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lslect023

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<title>Consultation Skills Research</title></titleStmt>

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<idno>lslct023</idno>

<availability><p>The British Academic Spoken English (BASE) corpus was developed at the

Universities of Warwick and Reading, under the directorship of Hilary Nesi

(Centre for English Language Teacher Education, Warwick) and Paul Thompson

(Department of Applied Linguistics, Reading), with funding from BALEAP,

EURALEX, the British Academy and the Arts and Humanities Research Board. The

original recordings are held at the Universities of Warwick and Reading, and

at the Oxford Text Archive and may be consulted by bona fide researchers

upon written application to any of the holding bodies.

The BASE corpus is freely available to researchers who agree to the

following conditions:</p>

<p>1. The recordings and transcriptions should not be modified in any

way</p>

<p>2. The recordings and transcriptions should be used for research purposes

only; they should not be reproduced in teaching materials</p>

<p>3. The recordings and transcriptions should not be reproduced in full for

a wider audience/readership, although researchers are free to quote short

passages of text (up to 200 running words from any given speech event)</p>

<p>4. The corpus developers should be informed of all presentations or

publications arising from analysis of the corpus</p><p>

Researchers should acknowledge their use of the corpus using the following

form of words:

The recordings and transcriptions used in this study come from the British

Academic Spoken English (BASE) corpus, which was developed at the

Universities of Warwick and Reading under the directorship of Hilary Nesi

(Warwick) and Paul Thompson (Reading). Corpus development was assisted by

funding from the Universities of Warwick and Reading, BALEAP, EURALEX, the

British Academy and the Arts and Humanities Research Board. </p></availability>

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<date>12/06/2003</date><equipment><p>video</p></equipment>

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<item n="speechevent">Lecture</item>

<item n="acaddept">Primary Health Care and General Practice</item>

<item n="acaddiv">ls</item>

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<item n="module">unknown</item>

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<u who="nm0338"><kinesic desc="projector is on showing slide" iterated="n"/> # <pause dur="0.9"/> i i have been <trunc>or</trunc> <trunc>dist</trunc> did just distribute # evaluation sheets <pause dur="0.4"/> they're actually the ones that are used for the Master's in Medical Education course but <pause dur="0.3"/> please do fill these out as you go along what we would really like <pause dur="0.4"/> on the reverse of the sheet <pause dur="0.3"/> is some sort of text comments as well of of the day and <pause dur="0.4"/> whether you would like it repeated i was just talking to my colleagues from <gap reason="name" extent="1 word"/> <trunc>whe</trunc> whether you would like <pause dur="0.5"/> one of <pause dur="0.3"/> the other sister universities perhaps to host the event <pause dur="0.4"/> next time 'cause i think people have appreciated the sort of <pause dur="0.4"/> the small group <pause dur="0.5"/> the other thing is i don't know if everybody's actually signed in has anybody not signed in <pause dur="0.3"/> can i just send this form round just <event desc="passes out attendance sheet" iterated="n"/></u><u who="nm0339" trans="latching"> thank you </u><u who="nm0338" trans="overlap"> for for people to to sign in <pause dur="0.3"/> and introduce our next speakers we've got three speakers from <pause dur="0.3"/> <gap reason="name" extent="1 word"/> University from the Department of Primary Care and General Practice <pause dur="0.4"/> Interactive Skills Unit <pause dur="0.5"/> # <gap reason="name" extent="2 words"/> <gap reason="name" extent="2 words"/> and <gap reason="name" extent="2 words"/> as stated and they're going to

talk to us about # <pause dur="0.3"/> consultation skills research <pause dur="0.2"/> thank you very much </u><pause dur="0.7"/> <u who="nf0340" trans="pause"> yes but fear not by the miracle of <trunc>m</trunc> rehearsal and careful timekeeping <pause dur="0.2"/> the three of us are going to present within the fifteen minute time slot <pause dur="0.6"/> <vocal desc="laughter" iterated="y" n="ss" dur="1"/> that's the challenge </u><u who="nm0348" trans="overlap"> <gap reason="inaudible" extent="1 sec"/> </u><u who="nf0340" trans="latching"> <vocal desc="laughter" iterated="y" n="sl" dur="1"/><pause dur="0.7"/> we're doing <vocal desc="laughter" iterated="y" n="sl" dur="2"/><pause dur="0.4"/> we're doing something for you that's # a little different from the previous presentations we're not doing # an in-depth presentation on a particular research <trunc>ini</trunc> initiative or methodology <pause dur="0.5"/> # what we thought might be interesting # <unclear>if</unclear> we've got an opportunity <pause dur="0.4"/> # <pause dur="0.3"/> while we've got a group of colleagues here from from different sides <pause dur="0.4"/> that we might just give you an overview of some of the research themes that we're looking at within the Interactive Skills Unit at the moment <pause dur="0.3"/> and that will be a very quick zip through # what's

happening at <gap reason="name" extent="1 word"/> <pause dur="0.4"/> # and then <pause dur="0.2"/> <gap reason="name" extent="1 word"/> myself and <gap reason="name" extent="1 word"/> will speak for just two or three minutes each <pause dur="0.3"/> # on our own personal favourite area of research <pause dur="0.5"/> # questions are welcome on anything that # we discuss <pause dur="0.4"/> and given that it is going to be a romp through a number of topics rather than an <trunc>in</trunc> in-depth <pause dur="0.4"/> # we're giving everybody a <pause dur="0.2"/> handout if you'd like to have one with supporting information <pause dur="0.3"/> and a business card on top so that if there is an area where you think <pause dur="0.7"/> i'd like to know a bit more about that or that's something we should be talking about together <pause dur="0.2"/> please feel free to give us a ring <pause dur="0.6"/> that's us <vocal desc="laugh" iterated="n"/></u><pause dur="1.1"/> <u who="nm0341" trans="pause"> that's us </u><u who="nf0340" trans="latching"> <vocal desc="laughter" iterated="y" dur="1"/> <pause dur="0.9"/> that's us <vocal desc="laughter" iterated="y" n="sl" dur="1"/> <pause dur="0.3"/> and the next slide that <gap reason="name" extent="1 word"/> is about to put up <kinesic desc="changes slide" iterated="n" n="nm0341"/> for me lovely thank you <gap reason="name" extent="1 word"/> <pause dur="0.4"/> # is # just an overview of the research currently <trunc>un</trunc> being undertaken by the

