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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

11 / Catherine F Schryer2 / Lorelei Lingard3 / Patricia K Hrynchak4





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

Citation Information: Communication & Medicine. Volume 3, Issue 1, Pages 81–92, ISSN (Online) 1613-3625, ISSN (Print) 1612-1783, DOI: 10.1515/CAM.2006.008, June 2006

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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

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