W.J. Eppich is associate professor of pediatrics-emergency medicine and medical education, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-4127-2825. T. Dornan is professor of medical education, School of Medicine, Dentistry and Biomedical Sciences, Queens University, Belfast, Northern Ireland, United Kingdom, and professor emeritus, Maastricht University, Maastricht, the Netherlands. J.-J. Rethans is professor of human simulation and director of medical education programs, Maastricht University, Maastricht, the Netherlands. P.W. Teunissen is professor of medical education, School of Health Professions Education, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
Acad Med. 2019 Jul;94(7):1033-1039. doi: 10.1097/ACM.0000000000002713.
Workplace-learning literature has focused on doing, but clinical practice also involves talking. Clinicians talk not only with patients but also about patients with other health professionals, frequently by telephone. The authors examined how the underexplored activity of work-related telephone talk influences physicians' clinical education.
Using constructivist grounded theory methodology, the authors conducted 17 semistructured interviews with physicians-in-training from various specialties and training levels from two U.S. academic health centers between 2015 and 2017. They collected and analyzed data iteratively using constant comparison to identify themes and explore their relationships. They used theoretical sampling in later stages until sufficiency was achieved.
Residents and fellows reported speaking via telephone regularly to facilitate patient care and needing to tailor their talk to the goal(s) of the conversation and their conversation partners. Three common conversational situations highlighted the interplay of patient care context and conversation and created productive conversational tensions that influenced learning positively: experiencing and dealing with (1) power differentials, (2) pushback, and (3) uncertainty.
Telephone talk contributes to postgraduate clinical education. Through telephone talk, physicians-in-training learn how to talk; they also learn through talk that is mediated by productive conversational tensions. These tensions motivate them to modify their behavior to minimize future tensions. When physicians-in-training improve how they talk, they become better advocates for their patients and more effective at promoting patient care. Preparing residents to deal with power differentials, pushback, and uncertainty in telephone talk could support their learning from this ubiquitous workplace activity.
工作场所学习文献主要关注实践，但临床实践也涉及交流。临床医生不仅与患者交流，还与其他卫生专业人员交流患者的情况，通常通过电话进行。作者研究了这项鲜少被探讨的工作相关电话交流活动如何影响医生的临床教育。
作者使用建构主义扎根理论方法，于 2015 年至 2017 年期间，在两家美国学术医疗中心，对来自不同专业和培训水平的实习医生进行了 17 次半结构化访谈。他们使用恒定性比较方法对数据进行反复收集和分析，以识别主题并探索其关系。在后期阶段，他们使用理论抽样，直到达到充分性。
住院医师和研究员报告说，他们经常通过电话进行交流，以促进患者的护理，并且需要根据谈话的目的和谈话对象来调整他们的谈话方式。三种常见的对话情景突出了患者护理背景和对话的相互作用，并产生了积极影响学习的富有成效的对话紧张局势：经历和应对（1）权力差异，（2）抵触，和（3）不确定性。
电话交流有助于研究生临床教育。通过电话交流，实习医生不仅学习如何交流，还通过富有成效的对话紧张局势进行学习。这些紧张局势促使他们调整自己的行为，以最小化未来的紧张局势。当实习医生改善他们的谈话方式时，他们成为更好的患者代言人，并更有效地促进患者护理。为住院医师准备处理电话交流中的权力差异、抵触和不确定性，可以支持他们从这种无处不在的工作场所活动中学习。
