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Presenting cases in front of patients: implications for a key medical education genre

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“Now, don’t worry. This is nothing whatever to do with you.”

(Chief surgeon Dr. Lancelott Spratt to a bedridden patient being discussed during teaching rounds in the 1954 film Doctor in the House)


Case presentations have been researched as both an important form of intra/inter-professional communication, where a patient’s clinical information is shared among health professionals involved in their care, and an equally key discursive tool in education, where learners independently assess a patient and present the case to their preceptor and/or care team. But what happens to the case presentation, a genre that governs physician (and learner) talk about patients, when it is used in patients’ presence? While they were commonly used at the bedside in the past, case presentations today are more commonly performed in hallways or conference rooms, out of patient earshot. This paper draws on interview data from a study involving patient-present case presentations in a medical education setting. Our analysis asks what participants’ metageneric comments about the encounter can teach us about the genre, about patient involvement in medical education, and about linguistic adaptations to the genre that the profession might make to support patient involvement.

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  1. Notes Key foundational texts include Bakhtin’s “The Problem of Speech Genres” (1986) and Miller’s “Genre as Social Action” (1984). For a useful introduction and overview, see Bawarshi & Reiff (2010).

  2. Examples of guidelines abound (see, for example, Dell et al., 2012; Goldberg, 2009; Nikakhtar, n.d.) and usually require the inclusion of identifying information/chief complaint, history of present illness (HPI), social history, physical examination findings, and assessment and plan.

  3. In Goffman’s (1959) theory, face reflects the way in which an individual wants to be perceived by the outside world.


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The Patient in the Learning Environment Study, from which this analysis drew its data, was generously supported by the Royal College/AMS CanMEDS Research Development Grant, Reference Number 19/AMS-01.

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Correspondence to Anneke van Enk.

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This study was approved by the University of British Columbia Behavioural Research Ethics Board and the Vancouver Coastal Health Research Institute (VCHRI) board, study number H18-02507. All participants provided written consent and received a copy of their consent form.

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van Enk, A., Nimmon, L., Buckley, H. et al. Presenting cases in front of patients: implications for a key medical education genre. Adv in Health Sci Educ 27, 621–643 (2022).

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