Constructing the Medical Voice: How doctors-in-training engage with communication challenges-a grounded theory of adapting

Abstract

Introduction This study addresses the gap in understanding how doctors-in-training learn to communicate in the real-world learning environment of the hospital. The purpose was to develop explanatory theory in relation to the research question: How do doctors-in-training engage with communication challenges in the hospital environment? Despite the increase in communication skills training in undergraduate medical curricula, complaints about communication in healthcare remain high. Understanding why undergraduate communication skills training may not transfer into the hospital environment is critical for improving communication related outcomes. Research Design The research design incorporates a constructivist grounded theory methodology embedded in a social constructionist framework. Sampling was purposive and theoretical, resulting in four focus group interviews with medical students and fifteen individual interviews with doctors and nurses. Data generation and analysis were concurrent and consisted of initial and focused coding; constant comparative analysis, using inductive and abductive logic; theoretical sensitivity; theoretical integration; and theoretical saturation. Memoing and reflexivity were integral throughout. Findings The research resulted in a grounded theory constructing the medical voice: Doctors engage with communication challenges by using a medical voice that is constructed through the process of adapting to the relational landscape of the team. The relational landscape provides the conditions under which voice is constructed. The medical voice is continually emergent, re-constructed and contingent upon the team environment. The core category of adapting has three categories: reading the cues, learning the rules and constructing voice. The voices that can be constructed vary according to whether the relational landscape is engaging, good enough, undermining or disabling. Conclusion This research has resulted in a theory of voice construction in the substantive area of medical communication in hospitals. The theory explains why undergraduate communication skills training may not transfer effectively into the postgraduate hospital environment. It highlights the significance of the relational aspects of everyday team interactions and the powerful way in which these influence the voice that individual doctors can use within a particular team. The theory offers new opportunities to effect change in how doctors communicate in hospital practice, with implications for future research, education and organisational change.