Team talk and team decision processes: a qualitative discourse analytical approach to 10 real-life medical emergency team encounters.

OBJECTIVES: Explore the function of three specific modes of talk (discourse types) in decision-making processes. DESIGN: Ten real-life admissions of patients with critical illness were audio/video recorded and transcribed. Activity-type analysis (a qualitative discourse analytical method) was applied. SETTING: Interdisciplinary emergency teams admitting patients with critical illness in a Norwegian university hospital emergency department (ED). PARTICIPANTS: All emergency teams consisted of at least two internal medicine physicians, two ED nurses, one anaesthetist and one nurse anaesthetist. The number of healthcare professionals involved in each emergency team varied between 11 and 20, and some individuals were involved with more than one team. RESULTS: The three discourse types played significant roles in team decision-making processes when negotiating meaning. Online commentaries (ONC) and metacommentaries (MC) created progression while offline commentaries (OFC) temporarily placed decisions on hold. Both ONC and MC triggered action and distributed tasks, resources and responsibility in the team. OFC sought mutual understanding and created a broader base for decisions. CONCLUSION: A discourse analytical perspective on team talk in medical emergencies illuminates both the dynamics and complexity of teamwork. Here, we draw attention to the way specific modes of talk function in negotiating mutual understanding and distributing tasks and responsibilities in non-algorithm-driven activities. The analysis uncovers a need for an enhanced focus on how language can trigger safe team practice and integrate this knowledge in teamwork training to improve communication skills in ad hoc emergency teams.

Team talk and team activity in simulated medical emergencies: a discourse analytical approach.

BACKGROUND: Communication errors can reduce patient safety, especially in emergency situations that require rapid responses by experts in a number of medical specialties. Talking to each other is crucial for utilizing the collective expertise of the team. Here we explored the functions of "team talk" (talking between team members) with an emphasis on the talk-work relationship in interdisciplinary emergency teams. METHODS: Five interdisciplinary medical emergency teams were observed and videotaped during in situ simulations at an emergency department at a university hospital in Norway. Team talk and simultaneous actions were transcribed and analysed. We used qualitative discourse analysis to perform structural mapping of the team talk and to analyse the function of online commentaries (real-time observations and assessments of observations based on relevant cues in the clinical situation). RESULTS: Structural mapping revealed recurring and diverse patterns. Team expansion stood out as a critical phase in the teamwork. Online commentaries that occurred during the critical phase served several functions and demonstrated the inextricable interconnections between team talk and actions. DISCUSSION: Discourse analysis allowed us to capture the dynamics and complexity of team talk during a simulated emergency situation. Even though the team talk did not follow a predefined structure, the team members managed to manoeuvre safely within the complex situation. Our results support that online commentaries contributes to shared team situation awareness. CONCLUSIONS: Discourse analysis reveals naturally occurring communication strategies that trigger actions relevant for safe practice and thus provides supplemental insights into what comprises "good" team communication in medical emergencies.

Visual Access in Interpreter-Mediated Learning Situations for Deaf and Hard-of-Hearing High School Students Where an Artifact Is in Use.

This article highlights interpreter-mediated learning situations for deaf high school students where such mediated artifacts as technical machines, models, and computer graphics are used by the teacher to illustrate his or her teaching. In these situations, the teacher's situated gestures and utterances, and the artifacts will contribute independent pieces of information. However, the deaf student can only have his or her visual attention focused on one source at a time. The problem to be addressed is how the interpreter coordinates the mediation when it comes to deaf students' visual orientation. The presented discourse analysis is based on authentic video recordings from inclusive learning situations in Norway. The theoretical framework consists of concepts of role, footing, and face-work (Goffman, E. (1959). The presentation of self in everyday life. London, UK: Penguin Books). The findings point out dialogical impediments to visual access in interpreter-mediated learning situations, and the article discusses the roles and responsibilities of teachers and educational interpreters.

Discourse types and (re)distribution of responsibility in simulated emergency team encounters.

Successful teamwork, constitutive of team talk, depends largely on shared responsibility in the coordination of tasks in a goal-oriented way. This paper examines how specific modes of talk or 'discourse types' are utilised by a healthcare team in simulated emergency care. The data corpus comprises six video-recorded simulation training sessions in an emergency department at a large Norwegian hospital. Our analysis focuses on the critical moment when the original healthcare team is joined by other specialists in an ad hoc manner, which necessitates the (re)distribution of expert responsibility in the management of the patient's condition. We examine the interactional trajectories and, in particular, the discourse types surrounding the critical moment which marks the incorporation of the new team members. The analysis centres on three discourse types (online commentary, offline commentary and metacommentary) that are utilised in accomplishing the multiple tasks in a collaborative and coordinated fashion. We suggest that team talk overlays and overlaps with distributed medical work in highly charged decision-making contexts such as emergency care. The findings have relevance for how healthcare professionals and students are trained in multidisciplinary team talk and teamwork.

The role of role-play: managing activity ambiguities in simulated doctor consultation in medical education.

This paper is concerned with simulated consultations between medical students and real patients, focusing in particular on multiple framings as they lead to activity-specific ambiguities. In these simulated consultations the misalignment of expectations between medical students and patients becomes evident in the opening and closing sequences in particular, which provides the rationale for focusing on these phases of the encounter. Transcribed video recordings were drawn from a Norwegian empirical study of simulated consultations in medical education. The analytic framework derives from a dynamic notion of activity type in conjunction with framing and hybridity. The data illustrate that agenda questions, targeted at the patient's reason for seeing the doctor, frame situations where the students had to manage ambiguities at different levels. While the medical students strive to negotiate the multi-layered frames at an implicit level, the patients negotiate the frames in a more explicit manner. There is uncertainty as to whether the role-play should be perceived as an authentic consultation, which seems to be the student's aspiration, or whether it is to be regarded as a training situation, which appears to be the patient's perception. The paper concludes by raising some issues about the role of role-play in medical education, with particular reference to communication skills training.