Abstract
OBJECTIVE: Oral presentation skills are central to physicianphysician communication; however, little is known about how these skills are learned. Rhetoric is a social science which studies communication in terms of context and explores the action of language on knowledge, attitudes, and values. It has not previously been applied to medical discourse. We used rhetorical principles to qualitatively study how students learn oral presentation skills and what professional values are communicated in this process.
DESIGN: Descriptive study.
SETTING: Inpatient general medicine service in a university-affiliated public hospital.
PARTICIPANTS: Twelve third-year medical students during their internal medicine clerkship and 14 teachers.
MEASUREMENTS: One-hundred sixty hours of ethnographic observation, including 73 oral presentations on rounds. Discourse-based interviews of 8 students and 10 teachers. Data were quanlitatively analyzed to uncover recurrent patterns of communication.
MAIN RESULTS: Students and teachers had different perceptions of the purpose of oral presentation, and this was reflected in performance. Students described and conducted the presentation as a rule-based, data-storage activity governed by “order” and “structure.” Teachers approached the presentation as a flexible means of “communication” and a method for “constructing” the details of a case into a diagnostic or therapeutic plan. Although most teachers viewed oral presentations rhetorically (sensitive to context), most feedback that students received was implicit and acontextual, with little guidance provided for determining relevant content. This led to dysfunctional generalizations by students, sometimes resulting in worse communication skills (e.g., comment “be brief” resulted in reading faster rather than editing) and unintended value acquisition (e.g., request for less social history interpreted as social history never relevant).
CONCLUSION: Students learn oral presentation by trial and error rather than through teaching of an explicit rhetorical model. This may delay development of effective communication skills and result in acquisition of unintended professional values. Teaching and learning of oral presentation skills may be improved by emphasizing that context determines content and by making explicit the tacit rules of presentation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Lipkin M Jr, Putnam SM, Lazare A, eds. The Medical Interview: Clinical Care, Education and Research. New York: Springer-Verlag; 1995.
Atkinson P. Constructing Cases. Medical Talk, Medical Work: The Liturgy of the Clinic. London: Sage Publications; 1995:107–25.
Hunter KM. Doctors’ Stories: The narrative Structure of Medical Knowledge. Princeton, NJ: Princeton University Press; 1991.
Pomerantz AM, Ende J, Erickson F. Precepting conversations in a general medicine clinic. In: Morris GH, Chenail R, eds. The Talk of the Clinic: Explorations in the Analysis of Medical and Therapeutic Discourse. Hillsdale, NJ: Lawrence Erlbaum and Associates; 1995:151–69.
Arluke A. Social control rituals in medicine: the case of death rounds. In: Dingwall R, Heath C, Reid M, Stacey M, eds. Health Care and Health Knowledge. London: Croom Helm; 1977:107–25.
Anspach RR. Notes on the sociology of medical discourse: the language of case presentation. J Health Soc Behav. 1988;29:357–75.
Bordage G. Elaborated knowledge: a key to successful diagnostic thinking. Acad Med 1994;69:883–5.
Donnelly WJ. The language of medical case histories. Ann Intern Med. 1997;127:1045–48.
Burack JH, Irby DM, Carline JD, Root RK, Larson EB. Teaching compassion and respect: attending physicians’ responses to problematic behaviors. J Gen Intern Med. 1999;14:49–55.
Winsor D. Writing like an engineer: a rhetorical education. Hillsdale, NJ: Lawrence Erlbaum and Associates; 1996.
Yates J. Control Through Communication: The Rise of System in American Management. Baltimore, Md: Johns Hopkins University Press; 1989.
Bazerman C. Shaping Written Knowledge: The Genre and Activity of the Experimental Activity in Science. Madison, Wis: University of Wisconsin Press; 1988.
Pare A. Discourse regulations and the production of knowledge. In: Spilka R, ed. Writing in the Workplace: New Research Perspectives. Carbondale, Ill: Southern Illinois University Press; 1993:124–40.
Hammersly M, Atkinson Paul. Ethnography: Principles and Practice. 2nd ed. London: Routledge; 1995.
Glaser B, Strauss A. The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago: Aldine Publishing Company; 1967.
Giacomini MK, Cook DJ. Users’ guide to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA. 2000;284:357–62.
Odell L, Goswami D, Herrington A. The discourse-based interview: a procedure for exploring the tacit knowledge of writers in nonacademic settings. In: Odell L, Goswami D, eds. Writing in Nonacademic Settings. New York: Guilford Press, 1985:221–36.
Caldicott CV. What’s wrong with this medical student today? Dysfluency on inpatient rounds. Ann Intern Med. 1998;128:607–10.
Hekelman FP, Blase JR. Excellence in clinical teaching: the core of the mission. Acad Med. 1996;71:738–42.
Lingard L, Haber RJ. Teaching and learning communication in medicine: a rhetorical approach. Acad Med. 1999;74:507–10.
Perl S. Understanding composing. College Composition and Communication. 1980;31:363–9.
Ende J. Feedback in medical education. JAMA. 1983;250:777–81.
Ende J, Pomerantz A, Erickson F. Preceptors’ strategies for correcting residents in an ambulatory care medicine setting: a qualitative analysis. Acad Med. 1995;70:224–9.
Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice-Hall; 1986.
Eskedal GA. Symbolic role modeling and cognitive learning in the training of counselors. J Counsel Psychol. 1975;22:152–5.
Lingard LA, Haber RJ. What do we mean by “relevance”? A clinical and rhetorical definition. Implications for teaching and learning the case presentation format. Acad Med. 1999; 74(suppl):S124–7.
Konner M. Becoming a Doctor: A Journey of Initiation in Medical School. New York, NY: Penguin; 1987.
Stein H. American Medicine as Culture. Boulder, Colo: Westview Press; 1990.
Novack DH, Suchman AL, Clark W, Epstein RM, Najberg E, Kaplan C, for the Working Group on Promoting Physician Personal Awareness. American Academy on Physician and Patient. Calibrating the physician: personal awareness and effective patient care. JAMA. 1997;278:502–9.
Giltrow J, Valiquette M. Genres and knowledge: students writing in the disciplines. In: Freedman A, Medway P, eds. Teaching and Learning Genre. Portsmouth, NH: Boynton/Cook; 1994.
Schon DA. The Reflective Practitioner: How Professionals Think in Action. New York: Basic Books; 1983.
Freedman A. Do as I say: the relationship between teaching and learning new genres. In: Freedman A, Medway P, eds. Genre and the New Rhetoric. London: Taylor and Francis; 1994:191–210.
Coe RM. An arousing and fulfillment of desires: the rhetoric of genre in the process era-and beyond. In: Freedman A, Medway P, eds. Genre and the New Rhetoric. London: Taylor and Francis; 1994:181–90.
Coe RM. Process, form and substance: a rhetoric for advanced writers. 2nd ed. Englewood Cliffs, NJ: Prentice-Hall; 1990.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Haber, R.J., Lingard, L.A. Learning oral presentation skills. J GEN INTERN MED 16, 308–314 (2001). https://doi.org/10.1046/j.1525-1497.2001.00233.x
Issue Date:
DOI: https://doi.org/10.1046/j.1525-1497.2001.00233.x