2019 HSC Section 2 - Practice Management

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TABLE 5. Summary of Verbal Response Mode Intent Criteria 18 Source of Experience Presumption About Experience Frame of Reference Mode

Speaker

Speaker

Speaker

DISCLOSURE (D) Reveals thoughts, feelings, perceptions, or intentions.

Other

EDIFICATION (E) States objective information.

Other

Speaker

ADVISEMENT (A) Attempts to guide behavior, suggestions, commands, permission, prohibition. CONFIRMATION (C) Compares speaker ’ s experience with other ’ s; agreement, disagreement, shared experience or belief. ACKNOWLEDGEMENT (K) Conveys receipt of or receptiveness to other ’ s communication; simple accep- tance, salutations. INTERPRETATION (I) Explains or labels the other; judgements or evaluations of other ’ s experience or behavior. REFLECTION (R) Puts other ’ s experience into words; repetitions, restatements, clari fi cations. UNCODABLE (U) is used only for incomprehensible utterances. QUESTION (Q) Requests information or guidance.

Other

Other

Speaker

Speaker

Other

Other

Speaker

Other

Informative utterances concern the speaker’s own experi- ence (Advisements, Disclosures, Confirmations, and Edifi- cations). Take, for example, a surgeon that asks a resident, “What would you have done differently?”. This statement is considered Attentive because the surgeon is asking the resident about the experience of that resident . However, if a surgeon says, “Traction [versus] counter-traction is every- thing in this procedure,” this is considered Informative , as the surgeon is telling the resident something that regards the surgeon’s own experience. The role dimension of Presumptuousness vs. Unassum- ingness concerns the “presumption about experience” VRM classification. When a speaker is Presumptuous in a conversation, they presume knowledge about the other person, such as in the modes of Interpretation, Reflection, Advisement, and Confirmation. By contrast, Unassuming utterances do not make such presumption, as in the modes Question, Acknowledgment, Disclosure, and Edification. For example, the statement “You did a good job handling the tissue,” is considered Presumptuous because the sur- geon is presuming to know how well the resident did. However, if they say, “The bowel looked good,” they do not have to presume knowledge of the resident and this is considered Unassuming. Finally, the role dimension of Directiveness vs. Acquiescence addresses the “frame of reference” VRM classification. Directive utterances use the speaker’s frame of reference to guide a conversation (Interpretations, Questions, Advisements, and Disclo- sures), whereas a speaker is Acquiescent when they

allow the other’s viewpoint to determine the course of conversation (Reflections, Acknowledgments, Confirmations, and Edifications). For example, if a surgeon says, “I want you to work on getting more of a secure counterpressure hold,” they are using their own frame of reference, and this is considered Direc- tive. However, in the statement, “After about 2 times you saw how that worked,” the surgeon is using the resident’s frame of reference, and thus this is consid- ered Acquiescent . A summary of the Role Dimensions and their cross-classification with VRM is shown in Table 6 . Two investigators independently coded 407 utteran- ces of training transcripts and achieved robust interrater reliability (Cohen’s Kappa = 0.956). VRM coding of feed- back transcripts and subsequent Role Dimension Analy- sis was then performed by the author. Statistical Analysis Chi-square tests for equality of proportions were per- formed using MedCalc for Windows, version 15.1 (MedCalc Software, Ostend, Belgium) to analyze the different Role Dimensions used during feedback given in-person and via SIMPL. t tests were performed using IBM SPSS Software to analyze the resident survey results and third-party assessments of each feedback modality.

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