Scripting in Net-Based Medical Consultation: The Impact of External Representations on Giving Advice and Explanations

  • Anne Runde
  • Rainer Bromme
  • Regina Jucks
Part of the Computer-Supported Collaborative Learning book series (CULS, volume 6)


In this chapter, a distinction is made between three concepts of scripting communication: 1) social roles as a non-deliberative, non-instructional form of scripting, 2) explicit and 3) implicit scripting. Both of the latter are forms used in instructional collaborative settings to influence and change behavior. As we established in a previous study, external representations both structure and constrain asynchronous expert-layperson communication (Bromme, Jucks, & Runde, 2005). According to Suthers (e.g., Suthers & Hundhausen, 2003), external representations guide discourses. Because shared external representations have the potential to influence learning and collaboration processes in a non-directive manner, we define the concept of representational guidance as implicit scripting. In the present study, we focused on the potential to support shared decision making when patients seek advice from medical doctors through the Internet. When communicating via computers, it is easy to make external representations available to both communication partners. Therefore, whether or not shared graphic representations function as an implicit script and have an impact on the communication content was tested empirically. Our main hypothesis is as follows: with a shared external representation in the background more specialist arguments are brought forward than without such a representation. In accordance with this hypothesis, we found that the external representation had a considerable influence on content selection during the discourse.


