Discourse Studies

This article deals with surgical practice as it is locally organized within the course of the operation; it focuses on the way in which surgical action shaping the body for the local purposes of the operation is organized in a timely, situated, interactive manner. In order to do that, I offer a systematic analysis of the instructions addressed by a chief surgeon to his assistant in the form of directives during a surgical operation, as well as of instructed actions of the assistant following the directives of the surgeon. In this way, I aim to show how surgery is a methodic collaborative achievement, relying on finely tuned coordination between staff members. More generally, the article sketches a systematic and detailed analysis of instructions as situated accomplishments in time, and of instructed action as resulting from an embodied and indexical understanding of directives and requests as they are produced in time and in context.

Examining a fragment of interaction that occurred during a surgery at a teaching hospital, we explore how particular instructed experiences are produced for two trainees, a surgeon in the residency program and a medical student in a surgical clerkship. We are concerned with what is produced as learnable in each case. Stated slightly differently, we are interested in the ways in which the attending surgeon uses demonstrations as instruction and the ways in which recipients of that instruction, in this case the resident and the clerk, respond with enactments of those demonstrated actions. The recipients of this kind of instruction participate in a form of experiential learning in which they enact their own versions of the instructor’s demonstrated actions to be observed and assessed by the instructor. These enactments provide learners with experiential access to the instructor’s demonstrated actions. They are designed to be experiences that learners may draw upon to make experientially warranted claims at some later time.

The present study examines the work of a group of medical scientists as they identify interpretative ‘pitfalls’ – recurrent sources of error – in the use of a new radiographic technique, formulate suggestions on how these pitfalls can be avoided and communicate their findings in the form of a scientific publication. The analysis focuses on a session in which previously diagnosed cases are discussed, and demonstrates the ways in which a certain source of diagnostic error gradually emerges as a taken-for-granted in the interaction. An increased sense of recognition, recurrence and typicality is discernible in the treatment of the cases. Talk characterized by expansions and elaborations, displays of understanding in the form of reformulations, understanding checks, and so on, leave room for brief typifications and reifications of interpretative difficulties in characteristics of the imaging technique. Topical treatment of perception and interpretation, as well as embodied engagement, become decreasingly salient. It is argued that the abstracted formulations in the published text rely on the case-by-case working up of generality from particularity; from individualized accounts of why ‘I’ interpreted the image in a certain way to proffered generalizations achieved through articulated perceptions of a generalized ‘one’. If these proffers are ratified, a potential ground is established for the consensual formulation of a pitfall. The formulation of novel instructions is consequently made relevant, projecting a re-instructed diagnostic practice.

The purpose of this study is to elucidate various practices for the structuring of images on an ultrasound monitor during prenatal ultrasound examinations. This study focuses on the practices that healthcare providers employ to invite pregnant women to differentiate a gray-tone image on the ultrasound monitor from the image’s background. In sequential environments in which pregnant women display difficulty in differentiating an image on the screen in response to the healthcare provider’s invitation, the healthcare provider employs practices that require additional bodily involvement to structure the images on the screen. Furthermore, on certain occasions, the healthcare provider also points to a particular abdominal location with the ultrasound transducer, which is held against the abdomen to produce the very image being differentiated. This study demonstrates that the image on the ultrasound monitor is intrinsically embodied and spatially (between the screen and the participants’ bodies) and modally (among vocal/auditory, visual, and tactile modes of orientation) distributed. In addition, the study suggests an interaction-organizational ground for an aspect of the ‘personification of the fetus’ through obstetric ultrasound.

This article explores the organization of instructional corrections in pre-clinical dental education. The students are practising manual skills using a simulator and tutors are inspecting and evaluating their progress. Simulators and simulation are critical to the organization of contemporary healthcare training, and the academic literature that explores forms of simulation in healthcare tends to consider the ‘fidelity’ (or ‘realism’) of systems and the extent to which they match the clinical situations that they are designed to mimic. In contrast, this article considers how tutors and students explicitly attend to matters of realism in the course of instructional sequences. We highlight the ways in which tutors routinely invoke ‘real life’ in instructional corrections and we discuss how these sequences reveal the work that tutors undertake to compensate for the ‘chronic insufficiency’ of the simulator. We show how tutors emphasize the reasoned character of manual bodily skills, reasons linked to the complexities and contingencies of clinical practice. To explore these issues and concerns, the article draws on the analysis of audio-visual data of everyday instruction.

This study explores questions posed by students in response to live video broadcasts of dental treatments. The aim of the study is to show and discuss the reflexive relationship between the questions, what they were occasioned by and how they are responded to. Procedures and anatomical features, that for the seminar leader are unproblematically seen in endodontic terms, repeatedly present problems for the students. Visible but unrecognized shifts in the dentist’s work, for instance, provide occasions for questions of the form ‘What is he doing now?’. In the midst of an ongoing procedure, questions tend to be formulated as noticings that elicit instruction either about some detail of the dentist’s actions or about what a generic ‘one should’ or ‘should not do’, what ‘frequently’ happens and so on. It is shown, however, that the movement between specific here-and-now features on the one hand and more general issues on the other characterizes the entire scope of the relevant material, particularly because the seminar leaders’ answers tend to place even minute details within more general endodontic considerations.