Scholarly Concentration in Language and Communication in Medicine

Office of Medical Education

Rhetoric is the study of the art of persuasion and argument. Aristotle and other classical philosophers believed rhetoric was essential to the study and practice of medicine. As medical education became more formalized and institutionalized during the nineteenth- and twentieth- centuries, however, examinations of rhetoric's relationship to medicine and medical communication fell out of favor. Beginning in the late 1990's, however, there has been a renewed interest in the study of rhetoric and medicine, particularly with regard to the ways in which an understanding of rhetoric can improve doctor-patient communication.

In the Language and Communication concentration, students will come to understand contemporary approaches to the rhetoric of medicine through intensive, guided reading of scholarly work in the field. In consultation with their mentor, students will then apply this knowledge by designing and conducting a rhetorically based qualitative research project. These projects will engage students in the process of writing and submitting research and IRB proposals and securing informed consent. Students will also gain experience with qualitative data collection and analysis, including the use of relevant qualitative software such as NVivo. Students will present their findings in the form of a scholarly article, a conference presentation, or another mutually agreed upon venue.

The research students do in this concentration will map on to at least one of the thirteen Entrustable Professional Activities (EPAs) approved by the Association of American Medical Colleges as all of these EPAs rely, to a greater or lesser extent, on effective use of rhetoric (i.e. argument, persuasion, and language).

  • EPA 1: Gather a history and perform a physical examination
  • EPA 2: Prioritize a differential diagnosis following a clinical encounter
  • EPA 3: Recommend and interpret common diagnostic and screening tests
  • EPA 4: Enter and discuss orders and prescriptions
  • EPA 5: Document a clinical encounter in the patient record
  • EPA 6: Provide an oral presentation of a clinical encounter
  • EPA 7: Form clinical questions and retrieve evidence to advance patient care
  • EPA 8: Give or receive a patient handover to transition care responsibility
  • EPA 9: Collaborate as a member of an interprofessional team
  • EPA 10: Recognize a patient requiring urgent or emergent care and initiate evaluation
  • EPA 11: Obtain informed consent for tests and/or procedures
  • EPA 12: Perform general procedures of a physician
  • EPA 13: Identify system failures and contribute to a culture of safety and improvement

Research Possibility - Melissa Nicolas, Ph.D.

While I will encourage students to design their own unique projects, I realize, because of time constraints, that many students will want to participate in my study. The project I describe below maps easily on to EPA 1: Gather a history and perform a physical examination and EPA 5: Document a clinical encounter in the patient record. My guiding research question is "What are the rhetorical choices doctors make that can lead to miscommunication and/or even mistrust between doctor and patient?"

  • I am beginning my investigation at two "sites." The first site is an archive of medical student charts that have been made available to me. These charts are from a medical education program in the Northeast. Using grounded theory, I will be analyzing the language in these charts for the rhetorical choices medical students made. Students at the School of Medicine can participate in this work by assisting with the coding and analysis of these records. Students may even use this archive to explore questions they generate about written histories, approaching the data from an angle that is not on my radar.
  • The second site for data collection is at the School of Medicine. After getting appropriate permissions, I am interested in analyzing transcripts (and possibly video recordings) of standardized patient interviews conducted by the medical students at the School of Medicine. Students in the scholarly concentration can participate at this site in multiple ways including designing a project where they reflect on their own standardized patient experiences throughout their medical education. Students might also consider conducting focus groups with fellow classmates to review the interviews and ask specific questions about rhetorical choices. Working alongside me, medical students can collect, analyze, and code data, and help create coding schemes.

Outcomes

By the end of this scholarly concentration students will be able to:

  • Explain and apply some basic theoretical concepts in the rhetoric of medicine
  • Design/participate in a qualitative research project that explores some aspect of rhetoric as it applies to at least one of the 13 AAMC's Entrustable Professional Activities
  • Write a qualitative research proposal and a successful IRB application
  • Collect and analyze qualitative data
  • Use qualitative software as appropriate
  • Produce a professional document or presentation

Timeline

This scholarly concentration requires approximately 4 weeks (160 hours) during the first two years and a 4th year elective of about 4 weeks (160 hours).

  • Summer of Years 1 and/or 2: Guided reading in rhetoric and medicine and qualitative research methods. (Approx. 4 weeks or 160 hours)
  • Year 3: Touch base with mentor at least once each semester about plans for 4th year elective
  • Year 4: Submit research proposal; upon approval, conduct research project
    • Prepare results for publication/presentation; submit article for publication or deliver presentation. N.B. Publication/presentation can occur after the official end of the concentration

Assignments

Annotated Bibliography: During the guided reading portion of the concentration, students will keep a running annotated bibliography of works read. Annotations should be no longer than one page per article and should include a brief summary of the piece and a reflection paragraph where the student shares his/her thoughts about what s/he is reading.

  • Research Proposal: This document, completed after the guided reading portion of the concentration will outline the intended research project and include a description of the project, a timeline, and an anticipated budget (if any). This document will need to be submitted to the mentor before submitting the IRB application.
  • IRB application: Once the research proposal has been approved by the mentor to go forward, the student will submit a formal IRB application to all appropriate review committees. NO DATA MAY BE COLLECTED UNTIL THE PROJECT IS FULLY APPROVED BY THE IRB.
  • Field Notes: Notes are taken during the course of data collection. Style and format will depend on type of project.
  • Presentation of Findings: Students may choose from a variety of presentation methods including, but not limited to: poster presentation, conference presentation, journal article, or website.

Contact: Melissa Nicolas manicolas@unr.edu