“Learning the lingo”: A grounded theory study of telephone talk in clinical education

Purpose: Although the workplace learning literature has focused on ‘doing’, clinical practice involves ‘talking’ not only with patients but also about patients with other health professionals. Work-related telephone conversations among clinicians are common, but their contribution to doctors’ learning remains underexplored. Using a socio-cultural perspective, the authors examined how telephone talk influences physicians’ clinical education.

Methods: Using constructivist grounded theory methodology, the authors conducted 17 semi-structured interviews with doctors from a variety of specialties and training levels from two American academic medical centers between 2015-2017. They collected and analyzed data iteratively using constant comparison to identify themes and explore their relationships. Theoretical sampling in later stages occurred until sufficiency was achieved.

Results: Residents and fellows reported speaking on the phone regularly to facilitate patient care and needing to learn how to tailor their talk based on goal(s) of the conversation and their specific conversation partners. Three common conversation situations highlighted the interplay between patient care context and conversation and created productive conversational tensions that influenced learning positively, namely experiencing and dealing with (a) power differentials, (b) pushback, and (c) uncertainty.

Conclusions: Telephone talk contributes to postgraduate clinical education. Physicians-in-training learn both ‘how to talk’ and ‘learn through talk’ on the telephone mediated by productive conversational tensions that motivate them to modify their behavior to minimize future tensions. An evolution of ‘how to talk’ enables physicians-in-training to advocate for their patients and promote patient care. Preparing residents to deal with pushback could support their learning from this ubiquitous workplace activity.