Interactive Skills Unit <pause dur="0.3"/> and the type of areas we get ourselves involved in <pause dur="0.8"/> the Interactive Skills Unit is essentially a unit based at <gap reason="name" extent="1 word"/> University primarily concerned with consultation <pause dur="0.2"/> and communication skills <pause dur="0.2"/> teaching and assessment <pause dur="0.7"/> and that's across primarily medicine but also nursing and dentistry <pause dur="0.6"/> and we start <trunc>wo</trunc> doing communication skills work with the undergraduates when they ooh two weeks after they arrive <pause dur="0.6"/> then they pass through our careful hands until year five <pause dur="0.5"/> # and then we're responsible for a number of training initiatives within the region <pause dur="0.4"/> # well we do a lot of work with # qualified health professionals <pause dur="0.5"/> including the areas that you would expect clinical consultations <pause dur="0.3"/> communication skills subjects but also a lot of management and leadership <pause dur="0.4"/> i'm not going to # read the list out for you you can see the range of work there <pause dur="0.3"/> just a couple of quick things to draw your attention to <pause dur="0.3"/> the contracted work that we do with the I-S-U <pause dur="0.2"/> that's things that

are commissioned through the # postgraduate dean's office <pause dur="0.6"/> our very good friend <gap reason="name" extent="2 words"/> <pause dur="0.4"/> engages us in that range of work <pause dur="0.3"/> # <pause dur="0.2"/> non-contracted is when the phone rings and people ring us up with weird and wonderful requests for programmes workshops and <pause dur="0.4"/> video work <pause dur="0.6"/> and the undergraduate programme's on the other side there <pause dur="0.2"/> and the areas marked with an asterisk are areas in which one or more members <pause dur="0.4"/> of our multidisciplinary team are currently researching <pause dur="2.1"/> so there's quite a bit going on at the moment <pause dur="1.1"/> and when we get our three-hundred-and-ninety first years next year there's going to be a lot more going on <pause dur="1.0"/><vocal desc="laugh" iterated="n"/><pause dur="0.5"/> if anybody's got any theories on how to make walls into rubber <pause dur="0.4"/> <vocal desc="laughter" iterated="y" n="ss" dur="1"/> i would like to hear about them at the end <vocal desc="laughter" iterated="y" dur="1"/> </u><u who="nm0341" trans="overlap"> that would be terrific thank you </u><pause dur="0.2"/> <u who="nf0340" trans="pause"> that's what we're up to at the moment next one please <gap reason="name" extent="1 word"/> <pause dur="3.6"/> <kinesic desc="changes slide" iterated="n" n="nm0341"/> this is my <pause dur="0.4"/> personal area of my main personal area of research at the moment

i've got a few things going on but this is the big one <pause dur="0.4"/> # 'cause this is my PhD which hopefully i'll be handing in <trunc>t</trunc> <pause dur="1.1"/> sometime in the <shift feature="voice" new="laugh"/>next <shift feature="voice" new="normal"/>few weeks <pause dur="0.6"/> # <pause dur="0.3"/> my particular area of interest is assessment # in particular how communication skills are assessed <pause dur="0.5"/> and there's been some references this morning to the interesting areas about <pause dur="0.2"/> consistency in assessing the candidate interview candidate's communication <pause dur="0.4"/> how can we start to begin to make <pause dur="0.2"/> judgements about attitude and professionalism <pause dur="0.4"/> this ties in i think quite nicely with that <pause dur="0.5"/> # <pause dur="0.8"/> it's a five year project that i'm going to attempt to describe in two minutes so <pause dur="0.2"/> in its briefest form <pause dur="1.9"/> in a in in year five as part of their final general practice exam <pause dur="0.7"/> our students have to undertake <pause dur="0.4"/> a long station OSCE effectively <pause dur="0.4"/> and two of those stations are full role played consultations <pause dur="1.0"/> we're a <trunc>mit</trunc> we're a multidisciplinary team in the Interactive Skills Unit which means that we're a mixture of <pause dur="0.3"/> commissions non-commissions linguists <pause dur="0.3"/> and a big

team of role players # from different teaching training and <pause dur="0.4"/> theatrical backgrounds <pause dur="0.9"/> # and the role players are a great resource we use them for teaching right through the curriculum <pause dur="0.5"/> and the most experienced ones # are used for assessment <pause dur="1.3"/> and the way that our <pause dur="0.3"/> voices examination works on the communications i mean on sorry on the stations where role play's happening <pause dur="0.6"/> is # a <trunc>t</trunc> an observing G-P examiner will score the students for <pause dur="0.2"/> clinical topics and areas of clinical management <pause dur="0.7"/> but the communication skills score <pause dur="0.7"/> which is <pause dur="0.4"/> worth a fifth of the station mark <pause dur="0.4"/> is negotiated between the examiner and the role player <pause dur="2.5"/> the scoring system that we use i've actually given you a copy of we use a banding system we we <pause dur="1.2"/> we abandoned checklists and rating scales # <pause dur="0.9"/> a while ago because they they don't work for communication in our experience <pause dur="0.4"/> we're trying to move towards this sort of more <pause dur="0.3"/> positive assessment # and that's our banding system is A to F and you've got a sample there of a <trunc>b</trunc> band

B <pause dur="0.3"/> which i'm happy to talk to anybody about afterwards if they want to <pause dur="1.4"/> basically my PhD is looking at the way that negotiation system takes place <pause dur="0.2"/> and a lot of data was collected <pause dur="0.4"/> over a four year period <pause dur="0.5"/> where i was recording <pause dur="1.2"/> independent <pause dur="0.4"/> score perception of every role player <pause dur="0.2"/> independent score perception of every examiner <pause dur="0.3"/> and then the mark that they finally agreed on which was the score awarded in the finals to the students <pause dur="0.3"/> and as you can guess basically looking for reliability <pause dur="3.0"/> next one please <gap reason="name" extent="1 word"/> <pause dur="2.3"/><kinesic desc="changes slide" iterated="n" n="nm0341"/> that's the very briefest summary of the most interesting areas of the results that i came across <pause dur="0.5"/> # across a sample of over a thousand consultations # <pause dur="1.1"/> irrespective of whatever <shift feature="voice" new="laugh"/>variables <shift feature="voice" new="normal"/> # we we looked at <pause dur="0.7"/> female students performed consistently higher <pause dur="0.7"/> or if you like were awarded consistently higher scores depending on how you choose to frame that <pause dur="0.6"/> # right across the sample <pause dur="0.4"/> and the that's that female student gender <pause dur="0.2"/>

significantly higher score <pause dur="0.2"/> was irrespective of <pause dur="0.5"/> the year of study the age of the examiner the <shift feature="voice" new="laugh"/>experience <shift feature="voice" new="normal"/>of the role player <pause dur="0.2"/> the time of day the month of year <pause dur="0.4"/> all of the exam variables that we looked at <pause dur="0.5"/> that was the one that stayed significant <pause dur="1.5"/> we found that students perform less well on some role play stations than others <pause dur="0.7"/> and we're starting to work towards some theories from that that there is a relationship <pause dur="0.4"/> between <pause dur="0.6"/> a student's communication skills performance <pause dur="0.3"/> and the content of the consultation <pause dur="1.8"/> found that the students are getting higher marks when they're discussing lifestyle issues <pause dur="0.3"/> than when they're required to <pause dur="0.3"/> discuss a new diagnosis <pause dur="0.4"/> for example </u><pause dur="0.8"/> <u who="nm0343" trans="pause"> <gap reason="name" extent="1 word"/> did you <pause dur="0.2"/> you said they did perform better did you say how much better what percentage or how did you score </u><pause dur="1.2"/> <u who="nf0340" trans="pause"> # i've i i can give you a lot of detail about that <trunc>i</trunc> <trunc>i</trunc> in a few minutes do you do you mind because there's </u><u who="nm0343" trans="overlap">

okay </u><u who="nf0340" trans="overlap"> three of us in a very short time would you mind awfully </u><u who="nm0343" trans="latching"> okay </u><u who="nf0340" trans="latching"> if i if i let my colleagues <pause dur="0.6"/> finish and we can discuss that afterwards <pause dur="0.4"/> i mean i've i've got i've got a PhD thesis of of which a third of it is the is the type of data that you're talking about <pause dur="0.4"/> and i mean yes i can pin that down to exact percentages for you if you wish no problem <pause dur="0.7"/> # <pause dur="1.7"/> performance factors # those were just some variables that we looked at to find out whether <pause dur="0.4"/> things like seeing eighteen candidates back to back <pause dur="0.2"/> had a significant impact on the scoring dynamic and found that it did <pause dur="0.4"/> so we're making changes around that <pause dur="0.7"/> # experience # age and year <pause dur="0.2"/> were just some other factors that we looked at again i can give you more detail of those things that interested you <pause dur="0.6"/> and the overall result thankfully was that # <pause dur="0.7"/> the system was consistent there were over seventy assessors involved in this study over four years <pause dur="0.5"/> and we did find the <pause dur="0.3"/> awarding of initial marks and

