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Communication and Medicine

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What healthcare students do with what they don't know: The socializing power of ‘uncertainty’ in the case presentation

Marlee M Spafford / Catherine F Schryer / Lorelei Lingard / Patricia K Hrynchak
Published Online: 2006-06-19 | DOI: https://doi.org/10.1515/CAM.2006.008


Healthcare students learn to manage clinical uncertainty amid the tensions that emerge between clinical omniscience and the ‘truth for now’ realities of the knowledge explosion in healthcare. The case presentation provides a portal to viewing the practitioner's ability to manage uncertainty. We examined the communicative features of uncertainty in 31 novice optometry case presentations and considered how these features contributed to the development of professional identity in optometry students. We also reflected on how these features compared with our earlier study of medical students' case presentations. Optometry students, like their counterparts in medicine, displayed a novice rhetoric of uncertainty that focused on personal deficits in knowledge. While optometry and medical students shared aspects of this rhetoric (seeking guidance and deflecting criticism), optometry students displayed instances of owning limits while medical students displayed instances of proving competence. We found that the nature of this novice rhetoric was shaped by professional identity (a tendency to assume an attitude of moral authority or defer to a higher authority) and the clinical setting (inpatient versus outpatient settings). More explicit discussions regarding uncertainty may help the novice unlock the code of contextual forces that cue the savvy member of the community to sanctioned discursive strategies.

Keywords: clinical uncertainty; case presentation; professional identity; professional socialization; optometry vs. medical students

About the article

Marlee M Spafford

Marlee M. Spaord is an Optometrist, an Associate Professor at the University of Waterloo School of Optometry, a Fellow of the American Academy of Optometry, and a core member of the Waterloo Institute for Health Informatics Research. Her research program investigates aspects of healthcare professional education, communication, socialization, and equity.

Catherine F Schryer

Catherine F. Schryer is a rhetorician, an Associate Professor at the University of Waterloo Department of English, Language and Literature and a core member of the Waterloo Institute for Health Informatics Research. Her research interests involve investigating genres or text types in specific social contexts, combing textual analysis with qualitative data-gathering techniques.

Lorelei Lingard

Lorelei Lingard is a rhetorician, an Associate Professor in the Departments of Pediatrics and Health Policy, Management, and Evaluation, and an educational scientist in the University of Toronto's Wilson Centre for Research in Education. Her research program explores team communication patterns as they impact on novice socialization and patient safety.

Patricia K Hrynchak

Patricia K. Hrynchak is an Optometrist, a Lecturer at the University of Waterloo, School of Optometry and a Fellow of the American Academy of Optometry. Her research interests include healthcare professional communication and clinical competence evaluation.

1Address for correspondence: University of Waterloo, School of Optometry, Waterloo, Ontario, N2L 3G1, Canada.

Published Online: 2006-06-19

Published in Print: 2006-05-01

Citation Information: Communication & Medicine, Volume 3, Issue 1, Pages 81–92, ISSN (Online) 1613-3625, ISSN (Print) 1612-1783, DOI: https://doi.org/10.1515/CAM.2006.008.

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