The reciprocal nature of trust in bedside teaching encounters
The objective of this chapter is to explore a broad and liberal conception of trust as manifest in bedside teaching encounters (BTEs) in which medical students learn with, from and about patients. Adopting an ethnomethodological conception of trust, it is postulated that trust, as a practical phenomenon, revolves around parties within a clinical setting sharing a mutual intelligibility of action and orienting to a world-known-in-common that provides the interactional resources to enable the mutual accomplishment of the medical encounter (Garfinkel 1963; 1967; Watson 2009; Schegloff 1992; Sacks 1995). The standard medical encounter between doctor and patient constitutes an experience that they routinely and recurrently enact. As a result it is reasonable to postulate that on any given instance of a medical interaction the different parties have a shared understanding as to the social roles that are being fulfilled by themselves and others. However, the presence of a medical student is not necessarily an intrinsic feature of medical encounters. Therefore a fruitful avenue of analysis is to explore how the triadic interaction between doctor-patient-student involves a modification of the interactional format and organisation of medical encounters. It is also critical to consider how the expectations and roles of the participants are negotiated, enacted and transformed, in the midst of the pursuit of patient health and wellbeing. The primary mode of enquiry has been video ethnography in conjunction with a linguistic ethnographic analytic mentality (Heath et al. 2010; Pink 2007). In short our data consists of video recordings of bedside teaching encounters (n=34, ongoing; mean average per encounter 23 minutes; approximate total recording time 788 minutes) in a variety of clinical settings (e.g. general practice surgeries, hospital wards, outpatient clinics) encompassing a range of clinical specialties (e.g. GP, paediatrics, geriatrics, and general surgery and medicine). The thrust of the analytic interests reside in understanding the dynamics that are constituted within the triadic interactions between doctor-patient-student and focalises the pivotal role that the student plays within BTEs whether as an observer or active participant.
Citation : Elsey, C., Monrouxe, L.V. and Grant, A. (2014) The reciprocal nature of trust in bedside teaching encounters. In: PELSMAEKERS, K., JACOBS, G. & ROLLO, C. (eds.) Trust and Discourse : Organizational Perspectives. Amsterdam: John Benjamins. pp. 45-70
ISBN : 9789027206473
Research Institute : Institute for Allied Health Sciences Research
Peer Reviewed : Yes