the awarded marks and the negotiation process <pause dur="0.3"/> to be consistent <pause dur="0.2"/> and it is reliable <pause dur="0.5"/> across the study period <pause dur="0.5"/> and there are some small areas that we're going to be tweaking and modifying and revising <pause dur="0.4"/> # but on the whole we're happy that this form of communication skills marking <pause dur="0.3"/> is currently running without bias <pause dur="0.7"/> thanks <gap reason="name" extent="1 word"/> </u><pause dur="1.0"/> <u who="nm0341" trans="pause"> you're welcome <pause dur="1.0"/> can i have the microphone </u><pause dur="0.4"/> <u who="nf0340" trans="pause"> you can </u><pause dur="0.6"/> <u who="nm0341" trans="pause"> hello <pause dur="1.8"/> say hello <gap reason="name" extent="1 word"/> </u><pause dur="0.2"/> <u who="ss" trans="pause"> hello <gap reason="name" extent="1 word"/> <vocal desc="laughter" iterated="y" n="ss" dur="1"/></u><pause dur="0.2"/> <u who="nm0341" trans="pause"> thank you very much <pause dur="0.7"/> # the actor in me will never die it # i was reflecting on the way here today that <pause dur="0.6"/> that my journey the journey that brings me here today started back in nineteen-eighty-one September nineteen-eighty-one when i joined the Theatre Studies department just down the road <pause dur="1.1"/> and was one of the people who did Theatre Studies and Dramatic Arts B-A

honours back between nineteen-eighty-one and eighty-four subsequently became an actor <pause dur="0.5"/> millions of other things and bits and pieces in between but over the last seven years <pause dur="0.3"/> have been working with # <pause dur="0.3"/> <gap reason="name" extent="1 word"/> and the team on the communication skills course at <gap reason="name" extent="1 word"/> so that's some of my background <pause dur="0.5"/><kinesic desc="changes slide" iterated="n"/> my particular research area is cross-disciplinary <pause dur="0.9"/> it causes all kinds of difficulties because it's not quite qualititative it's not quite quantitative it adds to knowledge in # <pause dur="0.6"/> hopefully in three different areas <pause dur="0.5"/> i'm not quite sure most of where or what <pause dur="0.4"/> # it's # currently a Master's looking for transfer to a PhD and we're going through that process at the moment so it's far earlier <trunc>inter</trunc> in the process than <pause dur="0.4"/> than <trunc>y</trunc> we're at with <gap reason="name" extent="1 word"/> at the moment <pause dur="0.4"/> but effectively i'm looking at doctor-patient communication skills <pause dur="0.5"/> i'm applying a linguistic model to look at contextually <pause dur="0.2"/> what is happening <pause dur="0.4"/> within doctor-patient communication skills <pause dur="0.5"/> and then i'm looking at

finding a visual representation of what a consultation looks like <pause dur="0.9"/> and applying <pause dur="0.5"/> a chaos theory measurement <pause dur="0.9"/> to that visualization to then say okay well what does this tell us about it so <pause dur="0.4"/> those of you who are aware of what a fractal is and what a fractal does will understand that those of you who don't <pause dur="0.4"/> i can give you three or four hours later to talk through it is that all right <pause dur="0.8"/> <vocal desc="laughter" iterated="y" n="ss" dur="1"/> that'd be great <pause dur="0.5"/> # those of you with in the University of <gap reason="name" extent="1 word"/> who are aware of Frances Griffiths will perhaps know that this is a big research area of Frances' <pause dur="0.4"/> and i've presented before the complexity in primary care group on a number of occasions <pause dur="0.3"/> on this particular area <pause dur="0.3"/> i don't propose to go into any great depth of it today for <pause dur="0.2"/> for for quite obvious time <pause dur="0.4"/> limitation reasons <pause dur="0.4"/> my hope is that ultimately where this will be leading will be to move towards <pause dur="0.3"/> looking at doctor-patient communication ultimately in terms of complexity

theory <pause dur="0.3"/> and this if you like is a doorway in <pause dur="0.5"/> what what is actually happening where is it working <pause dur="0.4"/> okay <pause dur="0.5"/> what's it look like <pause dur="1.8"/><kinesic desc="changes slide" iterated="n"/> those are consultations <pause dur="0.7"/> done in this way <pause dur="1.0"/> those are visualizations of consultations <pause dur="0.6"/> and what you can actually do is you can say <pause dur="1.1"/> a fractal very very briefly is the measurement of irregularity it is the statistical measurement of irregularity of that shape <pause dur="2.1"/> if you think about the coastline of Britain <pause dur="0.6"/> that has a fractal measurement of one-point-two-seven <pause dur="0.6"/> it's in between the first and the second dimension <pause dur="0.9"/> <vocal desc="laughter" iterated="y" n="ss" dur="1"/> are we getting into Doctor Who yet <pause dur="0.4"/> do you like it <pause dur="0.2"/> okay <pause dur="0.5"/> so the fractal measurements there are represented by # the <pause dur="0.2"/> the <pause dur="0.6"/> signified D-F equals one-point-three-one so we've got a smaller fractal <pause dur="0.4"/> value on that one than we have on that one my study is looking at why that is what that means what the implications for that are <pause dur="0.8"/> i think given the linguistic model that i've chosen what i'm looking

at at the moment and what i'm developing is something that measures <pause dur="0.3"/> style <pause dur="0.2"/> consultation style <pause dur="0.7"/> right <pause dur="1.1"/> it's looking at # what i call the topography that's the mathematical relationship to to chaos theory so we're looking at the topography of a consultation what is the rocky road that takes you from <pause dur="0.3"/> hello good morning come in sit down how can i help you through to yeah thanks doctor that's brilliant <pause dur="1.0"/> what is that road what does that journey look like is it smooth is it rough <pause dur="0.6"/> what does the roughness mean is the roughness appropriate is it not there are all sorts of issues around that <pause dur="0.6"/> # <pause dur="0.2"/> consequently <pause dur="1.3"/> variance of style how important is that how does that work what sort of level of flexibility have we got <pause dur="0.5"/> that is almost a measurement of flexibility that one <pause dur="0.4"/> has great flexibility that one has less so <pause dur="1.4"/> lot more in this what's the application <pause dur="0.5"/> reflective practice <pause dur="0.6"/> it's not an assessment tool it can't be done in that sort of way because it's largely a qualitative

study <pause dur="0.4"/> and the volume of information that would need to be sat behind it i think would be a problem <pause dur="0.6"/> my hope is to develop something that a doctor can sit down and look at and say hang on a minute <pause dur="0.6"/> why are these particular why do i work in these particular areas more than in other particular areas dependent on the circumstances <pause dur="0.5"/> of the consultation what the presenting condition is how long the consultation is how long the relationship has been with the patient and all those other variables <pause dur="0.5"/> so really <pause dur="0.3"/> that's kind of where i'm going at the moment <pause dur="0.4"/> so # <pause dur="0.6"/> almost within time i'm going to hand you over for a far more rigorous approach to # <vocal desc="laughter" iterated="y" n="sl" dur="1"/> <gap reason="name" extent="2 words"/> </u><gap reason="break in recording" extent="uncertain"/> <u who="nm0342" trans="pause"><kinesic desc="projector is on showing slide" iterated="n"/> i'm <pause dur="0.4"/> doing discourse analysis of <pause dur="0.2"/> recorded consultations <pause dur="0.4"/> and basically what i'm looking for <pause dur="0.5"/> is why do patients make initiations in consultations <pause dur="0.4"/> so why do they initiate new information <pause dur="0.5"/> in a consultation <pause dur="0.6"/><kinesic desc="changes slide" iterated="n"/> and i'm using something called the I-R-F model which was developed at

