Workplace-based communication skills training in clinical departments: Examining the role of collegial relations through positioning theory

Abstract

Introduction: Studies suggest that the workplace is a key to understanding how clinical communication skills learning takes place and that medical communication skills need to be reinforced over time in order not to deteriorate. This study explored the perceptions of doctors in four hospital departments who participated in a workplace-based communication training project. Its specific focus was the relationship between collegial relations and learning communication skills.

Methods: The study applied a qualitative design using an ethnographic methodology, i.e. interviews and observations. Positioning theory was used as the theoretical framework.

Results: Training communication skills with colleagues in the actual workplace setting was valued by the participants who experienced more sharing of communication challenges, previously understood as something private one would not share with colleagues. However, collegial relations were also barriers for providing critical feedback, especially from junior doctors to their seniors.

Conclusion: The position as “colleague” both reinforced the communication skills training and hindered it. The communication skills educational model had a flat, non-hierarchical structure which disturbed the hierarchical structure of the workplace, and its related positions.

Acknowledgements

The authors would like to express our appreciation toward all staff members from the four departments in Aarhus University Hospital and Randers Regional Hospital for their participation and constant collaboration in all stages of the project. Furthermore we would like to thank research assistant Jonas Roer Pedersen for assisting with the preliminary data analysis.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Glossary

Positioning theory: Is an analytical tool for understanding intentional interactions in social episodes “under a local moral order, and the local system of rights and obligations”. Its three core analytical concepts, known as the positioning triangle, i.e. (1) the position, (2) the action, and (3) the storyline. A position is defined as a cluster of rights and obligations to perform certain actions. An action, includes both speech acts and other actions. The toryline is the underlying moral and social order that orders the episode (Harré and Harré and Lagenhove 1999a, 1999b).

Additional information

Funding

This project was supported and funded by Central Denmark Region.

Notes on contributors

Jane Ege Møller

Jane Ege Møller, MA, PhD, is an assistant professor at Centre for Health Science Education, Aarhus University. She works with medical humanities and medical education. She is Professional Course Manager for the Post-graduate Medical Communication Skills Training in the Central Denmark Region.

Bente Vigh Malling

Bente Vigh Malling, MA (Health Professions Education), PhD (leadership of medical education), is an associate professor of Postgraduate Medical Education and Associate Director, Centre of Health Sciences Education, Aarhus University. She is a trained anesthesiologist.