'Talking the talk': school and workplace genre tension in clerkship case presentations

Background Socialisation into a community involves learning sanctioned ways of talking. This study investigates the case presentation genre as a site of socialisation into the clinical community of practice. Methods Sixteen oral case presentations and the teaching exchanges surrounding them (involving 11 students and 10 faculty members) were observed by paired researchers during inpatient paediatric medicine rounds. A total of 21 in-depth interviews were conducted with 11 students and 10 faculty. Both data sets were audio-recorded, transcribed and analysed for emergent themes and rhetorical strategies. Results Students emphasised case presentation as a school genre and described the ideal presentation as free of interruptions. As a consequence, students' presentation strategies were directed towards getting through the presentation without questions. In contrast, faculty responses suggested an understanding of the genre as a way of constructing shared professional knowledge. Faculty feedback was often explicit about critical issues in constructing shared knowledge, such as handling uncertainty. However, student presentations rarely reflected this feedback. Conclusions The school genre described and enacted by students conflicts in key ways with the workplace genre evident in faculty feedback, suggesting that school and workplace iterations of case presentation may be at cross-purposes. Such cross-purposes have implications, because when students and teachers perceive a genre differently, a 'gap' is created in their interactions. Even rich and contextually situated feedback may get lost or distorted as it crosses this gap. Explicit acknowledgement of the multiple and flexible iterations of case presentation will improve the learning that novices experience through acquiring this central form of professional 'talk'.