<gap reason="name" extent="1 word"/> in the seventies for educational discourse <pause dur="0.6"/> and I-R-F stands for initiation response and feedback and if you look on your handout on the first page <pause dur="0.4"/> you will see that <pause dur="0.4"/> an initiation <pause dur="1.7"/> basically is when a speaker <pause dur="0.3"/> attempts to engage a listener <pause dur="0.7"/> and then you get a response <pause dur="0.3"/> and <pause dur="1.2"/> what's quite unusual about educational discourse is you get feedback <unclear>in</unclear> <pause dur="0.2"/> so you get the teacher evaluating <pause dur="0.4"/> the response of the pupil <pause dur="0.9"/> and this also happens according to literature in medicine <pause dur="0.2"/> so you often get <pause dur="0.2"/> a doctor <pause dur="0.2"/> evaluating what the patient has said <pause dur="0.5"/> so an example from my corpus <pause dur="0.4"/> <reading>does it hurt a bit if i <trunc>d</trunc> does it hurt if i do that <pause dur="0.2"/> does it okay good</reading> <pause dur="0.4"/> now why did the doctor say good <vocal desc="laughter" iterated="y" n="ss" dur="1"/> <pause dur="0.4"/> when <pause dur="0.6"/> when the patient said it hurt <pause dur="1.0"/> is kind of strange to me <pause dur="0.4"/> and i wondered why this would be and as i'm not a G-P nor a doctor <pause dur="0.6"/> in another specialty i don't really know why <pause dur="0.3"/> a doctor would say good <pause dur="0.3"/> when a patient had said i've got pain <pause dur="0.7"/> but maybe he has a reassuring technique i'm not sure so and i'd

be interested to know what people think afterwards <pause dur="1.5"/> what i've tried to do then <pause dur="0.5"/> is <pause dur="0.9"/> categorize <pause dur="0.8"/> <trunc>c</trunc> the communication into exchanges <pause dur="0.6"/> okay which are basically <pause dur="0.9"/> communicative function <pause dur="0.4"/> and each new initiation <pause dur="0.2"/> is also a new exchange <pause dur="0.2"/> so every time you have a new <pause dur="0.2"/> initiation in a consultation <pause dur="0.4"/> it's a new exchange <pause dur="0.5"/> and i've come up with eight categories which i've also put <pause dur="0.3"/> on your handout <pause dur="1.0"/> # i think most of them are self-explanatory <pause dur="0.4"/> # <pause dur="0.8"/> informing exchanges are when <pause dur="0.2"/> the doctor or the patient gives information <pause dur="0.4"/> checking exchanges <pause dur="0.6"/> usually when the doctor usually is checking to make sure the patient's understood <pause dur="0.3"/> but sometimes the patient will initiate a check <pause dur="0.5"/> to make sure they have understood the doctor correctly <pause dur="0.7"/> directing exchanges <pause dur="0.3"/> that's when <pause dur="0.5"/> usually the doctor is <pause dur="0.5"/> giving a direction to the patient to <trunc>facili</trunc> to facilitate diagnosis so would you please take your shirt off for example <pause dur="1.4"/> advice exchanges <pause dur="0.4"/> usually when the doctor is talking about <pause dur="0.3"/> prescribing you

know i want you to take this <pause dur="0.5"/> once a day twice a day <pause dur="0.3"/> and so on <pause dur="1.9"/> okay <pause dur="0.7"/> could you move on to the next slide </u><u who="nm0341" trans="overlap"> sure </u><u who="nm0342" trans="overlap"> thanks <gap reason="name" extent="1 word"/> <pause dur="0.7"/> okay <pause dur="0.7"/><kinesic desc="changes slide" iterated="n" n="nm0341"/> so my main question for my PhD is why do patients initiate <pause dur="1.5"/> but we're also videotaping the consultations because <pause dur="0.2"/> from pilot studies of audio data <pause dur="0.4"/> we realized we were missing an awful lot <pause dur="0.3"/> of what was happening because a lot of the <pause dur="0.6"/> responses <pause dur="0.2"/> are non-verbal <pause dur="1.0"/> so in some cases we had lots of initiations by the doctor <pause dur="0.3"/> but there didn't seem to be a response <pause dur="0.3"/> so we had to assume therefore that the <pause dur="0.2"/> response was a non-verbal one that the audio tape didn't pick up <pause dur="0.5"/> so we're videotaping for that reason <pause dur="0.8"/> we're also combining this with a patient enablement instrument <pause dur="0.6"/> to see <pause dur="0.2"/> if <pause dur="0.5"/> there are certain exchange categories <pause dur="0.3"/> that influence high enablement scores so we're using John Howie's patient enablement instrument <pause dur="0.4"/> for that purpose <pause dur="0.3"/> because most <pause dur="0.5"/> discourse analysis studies <pause dur="0.2"/> are

based <pause dur="0.3"/> just on observation <pause dur="0.2"/> we don't actually use a measure of satisfaction <pause dur="1.1"/> okay <pause dur="0.6"/> we're also using this technique for <pause dur="0.2"/> a few other projects <pause dur="0.5"/> i've done a comparison of general practice with simulated emergency medicine <pause dur="0.3"/> consultations <pause dur="0.4"/> and what was interesting there <pause dur="0.9"/> we found <pause dur="0.6"/> for closed questions <pause dur="0.2"/> that in emergency medicine <pause dur="0.2"/> the doctors tended to stack <pause dur="0.2"/> the closed questions ones for the <pause dur="0.2"/> one on top of the other <pause dur="0.4"/> and they didn't wait for the patient to respond <pause dur="0.6"/> so they may have they may have asked four questions <pause dur="1.2"/> and <pause dur="0.2"/> it was sometimes puzzling for the patient <pause dur="0.5"/> which question do i answer first <pause dur="0.4"/> and that didn't really happen in general practice <pause dur="0.4"/> it was much slower so i would say <pause dur="0.3"/> that in emergency medicine <pause dur="0.3"/> a consultation is far more dense <pause dur="0.4"/> you have lots more closed questions coming at flying out at a patient <pause dur="0.4"/> whereas in general practice it's often more reflective <pause dur="1.5"/> we've also used this technique for evaluation of undergraduate role play <pause dur="0.6"/> and finally <pause dur="0.4"/> we've just finished a project to do with

