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Case presentations have been researched as both an important form of intra/inter-professional communication, where a patient's clinical information is shared among health professionals involved in their care, and an equally key discursive tool in education, where learners independently assess a patient and present the case to their preceptor and/or care team. But what happens to the case presentation, a genre that governs physician (and learner) talk about patients, when it is used in patients' presence? While they were commonly used at the bedside in the past, case presentations today are more commonly performed in hallways or conference rooms, out of patient earshot. This paper draws on interview data from a study involving patient-present case presentations in a medical education setting. Our analysis asks what participants' metageneric comments about the encounter can teach us about the genre, about patient involvement in medical education, and about linguistic adaptations to the genre that the profession might make to support patient involvement.

Introduction: Competence committees (CCs) centre their work around documentation of trainees' performance; undocumented contributions (i.e. informal, unrecorded material like personal judgements, experiential anecdotes and contextual information) evoke suspicion even though they may play a role in decision making. This qualitative multiple case study incorporates insights from a social practice perspective on writing to examine the use of undocumented contributions by the CCs of two large post‐graduate training programmes, one in a more procedural (MP) speciality and the other in a less procedural (LP) one. Methods: Data were collected via observations of meetings and semi‐structured interviews with CC members. In the analysis, conversations were organised into triptychs of lead‐up, undocumented contribution(s), and follow‐up. We then created thick descriptions around the undocumented contributions, drawing on conversational context and interview data to assign possible motivations and significance. Results: We found no instances in which undocumented contributions superseded the contents of a trainee's file or stood in for missing documentation. The number of undocumented contributions varied between the MP CC (six instances over two meetings) and the LP CC (22 instances over three meetings). MP CC discussions emphasised Entrustable Professional Activity (EPA) observations, whereas LP CC members paid more attention to narrative data. The divergent orientations of the CCs—adding an 'advis[ing]/guid[ing]' role versus focusing simply on evaluation—offers the most compelling explanation. In lead‐ups, undocumented contributions were prompted by missing and flawed documentation, conflicting evidence and documentation at odds with members' perceptions. Recognising other 'red flags' in documentation often required professional experience. In follow‐ups, purposes served by undocumented contributions varied with context and were difficult to generalise; we, therefore, provide deeper analysis of two vignettes to illustrate. Conclusions: Our data suggest undocumented contributions often serve best efforts to ground decisions in documentation. We would encourage CC practices and policies be rooted in more nuanced approaches to documentation. van Enk and colleagues show that undocumented contributions in competency committees often work in service of best efforts to ground decisions in documentation. [ABSTRACT FROM AUTHOR]

Much research on reading and writing in schools continues to focus on individual cognitive skills. In contrast, investigations of literacy-learning in out-of-school settings have often taken a socio-cultural perspective, situating reading and writing in social relations and cultural institutions. The last 20 years have seen a proliferation of studies documenting the ways in which printed texts are taken up in a wide variety of settings from after-school clubs and community-based adult literacy programmes to workplaces, the Internet, and "everyday life". Increasingly, there have been calls for sociocultural literacy researchers to begin directing their attention to mainstream educational contexts. In this paper, we join in and seek to contribute to such calls by drawing out some of the complexities and caveats that also need to be kept in mind. After briefly reviewing what it means to define literacy and learning in relation to socio-cultural context, we explore some recent arguments for conceptual and methodological refinements. We then turn our attention to schools and to what a socio-cultural definition of literacy has to offer in terms of addressing diversity and educational inequity, and we draw out several issues that require closer consideration.

Background/Purpose: Although much has been written about the medical learning environment, the patient, who is the focus of care, is rarely the focus in this literature. The purpose of this study was to explore the role of the patient as an active participant with agency in the medical learning environment from the standpoint of the learner, the attending physician, and most importantly, the patient. We hoped to gain insights into the mechanisms that can reinforce professional values such as patient‐centred and respectful behaviours in a patient‐present learning environment. Methods: We conducted this study in an ambulatory internal medicine clinic using 'patient‐present' clinic visits. All case presentations occurred in examination rooms with the patient. We invited participants (attending physicians, undergraduate and postgraduate learners, patients and family members) to participate in semistructured interviews after each clinic visit to explore the impact of the patient‐present learning environment. We recruited 34 participants in the study; 10 attending physicians, 12 learners, 10 patients and 2 family members. We analysed the data deductively using a conceptual framework of agency. Summary/Results: We identified three major insights: (1) Patients felt engaged and valued opportunities to be heard; (2) Attending physicians and learners reported a more respectful learning environment and a positive though challenging teaching and learning experience; and (3) A hidden curriculum emerged in a performance‐based view of professional behaviour. Conclusions: Patient‐present teaching engaged patients and enhanced their agency by recasting the patient as the central focus within the healthcare encounter. We identified a tension between performing and learning. This study adds new insights to the concept of patient centredness and professionalism from the perspectives of all participants in the medical teaching and learning environment. A patient‐centred approach to teaching, learning and patient care is shown to create tension between upholding a performance role versus a learning role that challenges us to think critically about the complexity of balancing needs. [ABSTRACT FROM AUTHOR]

Issue: Research in education, including health professions education, has long struggled with the competing concerns of academic and practice-based stakeholders. Inspired partially by the work of Stokes and other theorists in science and technology studies, we propose that discussions about compelling research in health professions education might be usefully advanced by considering what it would mean if the community framed itself as a knowledge-producing field instead of aligning itself with either disciplinary or practical interests. Evidence: Efforts to foreground disciplinary or practical interests in education research have been unproductive, leading to the privileging of one group's expertise at the expense of the other. Currently proposed principles and practices for responding to the divergence between these interests, such as knowledge translation or practitioner inquiry, have yielded comparatively little in the way of mutual satisfaction. Implications: As a field, health professions education research would not privilege either disciplinary or practical interests, nor would it attempt any sort of definitive blueprint for resolution to the tension. Rather it would regard these interests as inherently interconnected and, therefore, always in tension to varying degrees. The challenge for a field is not to resolve that tension but to harness it in productive ways through collaboration, negotiation, and compromise, through ever-shifting engagements that will not necessarily be comfortable but will nonetheless foster knowledge that resonates with all parts of the community. [ABSTRACT FROM AUTHOR]