Social Role Collaborative Learning Communication Partner Medical Expert External Representation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Baker, M., & Lund, K. (1997). Promoting reflective interactions in a CSCL environment. Journal of Computer Assisted Learning, 13, 175–193.CrossRefGoogle Scholar
  2. Bekker, H., Thornton, J. G., Airey, C. M, Connelly, J. B., Hewison, J., Robinson, M. B., et al. (1999). Informed decision making: An annotated bibliography and systematic review. Health Technology Assessment (Winchester, England), 3(1), 1–156.Google Scholar
  3. Bromme, R., Jucks, R., & Runde, A. (2005). Barriers and biases in computer-mediated expert-layperson-communication. In R. Bromme, F. W. Hesse, & H. Spada (Eds.). Barriers, biases and opportunities of communication and cooperation with computers (pp. 89–118). New York: Springer.CrossRefGoogle Scholar
  4. Coulter, A., Entwistle, V., & Gilbert, D. (1999). Sharing decisions with patients: Is the information good enough? British Medical Journal, 318, 318–322.Google Scholar
  5. Coulter, A. (1997). Partnership with patients: The pros and cons of shared clinical decision-making. Journal of health services research & policy, 2(2), 112–121.Google Scholar
  6. Dillenbourg, P. (2005). Designing biases that augment socio-cognitive interactions. In R. Bromme, F. W. Hesse, & H. Spada (Eds.). Barriers, biases and opportunities of communication and cooperation with computers (pp. 243–264). New York: Springer.CrossRefGoogle Scholar
  7. Dowell, J., & Hudson, H. (1997). A qualitative study of medication-taking behavior in primary care. Family Practice, 14(5), 369–375.CrossRefGoogle Scholar
  8. Ertl, B., Fischer, F., & Mandl, H. (in press). Conceptual and socio-cognitive support for collaborative learning in videoconferencing environments. Computers & Education.Google Scholar
  9. Jucks, R., Bromme, R., & Becker, B.-M. (2006). Lexical entrainment — Is Expert’s Word Use Adapted to the Addressee? Manuscript accepted for publication (major revisions needed). Discourse Processes.Google Scholar
  10. Jucks, R., Bromme, R., & Runde, A. (2006). Explaining with non-shared illustrations: How they constrain explanations. To appear in Learning and Instruction.Google Scholar
  11. Jucks, R., Bromme, R., & Runde, A. (2003). Audience Design von Experten in der netzgestützten Kommunikation: Die Rolle von Heuristiken über das geteilte Vorwissen. Zeitschrift für Psychologie, 211(2), 60–74.CrossRefGoogle Scholar
  12. Kaplan, S. H., Greenfield, S., & Ware, J. E. (1989). Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Medical Care, 27(3), 110–127.CrossRefGoogle Scholar
  13. Koc, F. (2002). Medizin im Internet. Evidenz-based-Medicine und Qualitätsmanagement online. Berlin: Springer.Google Scholar
  14. Luhmann, N. (1999). Soziale Systeme. Grundriß einer allgemeinen Theorie (7. Auflage). Frankfurt a. M.: Suhrkamp.Google Scholar
  15. O’Donnell, A. M., & Dansereau, D. F. (1992). Scripted cooperation in student dyads: A method for analyzing and enhancing academic learning and performance. In R. Hertz-Lazarowitz & N. Miller (Eds.), Interaction in cooperative groups: The theoretical anatomy of group learning (pp. 120–144). New York: Cambridge University Press.Google Scholar
  16. Pezza, P. E. (1990). Orientation to uncertainty and information seeking about personal health. Health Education Research, 21(2), 34–36.Google Scholar
  17. Pinkwart, N., Hoppe, H. U, Bollen, L., & Fuhlrott, E. (2002). Group oriented modelling tools with heterogeneous semantics. In S. A. Cerri, G. Gouarderes, & F. Paraguacu (Eds.), Lecture notes in Computer Science 2363, Intelligent Tutoring Systems (pp. 21–30). Berlin: Springer.Google Scholar
  18. Runde, A. (2004). Die Rolle externer Repräsentationen in der netzgestützten Arzt-Patienten-Kommunikation. Unveröffentlichte Dissertation der Westfälischen-Wilhelms Universität, Münster.Google Scholar
  19. Rummel, N., & Spada, H. (2005). Instructional support for collaboration in desktop videoconference settings. In R. Bromme, F. W. Hesse, & H. Spada (Eds.). Barriers, biases and opportunities of communication and cooperation with computers (pp. 59–88). New York: Springer.CrossRefGoogle Scholar
  20. Schank, R., & Abelson, R. P. (1977). Scripts, plans, goals, and understanding. Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
  21. Stalnaker, R. C. (1978). Assertion. Syntax & Semantics: Pragmatics, 315–332.Google Scholar
  22. Suthers, D. D., & Hundhausen, C. D. (2003). An experimental study of the effects of representational guidance on collaborative learning processes. The Journal of the Learning Sciences, 12(2), 183–218.CrossRefGoogle Scholar
  23. Suthers, D. D. (2005). Technology affordances for intersubjective learning, and how they may be exploited. In R. Bromme, F. W. Hesse, & H. Spada (Eds.). Barriers, biases and opportunities of communication and cooperation with computers (pp. 295–314). New York: Springer.CrossRefGoogle Scholar
  24. Tulsky, J. A., Chesney, M. A., & Lo, B. (1995). How do medical residents discuss resuscitation with patients? Journal of general internal medicine, 10(8), 436–442.CrossRefGoogle Scholar
  25. van Boxtel, C, van der Linden, J., Roelofs, E., & Erkens, G. (2002). Collaborative Concept Mapping: Provoling and supporting meaningful discourse. Theory into Practice, 41(1), 40–46.CrossRefGoogle Scholar
  26. Watzlawick, P., Beavin, J. H., & Jackson, D.D. (2000). Menschliche Kommunikation. Formen, Störungen, Paradoxien. Bern: Huber 2000Google Scholar
  27. Weinberger, A., Reiserer, M., Ertl. B., Fischer, F., & Mandl, H. (2005). Facilitating collaborative knowledge construction in computer-mediated learning environments with cooperation scripts. In R. Bromme, F. W. Hesse, & H. Spada (Eds.). Barriers, biases and opportunities of communication and cooperation with computers (pp. 15–37). New York: Springer.CrossRefGoogle Scholar
  28. Wintermantel, M. (1991). Dialogue between expert and novice: On differences in knowledge and their reduction. In I. Markova & K. Foppa (Eds.), Asymmetries in dialogue (pp. 124–142). Hertfordshire: Harvester WheatsheafBarnes & Noble Books/Bowman & Littlefield Publishers, Inc.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Anne Runde
    • 1
  • Rainer Bromme
    • 1
  • Regina Jucks
    • 1
  1. 1.Westfälische Wilhelms-UniversitätMünster

Personalised recommendations