evaluation of training interventions for early intervention in psychoses <pause dur="0.8"/> # <pause dur="0.5"/> which is interesting too <pause dur="0.5"/> # if you have any questions i'll <pause dur="0.2"/> i'll answer them afterwards and that's it <pause dur="0.2"/> thanks <gap reason="name" extent="1 word"/> <pause dur="1.0"/> cheers </u><pause dur="1.2"/> <u who="nm0341" trans="pause"> thank you <unclear>again</unclear> </u><pause dur="1.9"/> <u who="nm0338" trans="pause"> thanks very much could i bring <gap reason="name" extent="1 word"/> back to the front as well 'cause i'm sure there'll be lots of questions for <pause dur="0.8"/> the three of you assembled <pause dur="0.4"/> or individually </u><u who="nm0342" trans="latching"> sorry can i sit <shift feature="voice" new="laugh"/>down <shift feature="voice" new="normal"/><vocal desc="laughter" iterated="y" dur="1"/> </u><u who="nm0341" trans="latching"> of course you can </u><u who="nm0341" trans="overlap"> <vocal desc="laughter" iterated="y" n="ss" dur="3"/> <shift feature="voice" new="laugh"/>no it's all right i'll take that chair <vocal desc="laughter" iterated="y" dur="2"/><shift feature="voice" new="normal"/> </u><u who="nf0340" trans="overlap"> give the patient the chair </u><pause dur="1.5"/> <u who="nm0338" trans="pause"> would any of you like to to to lead off with a <pause dur="0.8"/> a question </u><pause dur="4.1"/> <u who="nm0343" trans="pause"> <gap reason="name" extent="1 word"/> can i take you up for that <pause dur="0.5"/> # part i raised <pause dur="0.4"/> in during your talk sorry to

interrupt you there <pause dur="0.6"/> but if you teach people separately <pause dur="0.4"/> # <pause dur="0.6"/> there are studies to show if you teach <pause dur="0.4"/> females separately and males females <pause dur="0.7"/> do better than male students </u><u who="nf0340" trans="overlap"> yes </u><u who="nm0343" trans="overlap"> this is at high school level </u><u who="nf0340" trans="latching"> there's a lot of parallels in education yeah </u><u who="nm0343" trans="overlap"> right in # <trunc>n</trunc> now what is <trunc>go</trunc> what is <pause dur="0.5"/> what do i say going wrong <pause dur="0.5"/> i think the females are superior class of beings i definitely <vocal desc="laughter" iterated="y" n="ss" dur="2"/> have no doubt about that <pause dur="0.4"/> but why does it happen does it <trunc>wh</trunc> what what's the microanatomy behind it why is it student you know female students are <pause dur="0.7"/> perform we find that our housemen <pause dur="0.3"/> student # female students do better than our male </u><u who="nf0340" trans="latching"> mm-hmm </u><u who="nm0343" trans="latching"> now what what is the <pause dur="0.9"/> </u><u who="nf0340" trans="pause"> well </u><u who="nm0343" trans="overlap"> what do you find in your research </u><u who="nf0340" trans="latching"> i i i mean i've run into i mean <pause dur="0.6"/> my my my my actual hard

research is is looking at really <pause dur="0.3"/> is looking at the numbers and looking at the statistics <pause dur="0.4"/> i <trunc>haven</trunc> i i i'm not an expert on <pause dur="1.5"/> some of the clinical factors that lie behind gender gender performance <pause dur="0.5"/> i have a i have a theory from having looked around at other educational sources like # <pause dur="0.3"/> recent government studies on <pause dur="0.6"/> school performance <pause dur="0.4"/> i have a theory that <pause dur="0.2"/> with # # <pause dur="0.4"/> girls maturing faster and apply themselves at an earlier age <pause dur="0.3"/> to learning perhaps in a way that some of their male peers don't and that may continue into higher education <pause dur="0.6"/> but i think we have to be a little bit careful about making generalizations because <pause dur="0.4"/> what we have here <pause dur="0.3"/> is evidence that female students <pause dur="0.3"/> are scoring higher <pause dur="0.2"/> in a communication skills tests <pause dur="0.2"/> than their male colleagues <pause dur="0.3"/> and that's usually by a margin of <pause dur="0.2"/> one-and-a-half to two-and-a-half marks <pause dur="0.6"/> out of a hundred <pause dur="1.0"/> across the board <pause dur="1.4"/> what we don't have yet but i'm collecting is comparative data and what i'd like to know is are those same female students <pause dur="0.7"/>

performing <pause dur="0.9"/> better on machine marked tests <pause dur="0.7"/> or might we find that this is a particular style of examination <pause dur="0.6"/> that suits our female students and there are other areas of the test <pause dur="0.2"/> like audit where perhaps our male students are doing better <pause dur="0.4"/> so what this has sparked off for me as a single result <pause dur="0.6"/> is the need to do <pause dur="0.3"/> a load of comparative studies around voices and around other areas of the curriculum <pause dur="0.5"/> to try and provide the data <pause dur="1.0"/> that you're talking about <pause dur="0.6"/> i mean there's all sorts of speculation could be made as to <pause dur="0.4"/> why the girls do better in this situation <pause dur="0.7"/> it may be because it's just a <pause dur="0.4"/> a situation where they're they're being # # # assessed on a number of skills simultaneously <pause dur="0.5"/> and that perhaps some of our female students find it easier to <pause dur="0.2"/> think about a number of things consecutively <pause dur="0.6"/> i read # i <pause dur="0.2"/> read something by a psychologist suggesting <pause dur="0.4"/> that men are much more focused in their thinking <pause dur="0.3"/> that women perhaps are more apt at multitasking <pause dur="1.1"/> that's one view <pause dur="1.8"/> i

don't have # i mean i i don't think myself or any psychiatrist or psychologist or commissioner in the country can give a definite answer to <pause dur="0.7"/> why has this female student done better at this task than this male student <pause dur="0.9"/> what we have got is evidence that it's happening and and what we're realizing is that it's important <pause dur="0.4"/> to find out what teaching and learning methods are suiting which groups of students <pause dur="0.3"/> so that we can make sure that we're offering an appropriate range <pause dur="0.5"/> of teaching and testing methods <pause dur="0.2"/> to give all our students the chance of being the best that they possibly can be </u><pause dur="2.9"/> <u who="nm0341" trans="pause"> hello </u><u who="nm0344" trans="latching"> can i ask <gap reason="name" extent="1 word"/> about # <pause dur="0.5"/> the way you tried to map the consultation </u><pause dur="0.4"/> <u who="nm0342" trans="pause"> mm-hmm </u><u who="nm0344" trans="overlap"> the process itself <pause dur="0.2"/> i mean you say it's very useful as a reflecting which i agree but how complicated is to map that <pause dur="0.7"/> sort of chart </u><pause dur="0.2"/> <u who="nm0342" trans="pause"> # it's very time-consuming because </u><u who="nm0344" trans="overlap"> <gap reason="inaudible" extent="1 sec"/> it is mm </u><u who="nm0342" trans="latching">

you have to sort of every utterance you have to give <pause dur="0.3"/> a category to <pause dur="0.6"/> # <pause dur="1.0"/> and it takes and what i tend to do is i code <pause dur="0.9"/> a consultation on one day <pause dur="0.3"/> and then i will leave it two weeks and then i will code it again <pause dur="0.3"/> on a blank piece of paper and compare the two <pause dur="1.2"/> # so i so i try to get some kind of reliability in my coding system and then i also ask other people to code <pause dur="0.3"/> as well </u><pause dur="0.6"/> <u who="nm0344" trans="pause"> so <pause dur="0.5"/> i'm just thinking about one other function that your </u><u who="nm0342" trans="overlap"> okay </u><u who="nm0344" trans="overlap"> your unit uses for poorly perform <pause dur="0.5"/> doctor </u><pause dur="0.5"/> <u who="nf0340" trans="pause"> yes </u><u who="nm0344" trans="latching"> # yeah <pause dur="0.5"/> so if i got a poorly perform doctor </u><u who="nm0342" trans="overlap"> mm-hmm </u><u who="nm0344" trans="overlap"> i want to look at his communication </u><u who="nm0342" trans="latching"> yeah </u><pause dur="0.2"/> <u who="nm0344" trans="pause"> or consultation skills one of the aspect <pause dur="1.2"/> you will have <pause dur="0.5"/> one person look at the consultation yourself chart it and then leave it for a couple of weeks then another person to chart it <pause dur="0.2"/> and then reflect it back to the doctor </u><u who="nm0342" trans="overlap">

