Frame ambiguity in student-patient interaction

Abstract In this article I will illustrate how training interviews in the medical education are characterised by frame ambiguity and should be understood as hybrid communicative activity types. The presentation is based on my doctoral thesis on clinical interviews in nursing and medical education. The data used in this presentation is from medical education, and the data consists in five video recordings of medical student / patient consultations – referred to here as training interviews. The analyses give insight into the training interview as a specific and complex communicative activity that is distinctly different from authentic clinical interviews. In order to achieve efficient communication in the student / patient interaction, students must be aware of the qualities and possibilities inherent to training consultations in contrast to authentic consultations. The nature of the interaction is not always obvious to the patient. An important insight from the analyses is the uncertainty or confusion related to whether the clinical interview is to be perceived as authentic, which is the students' aspiration, or whether it is a training situation, which seems to be the patients' perception. In the dialogue this becomes evident especially in the opening phases and in the conclusion of the interaction. At the beginning of the session, this is manifested in patient-initiated negotiations of the general frame(s) for the conversation and in changes of frame(s). At the conclusion of the interview the ambiguity of the situation again becomes evident and manifests itself in how summaries are performed, how the conversation is ended, and how courtesies are exchanged. The analysed conversations can be seen as complex activities with ambiguous frames, and this fact is not made explicit by the students. Keywords: Framing, activity type, hybridization, simulation, training interwiev, medical education, practical relevance.