague" both reinforced the communication skills training and hindered it. The communication skills educational model had a flat, non-hierarchical structure which disturbed the hierarchical structure of the workplace, and its related positions. Practice points Workplace communication skills' training is a valuable contribution to continuing professional development. Situating communication training in the workplace enable doctors to share challenges otherwise understood as something too private to share with colleagues. The position as "colleague" both reinforces the communication skills training and hinders feedback. Educational models with a flat, non-hierarchical structure disturbs the hierarchical structure of the workplace.
In this paper we describe and discuss communication skills training in Denmark - it has come a lo... more In this paper we describe and discuss communication skills training in Denmark - it has come a long way. After a short review of current research we outline the history of communication training in Denmark and describe the case of communication training at Aarhus University, which illustrates how the Danish universities have radically changed their communication training in the last decade. Finally, we discuss communication models and teaching methods and recommend an attempt to reach a national consensus on communication training.
This qualitative study presents results from a development project of clinical communication skil... more This qualitative study presents results from a development project of clinical communication skills training for physicians in a paediatric ward. Overall, the doctors express that the training positively supports their clinical work and that it provides a model for discussing communication challenges with colleagues. Challenges, however, are time constraints and overcoming conventional hierarchical structures. Prerequisites for ward-based communication training thus are: a suitable timeframe, use of a structured feedback model, managerial backup, and support from external expertise.
Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 2011
The article investigates the role of the social in medicine through an empirical study of social ... more The article investigates the role of the social in medicine through an empirical study of social technologies in Diabetes 2 and COPD patient education in Denmark. It demonstrates how the social at the same time is the cause of disease but also functions as a solution to the problem. Furthermore it suggests that the patient groups have an ambiguous role in medicine; they appear to be organized as communities of empowerment, critical of the individualizing effects of medicine, but at the same time these groups are embedded in medical practices, transferring responsibility for illness and health to the level of the citizens. The article provides an empirical analysis of how the social in patient education works. The empirical analysis challenges an existing understanding that patient groups automatically support healthy lifestyle changes. We point out the multiple ways in which the social works.
Over the last 15-20 years, the scope of medical education has broadened to include disciplines ot... more Over the last 15-20 years, the scope of medical education has broadened to include disciplines other than the biomedical. Many educators from the humanities and social sciences are thus currently teaching in the faculty of medicine. But how should we understand and communicate the position from which we - as 'non-doctors' - teach in this field? This article provides a reflection on how both doctors and 'non-doctors' in medical education seem to confirm and reproduce an underlying norm, namely that doctors are the most suitable teachers in medical education. I argue that these norms could and should be challenged. I provide examples of how a 'gaze from the outside' is fruitful and may be necessary in medical education, and highlight the potential strength of cross-disciplinary teaching that involves medical educators 'within and outside' medicine.
Uploads
Papers by Jane Møller