# i don't </u><u who="nm0344" trans="overlap"> i just wonder how complicated the process </u><u who="nm0342" trans="overlap"> i don't use the i don't i haven't used my <pause dur="0.5"/> the system for # to rate a poorly performing doctor </u><pause dur="0.2"/> <u who="nm0344" trans="pause"> okay <pause dur="0.2"/> # </u><u who="nm0342" trans="overlap"> # </u><pause dur="0.3"/> <u who="nm0344" trans="pause"> but you can apply <unclear>all it</unclear> <pause dur="0.2"/> <gap reason="inaudible due to overlap" extent="2 secs"/></u> <u who="nm0342" trans="pause"> yeah i'm i'm i'm sure there has i'm sure there is an application then yes <pause dur="0.3"/> # <pause dur="0.9"/> it's i mean this form of discourse analysis is quite well known in educational circles and can be taught to <pause dur="0.5"/> to people quite easily </u><pause dur="0.3"/> <u who="nm0344" trans="pause"> so people can easily learn how to do this </u><u who="nm0342" trans="overlap"> # i i think probably with # <pause dur="1.2"/> gosh a day training they'd be able to code quite <pause dur="0.3"/> do simple coding yes </u><pause dur="0.2"/> <u who="nm0344" trans="pause"> because particular for poorly perform doctor i find <pause dur="0.3"/> is actually make them <pause dur="0.4"/>

appreciate they're poorly <shift feature="voice" new="laugh"/>performing <shift feature="voice" new="normal"/> </u><pause dur="0.2"/> <u who="nm0342" trans="pause"> mm </u><pause dur="0.3"/> <u who="nm0344" trans="pause"> # </u><u who="nm0342" trans="overlap"> <unclear>well it's</unclear> <pause dur="0.2"/> yeah </u><u who="nm0344" trans="overlap"> if you can have this sort of scoring system it's much easier to for them to look at yes i didn't do very well <pause dur="0.3"/> rather than than you know <pause dur="0.3"/> subjectively somebody criticizing </u><u who="nm0342" trans="overlap"> one <pause dur="0.2"/> one problem i've noticed with <pause dur="0.3"/> this system <pause dur="0.4"/> is that <pause dur="0.5"/> it's very initiation focused <pause dur="0.4"/> it's it focuses on the initiation so the exchanges are dictated <pause dur="0.3"/> by the initiations <pause dur="0.2"/> and because <pause dur="0.3"/> in my corpus of data <pause dur="0.5"/> over eighty per cent of the initiations are made by the doctor <pause dur="0.3"/> it means the patient's voice is kind of <pause dur="0.3"/> not heard <pause dur="0.2"/> so what i'm what i'm doing now is </u><u who="nm0344" trans="overlap"> <gap reason="inaudible" extent="1 sec"/></u><u who="nm0342" trans="overlap"> going back <pause dur="0.6"/> and looking at the responses because the responses are what the patient does most of all <pause dur="0.3"/> so that's what i need to do <pause dur="0.2"/> and i'm trying to work with a framework of responses <pause dur="0.2"/> that works in the same way that a <trunc>frame</trunc> framework initations <unclear>with this</unclear> </u><u who="nm0344" trans="latching"> thank you very much </u><u who="nm0342" trans="latching"> thank you </u><u who="nf0340" trans="latching">

we do <pause dur="0.2"/> sorry can i if i just pick up very briefly on that <pause dur="0.4"/> # we do use audio recording # <trunc>w</trunc> we're referred doctors particularly when the when the difficulty's a language problem <pause dur="0.4"/> # or a verbal communication problem <pause dur="0.4"/> and # our professor <gap reason="name" extent="2 words"/> who's a a <pause dur="0.2"/> a a linguist with a lot of expertise in this area <pause dur="0.4"/> he does record consultations to play back to <pause dur="0.6"/> # doctors that are referred to us <pause dur="0.3"/> but our primary method is role play <pause dur="0.8"/> or # referred doctor coaching </u><pause dur="1.3"/> <u who="nm0345" trans="pause"> # i just wanted to ask <gap reason="name" extent="1 word"/> # <pause dur="0.6"/> the the the topic of your <event desc="stands up" iterated="n" n="nm0341"/></u><u who="nm0341" trans="overlap"> i'll stand up </u><u who="nm0345" trans="overlap"> your work is is only it's a like <trunc>n</trunc> like nothing i've ever heard before <pause dur="0.5"/> # <pause dur="0.4"/> and and i </u><u who="nm0341" trans="pause"> really <vocal desc="laughter" iterated="y" n="sl" dur="1"/> </u><u who="nm0345" trans="overlap"> <gap reason="inaudible due to overlap" extent="1 sec"/> </u><u who="nm0341" trans="overlap"> <gap reason="inaudible due to overlap" extent="1 sec"/> completely familiar with <gap reason="inaudible due to overlap" extent="1 sec"/> <pause dur="0.2"/> sorry </u><u who="nm0345" trans="overlap"> # what i was wondering is <trunc>i</trunc> is this something that is established and has been done </u><u who="nm0341" trans="overlap"> mm </u><u who="nm0345" trans="overlap"> a

great deal of or is this something that you're sort of <pause dur="0.2"/> beginning the pioneering process of <pause dur="0.8"/> and if so <pause dur="0.2"/> or or or or you know where has it been used before and for what reason </u><pause dur="0.3"/> <u who="nm0341" trans="pause"> well that's <shift feature="voice" new="laugh"/>time up <shift feature="voice" new="normal"/> isn't it <vocal desc="laughter" iterated="y" n="sl" dur="1"/> <pause dur="0.4"/> # <trunc>i</trunc> no it hasn't <pause dur="0.3"/> is the answer to your question the # <trunc>whe</trunc> where i'm where i'm at with this is <pause dur="2.6"/> <trunc>th</trunc> the short answer to your question is that visualization of <pause dur="0.3"/> consultations in the kind of way that i'm doing that's a radar graph in Excel it's nothing more complex than that but visualization of consultations is not something that appears to be regular in the literature <pause dur="0.6"/> if it is it's looked at in quite a different way it's bandings around which particular clinical areas are being picked up <pause dur="1.1"/> my journey to reach the point that i'm at at the moment is an interest in complexity theory which is the <trunc>i</trunc> which which is an idea that <pause dur="1.0"/> very briefly the sum of a whole bunch of entities a whole

