Sociolinguistics Bundle: Introducing Sociolinguistics
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Each chapter includes exercises that enable readers to engage critically with the text, break-out boxes making connections between sociolinguistics and linguistic or social theory, and brief, lively add-ons guaranteed to make the book a memorable and enjoyable read. With a full glossary of terms and suggestions for further reading, this text gives students all the tools they need for an excellent command of sociolinguistics.
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Your new password has been sent to your email! It seems to be a consequence of the assessed, simulated setting then, that participants use these formulaic, trained professional phrases and interactional moves with a much higher frequency than real-life. Yet these phrases appear much less frequently in real consultations [ 27 ]. Interestingly, weaker CSA candidates who also produce these types of phrases, albeit slightly less frequently, were assessed as formulaic in examiner feedback:.
It seems just very formulaic and a lot of it seems learned.
It is in these small details of talk, here in the small variations in delivery of exam-modelled phrases, that we can see how power and social relationships are constituted in the micropractices of interaction and its evaluation [ 25 ]. In terms of construct validity, does the simulated consultation measure what it purports: the interpersonal capabilities expected of a doctor?
The answer is a complex one. Though the simulation may be good at testing skills such as giving explanations and structuring the consultation, there are a number of linguistic features which do not mimic real-life practice.
In terms of assessment theory, there is a "construct-irrelevant variance" [ 57 ] in which certain know-how is assessed which is not a requirement of real consultations. There is wide recognition that for many candidates trained outside their home country for the assessment, simulations are often a new phenomenon and that, like any type of assessment, lack of familiarity affects performance [ 58 ]. The simple solution offered is that this group need more practice with simulations. However, detailed sociolinguistic analysis suggests that simulations may cause difficulties for this group of candidates in other ways as well.
As indicated above, simulations lead to more talk, more formulaic phrases and more work to ensure that such talk sounds sincere. This focus on talk and how it sounds in contexts of intense assessment puts particular pressure on those whose style of communicating is different from the majority of examiners and also, perhaps, the patient role-players. Small differences in such subtle features as intonation, word stress and other small markers of speech can be amplified and read off as showing negative characteristics, such as formulaic responses or not engaging, attracting lower marks in the interpersonal page 32—73 [ 27 ].
Additionally, since it can be difficult to make standardised, simulated cases reflect the same variation as real-life consulting, performance will not reflect the ability to interact effectively and flexibly with a diverse patient population. In many such exams, while UK graduates are not assessed on consulting in linguistically challenging situations, International Medical Graduates, many of whom consult regularly in another expert language within the British multi-cultural context, have no opportunity to display this skill as they might use it in their everyday practice.
Such competence in linguistically and culturally challenging situations is increasingly important for medical practitioners treating diverse patient populations, both in the UK and globally.
Talk is always a performance in context and in simulations, the role-playing patient, the candidate and the examiner all have to work hard to maintain the illusion. Candidates who can handle the social and linguistic complexity of this somewhat artificial, standardised situation score highly — yet what is being assessed is not real communication but the ability to voice a credible appearance of such communication. It follows that if communication skills are assessed purely through simulated patients, this may not reflect the real consulting abilities of candidates. The discipline of sociolinguistics offers an evidenced approach to these questions around professional communication.
While a single awkward moment is unlikely to lead to failure, in settings of intense evaluation, perceived infelicities such as an unfilled pause or formulaic phrase become amplified. The cumulative effect of such micro-features may lead to a candidate being judged as "not developing rapport" or as showing inadequate responsiveness to "verbal and non-verbal cues" and an overall negative impression of interpersonal abilities. Although a number of studies have identified that simulated interactions show important differences from real-life professional communication [ 27 , 28 , 33 — 37 ], we are not arguing that simulation has no place in teaching or assessment.
Summative simulated assessments, however, must carefully consider the difficulties of assessing interpersonal skills in this setting. Hence, we do not seek to bury the OSCE, but in introducing the sociolinguistic perspective, we do seek to debate its level of validity for assessing communicative and interactional aspects of clinical performance. The authors are grateful to the research funders who facilitated the work with the Royal College of General Practitioners, which is referred to in this paper.
We are also grateful to the Royal College of General Practitioners for the access and close advice they gave the authors throughout the original research, on which this debate article is built, and to all the exam candidates who gave their consent to be part of the study. Competing interests.
The authors have no other competing interests to declare. SA was originally the Research Associate who conducted the analytic work on the Clinical Skills Assessment described in this article and drafted the first version of this debate article. CR was originally the Principle Investigator on the research project with the Royal College of General Practitioners and substantially contributed to the first draft and subsequent versions of this article.
KH contributed a significant amount of analytic work and discussion as an adviser on the original project with the Royal College of General Practitioners. TG has conducted extensive research in the field of medical education and has drawn on this in substantially rewriting the initial and subsequent versions of this article. All authors contributed to conceptualizing and writing the paper, sourcing material.
All authors have seen and approved the final manuscript. National Center for Biotechnology Information , U. BMC Med Educ. Published online Jan Author information Article notes Copyright and License information Disclaimer. Sarah Atkins, Email: ku. Corresponding author. Received Sep 18; Accepted Jan 6. This article has been cited by other articles in PMC. Abstract Background Assessment of consulting skills using simulated patients is widespread in medical education. Discussion In this debate article, we draw on a detailed empirical study of assessed role-plays, involving sociolinguistic analysis of talk in OSCE interactions.
Summary Fidelity may not be the primary objective of simulation for medical training , where it enables the practising of skills. Discussion The simulated consultation as a proxy for the real Social interaction cannot ultimately be standardised. The simulated consultation as performance One of the concerns voiced about OSCE examinations is that they test acting skills as much as they do professional communication [ 30 , 41 ].
The talk-heavy nature of the consultations In simulated consultations, it is primarily talk-in-interaction that is assessed. The design and timing of cases The design of cases for simulated consultations moves the focus from the how of patient care to the why of the particular selected case. The shift of power to the role-player Sociolinguistic research has identified how asymmetrical interactions, where one speaker has more power than another, show small-scale differences in talk.
A bit resentful if the doctor appears to be telling you off. You are familiar with GPs and hospitals, so you are comfortable with the doctor. Open in a separate window. Who fails such assessments — and why? Interestingly, weaker CSA candidates who also produce these types of phrases, albeit slightly less frequently, were assessed as formulaic in examiner feedback: It seems just very formulaic and a lot of it seems learned. Acknowledgements The authors are grateful to the research funders who facilitated the work with the Royal College of General Practitioners, which is referred to in this paper.
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Faculty development in assessment: the missing link in competency-based medical education. Acad Med.
Sociolinguistics Bundle: Introducing Sociolinguistics
Keeping it real! Enhancing realism in standardised patient OSCE stations. Clin Teach. BMC Med.
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