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Communication and Medicine

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Negotiating frame ambiguity: A study of simulated encounters in medical education

Clive Seale / Christopher C Butler / Ian Hutchby / Paul Kinnersley / Stephen Rollnick
Published Online: 2007-12-04 | DOI: https://doi.org/10.1515/CAM.2007.021


We report an investigation of the sociolinguistic characteristics of simulated encounters (role plays) in medical education, focusing in particular on frame negotiation. The role played by context in influencing the nature of out-of-frame activity is noted through comparison with another published study of simulations (Linell and Thunqvist 2003). While in general sustaining a role-playing frame that involved an orientation to exact mimicry of clinical situations, the interactional work done to sustain this appearance of ‘authenticity’ at certain moments was revealed by out-of-frame utterances. One participating doctor in particular used humor to exploit the ambiguous realism of the role-playing frame. The success of this doctor in acquiring and applying new communication behaviors problematizes the view that ‘realism’, achieved through mimicry, is solely responsible for the success of training interventions. The implications for studying other kinds of simulated encounters, including an outline for a program of research into the sociolinguistics of acting tasks in general, are outlined. Sociolinguistic researchers involved in observational studies of talk would benefit from adopting the view that role-played, rehearsed, and even scripted talk of the sort used in dramatic performance is a variety of naturally occurring data and therefore worthy of study.

Keywords: medical education; simulations; role play; frames; conversation analysis; discourse analysis

About the article

Clive Seale

Clive Seale is Professor, School of Social Sciences, Brunel University, West London, UK. He is author of The Quality of Qualitative Research (Sage, 1999), Media and Health (Sage, 2003), and co-editor (with David Silverman, Jaber Gubrium, and Giampietro Gobo) of Qualitative Research Practice (Sage, 2004). Recent articles have appeared in Body and Society, British Medical Journal, Health, Journal of Advanced Nursing, Palliative Medicine, Social Science and Medicine, Sociology of Health and Illness.

Christopher C Butler

Christopher Butler is head of the Department of General Practice at Cardiff University. He has a major research interest in the management of common infections in primary care, with involvement in treatment trials, cohort studies of clinical outcomes, description of natural history, qualitative research on antibiotic prescribing, and observation studies of clinician–patient interaction. He has been the PI or co-applicant on relevant grants from the Medical Research Council, Wellcome Foundation, and leads the clinical platform of a EU-Funded Network of Excellence.

Ian Hutchby

Ian Hutchby is Professor, Department of Sociology, University of Leicester. He is author of Conversation Analysis and the Study of Broadcasting (Open University Press, 2006), Children, Technology and Culture (Routledge-Falmer, 2001, with J. Moran-Ellis), and Conversation Analysis. (Polity Press, 1998, with R. Wooffitt). Recent articles have appeared in Sociology, Discourse and Society, Discourse Studies, Research on Language and Social Interaction, Children and Society.

Paul Kinnersley

Paul Kinnersley is Reader in the Department of General Practice at Cardiff University and a general practitioner in Cardiff. Throughout his career he has worked with actors, initially to train and assess medical students but more recently to evaluate the quality of care provided in clinical settings. He has studied consultations in hospital and primary-care settings with particular emphasis on patient-centered care. Recent publications have appeared in Medical Education and the British Journal of General Practice.

Stephen Rollnick

Stephen Rollnick is a clinical psychologist and Professor of Healthcare Communication in the Department of General Practice at Cardiff University. He was a practicing psychologist in the UK National Health Service for 16 years, and then became a teacher and researcher on the subject of communication. He has written books on Motivational Interviewing and Health Behaviour Change and has a special interest in challenging consultations in hospital and primary-care settings. He has published widely in scientific journals and has taught practitioners in many countries and continents.

*Address for correspondence: School of Social Sciences, Brunel University, Uxbridge, Middlesex UB8 3PH.

Published Online: 2007-12-04

Published in Print: 2007-10-26

Citation Information: Communication & Medicine, Volume 4, Issue 2, Pages 177–187, ISSN (Online) 1613-3625, ISSN (Print) 1612-1783, DOI: https://doi.org/10.1515/CAM.2007.021.

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