bunch of individual things put together <pause dur="1.2"/> gives you a whole and that whole is far greater than the sum of its parts now that to me is a human interaction <pause dur="1.1"/> finding a way back from that <pause dur="0.4"/> is trying to find a way that is meaningfully representative rather than me standing here and saying to you oh no it's very important because of this this this and this <pause dur="0.3"/> it's finding a diagrammatical representation that's fast and easy to use <pause dur="0.4"/> the traditional measurement of that representation <pause dur="0.4"/> within <pause dur="0.2"/> complexity theory which is what's underpinning my feeling about how <pause dur="1.0"/> discourse works <pause dur="0.8"/> what # traditionally underpins that is <pause dur="0.3"/> a series of <trunc>mes</trunc> mathematical measurements of which fractals is one <pause dur="0.9"/> it's a <trunc>hap</trunc> it's a happy circumstance that you can measure the irregularity <pause dur="0.5"/> of something that is travelling through different types of contexts <pause dur="0.5"/> visually <pause dur="0.3"/> and then pick up a measurement that expresses <pause dur="0.2"/> philosophically <pause dur="0.8"/> its complexity and irregularity which i think is what a human interaction is about

rather than a series of <pause dur="0.5"/> rather than a series of very basic exchanges <pause dur="0.3"/> as i'm saying that i'm aware <pause dur="0.5"/> of a parallel with what <gap reason="name" extent="1 word"/>'s saying but i'm looking at it in a different kind of way <pause dur="0.4"/> and that's no reflection on <pause dur="0.8"/> # on that does that sort of answer your question </u><pause dur="1.1"/> <u who="nm0345" trans="pause"> mm <pause dur="0.3"/> probably won't sleep tonight </u><u who="nm0341" trans="overlap"> but it <trunc>e</trunc> </u><u who="nm0345" trans="overlap"> but # </u><u who="nm0341" trans="overlap"> <vocal desc="laughter" iterated="y" n="sl" dur="2"/> <pause dur="0.4"/> well taped it and # <pause dur="0.2"/> <vocal desc="laughter" iterated="y" n="nm0345" dur="1"/> i mean but no it's a but but no i don't think anything quite like it has been done and i think that's one of the things that <pause dur="0.2"/> one of the things that A makes it very interesting to me but B makes it extraordinarily difficult </u><pause dur="0.4"/> <u who="nm0345" trans="pause"> mm </u><u who="nm0341" trans="overlap"> within the health professionals' culture to describe it because it's largely qualititative <pause dur="0.4"/> in terms of where it's going <pause dur="0.3"/> with a quantitative output <pause dur="1.4"/> so it's a it's it's quite difficult to match the two things together really </u><pause dur="0.7"/> <u who="nm0338" trans="pause"> # <trunc>g</trunc> i was just going to say can we just have two more questions <gap reason="name" extent="1 word"/> and # <gap reason="name" extent="1 word"/> <pause dur="0.2"/> is that

all right </u><u who="nm0346" trans="latching"> i think that maybe the talk alluded to this anyway but sort of <pause dur="0.3"/> an extension of <gap reason="name" extent="1 word"/>'s point i think is <pause dur="0.4"/> do you <trunc>ev</trunc> envisage a problem with what you're doing really is you're you're <trunc>men</trunc> you're <pause dur="0.5"/> coming out with some very theoretical results about communication </u><u who="nm0341" trans="overlap"> absolutely </u><pause dur="0.6"/> <u who="nm0346" trans="pause"> do you envisage a problem with actually transferring that back into <pause dur="0.6"/> # i mean what are you going to do with your results apart from saying this here's the theory this is very interesting but what in real terms a doctor's going to do when you say that to him 'cause it's all so theoretical <pause dur="0.4"/> do you see a problem with going back into <pause dur="0.8"/> practical side <gap reason="inaudible" extent="1 sec"/> </u><u who="nm0341" trans="overlap"> i don't i don't don't see a problem with going back into it really because it's it's around where it's around where the diagrams are coming from because <pause dur="0.3"/> the key to the key to it is and this is what where there wasn't time to explain i'll very briefly <pause dur="0.3"/> say it's based on <pause dur="0.4"/> four different

elements of a consultation which very briefly are meet and greet <pause dur="0.6"/> # patient explaining the problem <pause dur="0.2"/> doctor exploring the <trunc>plob</trunc> <pause dur="0.2"/> problem <pause dur="0.4"/> and consultation resolution so where are we going so which <pause dur="0.2"/> of those areas are we in <pause dur="0.4"/> visually you can tell from that graph <pause dur="0.4"/> which of those contexts the consultation spends most of its time in <pause dur="0.9"/> that i think is a helpful <unclear>in</unclear> tool for self <pause dur="0.3"/> # reflection <pause dur="0.3"/> on the pilot study which has looked at thirty consultations of which those are two <pause dur="0.7"/> one of the things that has become very clear and it echoes something that <gap reason="name" extent="1 word"/> was saying about initiations <pause dur="0.3"/> is that an awful lot of time is spent in the area of the doctor exploring the problem which feels to me is kind of how it should be <pause dur="0.2"/> okay tell me a bit more about that when did the pain first start <pause dur="0.2"/> those sorts of questions where you're exploring what you've been told by the patient <pause dur="0.7"/> now what it's saying is if <pause dur="0.7"/> contextually depending on what the presenting condition is <pause dur="1.1"/> is it useful to be spending i'm not

saying is it right i'm saying is it useful to be spending as much time in that area i think at the moment it's a tool for reflection <pause dur="0.4"/> it's very very early days in developing the idea because as <gap reason="name" extent="1 word"/>'s just <pause dur="0.3"/> pointed out <shift feature="voice" new="mimicking an other's voice"/><gap reason="inaudible" extent="1 sec"/> done it <shift feature="voice" new="normal"/> <pause dur="0.5"/> so <pause dur="0.4"/> i i can't say further than that but that's the way the thinking's going and i do think it has a practical application in terms of coding the data <pause dur="0.3"/> that can be done very quickly and again it would be a fast training process because you're not looking at <pause dur="0.3"/> an eighty-five point hierarchy or whatever the <unclear>calibre of</unclear> scale is in terms of marking up a transcript <pause dur="0.6"/> does that <pause dur="0.3"/> <trunc>m</trunc> sort of make sense </u><pause dur="0.5"/> <u who="nm0346" trans="pause"> thank you </u><pause dur="1.8"/> <u who="nm0347" trans="pause"> # it's not precisely a question but i hope in some ways it's an answer to your question <pause dur="1.0"/> communication skills of course are only one domain <pause dur="0.2"/> of consultation skills </u><u who="nm0341" trans="overlap"> absolutely </u><u who="nm0347" trans="latching">

and <pause dur="0.6"/> my experience with undergraduates # at <gap reason="name" extent="1 word"/> is that the domain our students third and fourth year students struggle with most is in their problem solving <pause dur="0.4"/> so it's the cognitive aspects of the consultation </u><u who="nm0341" trans="overlap"> mm-hmm </u><pause dur="0.3"/> <u who="nm0347" trans="pause"> and <pause dur="0.4"/> what limited work i've done with <pause dur="0.3"/> # <pause dur="0.4"/> qualified doctors also <pause dur="0.3"/> i think that applies too <pause dur="0.3"/> so when consultations go wrong <pause dur="0.3"/> i think it <trunc>o</trunc> it often is rooted <pause dur="0.4"/> in the problem solving <pause dur="0.8"/> and <pause dur="0.2"/> it <pause dur="0.7"/> so i think <pause dur="0.8"/> that's why it's sometimes quite difficult for non-commissions to evaluate what's happening in the consultation </u><u who="nm0341" trans="latching"> absolutely </u><u who="nm0347" trans="overlap"> which is why i have the immediate answer to your question the reason why the doctor says oh good <pause dur="0.4"/> is because at the point <pause dur="0.4"/> that the information he gathered the fact it hurt then <pause dur="0.2"/> helped him confirm his diagnostic reasoning at that point <pause dur="0.3"/> so what he's saying is oh good i now know what the diagnosis is </u><u who="nm0341" trans="latching"> mm-hmm </u><u who="nm0347" trans="overlap"> not oh good i've hurt you <pause dur="0.5"/> # and it's i think

it's the fact that all of this happens in an integrated way <pause dur="0.5"/> makes it i mean it's a particular skill </u><u who="nm0341" trans="overlap"> mm </u><u who="nm0347" trans="overlap"> analysing <pause dur="0.3"/> anybody's consultation skills </u><u who="nm0341" trans="overlap"> absolutely </u><u who="nm0347" trans="overlap"> because <pause dur="0.2"/> in a sense you have to have an equal level of skill if not higher <pause dur="0.3"/> in order to make those kind of judgements <pause dur="0.7"/> and <pause dur="0.3"/> certainly i think <pause dur="0.4"/> that's you know where most undergraduates <pause dur="0.3"/> # are really struggling <pause dur="0.4"/> # </u><u who="nf0340" trans="overlap"> yeah i think that's really interesting i'm <pause dur="0.3"/> thinking what you're saying </u><u who="nm0341" trans="overlap"> mm </u><u who="nf0340" trans="overlap"> might link in to this this this thing we're finding about <pause dur="0.3"/> the communication marks for the students varying according to the content of the scenario <pause dur="0.7"/> and they're <trunc>s</trunc> definitely more confident and better at communicating <pause dur="0.4"/> when they're discussing <pause dur="0.5"/> a lifestyle </u><u who="nm0347" trans="overlap"> mm </u><u who="nf0340" trans="overlap"> issue or <pause dur="0.2"/> counselling somebody talking to somebody that's <pause dur="0.2"/> got a known long-term illness that the patient has had for a long time <pause dur="0.4"/> put them in a situation where you give them a test result <pause dur="0.3"/> and they have to interpret the

test result work out the plan of management <pause dur="0.2"/> and then explain and negotiate with the patient <pause dur="0.2"/> those communication marks are poorer </u><pause dur="0.2"/> <u who="nm0347" trans="pause"> yeah </u><pause dur="0.4"/> <u who="nf0340" trans="pause"> and i i'm i'm i'm thinking what you've said is </u><u who="nm0347" trans="overlap"> <gap reason="inaudible" extent="1 sec"/></u><u who="nf0340" trans="overlap"> very interesting and perhaps </u><u who="nm0347" trans="latching"> mm </u><u who="nf0340" trans="overlap"> looking at that in terms # i'm going to revisit those questions <pause dur="0.3"/> and actually think about what you've said and revisit them in terms of <pause dur="0.5"/> are the lower scoring questions more heavily based in problem solving than the higher scoring questions <pause dur="0.9"/> and if i find that i shall give you a ring 'cause i shall <shift feature="voice" new="laugh"/>want to talk to you about that some more <vocal desc="laughter" iterated="y" dur="1"/><shift feature="voice" new="normal"/></u><u who=" nm0347" trans="overlap"> <shift feature="voice" new="laugh"/> absolutely <shift feature="voice" new="normal"/><pause dur="0.6"/> i mean we have <pause dur="0.4"/> what we've done in our in i don't know i don't know if you know how <gap reason="name" extent="1 word"/> assesses its students in the Clinical Methods course but what we have got is a

wealth of data <pause dur="0.4"/> because we actually code what their strengths and weaknesses are </u><u who="nf0340" trans="overlap"> mm </u><pause dur="0.2"/> <u who="nm0347" trans="pause"> and <pause dur="0.4"/> we so over about six-hundred seven-hundred <pause dur="0.2"/> assessments we now know <pause dur="0.3"/> what <pause dur="0.2"/> <gap reason="name" extent="1 word"/> # <pause dur="0.2"/> and some <gap reason="name" extent="1 word"/> students do well and do less well <pause dur="0.3"/> and problem solving is usually where they struggle </u><u who="nf0340" trans="overlap"> mm </u><pause dur="0.3"/> <u who="nm0347" trans="pause"> and certainly <pause dur="0.5"/> my anecdotal experience is that <pause dur="0.2"/> that if the student doesn't really know what the diagnosis is <pause dur="0.3"/> their scores on management are going to be quite low </u><u who="nf0340" trans="latching"> yeah </u><u who="nm0347" trans="latching"> # </u><u who="nm0341" trans="latching"> is that awaiting publication or <gap reason="inaudible due to overlap" extent="1 sec"/> </u><u who="nm0347" trans="overlap"> # hopefully yes </u><pause dur="0.4"/> <u who="nm0341" trans="pause"> i was going to say <trunc>c</trunc> 'cause <trunc>th</trunc> that would be very interesting would be <pause dur="0.2"/> very interested to </u><u who="nm0347" trans="overlap"> yeah </u><u who="nm0341" trans="overlap"> see that seriously if you would send <gap reason="inaudible" extent="1 sec"/> </u><u who="nm0347" trans="overlap"> yeah <pause dur="0.2"/> i mean we have a sense that within this huge mass of data because most students end up with about ten or fifteen codes for which they're either strengths or weaknesses </u><u who="nm0341" trans="overlap"> yeah </u><pause dur="0.4"/> <u who="nm0347" trans="pause">

# that we may be able to identify patterns of strengths and weakness amongst students so you might identify the student as a poor problem solver <pause dur="0.3"/> but who has quite good communication skills </u><u who="nm0341" trans="overlap"> yeah </u><pause dur="0.2"/> <u who="nm0347" trans="pause"> and you might have a student whose basic problems lie perhaps more in in in interviewing and history taking they're just so bad at talking to people </u><pause dur="0.3"/> <u who="nf0340" trans="pause"> mm-hmm </u><u who="nm0347" trans="overlap"> the information they get back is rubbish <pause dur="0.3"/> and so <pause dur="0.2"/> you know </u><pause dur="1.2"/> <u who="nf0340" trans="pause"> yeah absolutely </u><u who="nm0341" trans="overlap"> that's right thanks very much </u><pause dur="0.6"/> <u who="nf0340" trans="pause">

and # if i reiterate what <gap reason="name" extent="1 word"/> said about thank you for having us today it's been a </u><u who="nm0341" trans="overlap"> yeah it's lovely </u><u who="nf0340" trans="overlap"> a really interesting day so far and we look forward to the rest of it </u><pause dur="0.4"/> <u who="nm0338" trans="pause"> thank you very much <pause dur="5.9"/> <kinesic desc="applause" iterated="y" n="ss" dur="5"/><vocal desc="laughter" iterated="y" n="ss" dur="1"/> one of the things that we hope will come out of today is that we've sparked some collaborative <pause dur="0.4"/> initiatives <pause dur="0.5"/> because the way we teach students <pause dur="0.6"/> at <gap reason="name" extent="1 word"/> and <gap reason="name" extent="1 word"/> <pause dur="0.2"/> in relation to the consultation is obviously different to <pause dur="0.4"/> or slightly different to what happens at <gap reason="name" extent="1 word"/> so <pause dur="0.7"/> i'm <pause dur="0.4"/> i hope we've sowed those seeds of <pause dur="0.2"/> collaboration and we'll be able to to take those forward

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