Running head: MEDICAL SCHOOL AS A DISCOURSE COMMUNITY

Medical School as a Discourse Community Anne K. Przybysz Ohio University

MEDICAL SCHOOL AS A DISCOURSE COMMUNITY All humans are involved in communities that possess a certain language and style of communication whose objective is to obtain a shared goal. These communities are called discourse communities. In Writing About Writing John Swaless article The Concept of Discourse Community introduced us to the ideas that a discourse community has a set of

common goals, special mechanisms for members to communicate, means to provide feedback, at least one genre for the furtherance of communication, specific lexis (vocabulary), and an entry level of membership that allows members to relate to other members (2011, pp. 471-473). Swales demonstrated these six ideas in the form of the Hong Kong Study Circle of which he is a participating member. Swales group worked towards fostering peoples interest in Hong Kongs stamps, and through its publications, special lexis, language, and genre, members came together to form a unique discourse community. Tony Mirabelli expanded on Swaless idea of a discourse community to include the serving profession. In Mirabellis article Learning to Serve: the Language and Literacy of Food Service Workers he explored the use of multiliteracies, specifically verbal and non-verbal communication, to understand the ability of a food server to thrive at work. The discourse community took place in the physical setting of the restaurant. Each restaurant was its own discourse community consisting of common goals, communication mechanisms, individualized language, specialized vocabulary, and levels of membership. Mirabelli demonstrated that his restaurants met Swaless criteria for a discourse community. Furthermore, he demonstrated that as members moved up in the community they needed to have the ability to communicate with people inside and outside the community. For people outside of the community, typically new customers, Mirabelli used the example of knowing a restaurants menu can give a server power to persuade people to that server power over what they order (2011, p.547). This power strives

MEDICAL SCHOOL AS A DISCOURSE COMMUNITY for goals such as producing better tips for the employees. Mirabellis argument challenges the notion that serving requires a low level of education and the idea that serving is not a real profession (2011, p. 541). The perception held by many people in general of medical students is that they are only book smart. However, just as Mirabellis servers require multiliteracies so too do medical students if they are able to succeed at their chosen profession. What sets apart excellent medical students from the average ones is their ability to interact and care for others by reading individuals non-verbal communication. In addition to reading non-verbal communication, medical students must learn to read and interpret medical tests such as blood tests, electrocardiograms (EKGs), and Magnetic Resonance Images (MRIs). This ability to read and understand non-verbal communication, numbers, graphs, and pictures can be referred to as the

multiliteracies of medicine. Being book smart will get medical students their Medical Doctorate, but being personable and reading others will help medical students to gain patients confidence and trust. My brother Steve entered into this discourse community four years ago, and while I may be bias, I believe he is acquiring all the skills he needs to be a thriving member of this community. His choice to enter this community came as a surprise to many members in the family since he could never stand the sight of blood when he was younger. I remember one time when we were younger we got into a fight that caused one of my ear piercings to bleed, so when he saw the blood he gave up the fight and squeamishly backed away. Now, he faces the sight of blood daily at his job. It is amazing how people can change over the years.

MEDICAL SCHOOL AS A DISCOURSE COMMUNITY Research Methods To properly research this area I borrowed Steves pathology textbook, Pathologic Basis of Disease 8th edition by Robbins and Cotran, and some of his medical notes. I looked over the textbook to get a sense of some of the questions I should ask and to get a general sense of the

material that he worked with to advance in the field. Steve chose the pathology textbook because pathology lays the groundwork for education in the medical field. As such, the pathology textbook seemed like the most logical starting point to get a foothold in this area. Because I have known Steve all of his life I could identify what new literacies he developed from the time he started medical school. Also, our personal connection meant that he would be completely open and honest with me and that he would not withhold inside information. Now that he is at the end of his third year at Marshall University I think that Steve has become well versed and a good source of information on his medical discourse community. Steve and I conducted our interview over Skype. We kept out interview lighthearted and touched on how family was doing as well asking questions about the research project. I sent Steve a copy of the interview questions prior to the interview, so the process went along smoothly. The total interview process, including our brief personal interactions, lasted just under a half an hour. I gave Steve the chance to expand on any question I asked or to add any additional information he felt relevant; he did not expand beyond the questions I set up. The interview questions are available for review at the end of this paper in Appendix A. Results To begin, looking over the pathology book that Steve gave me affirms the common held belief that medical students have to be book smart; the book is 1450 pages and is only one of many books that a medical student would have to study over his career. However, judging from

MEDICAL SCHOOL AS A DISCOURSE COMMUNITY the interview and his medical notes, it is clear that medical students have to be able to expand beyond their books or risk failure. Other important areas that came up were varying styles of communication, varying forms of literacies, and a sense of humor that helps a medical student

make it first through the days and then the years of medical school. Although for the purposes of this paper, all the facets that allow a student to operate inside medical school would be useless for this paper if medical school did not meet Swaless definition of a discourse community. Swaless six standards for what qualifies a discourse community, described in the introduction, apply to medical school and students in medical school. First, medical school has three common goals according to Steve: achieve positive patient outcomes, educate medical students, and to avoid litigation. While simple in nature, participants in medical school are aware of their role in the health of their patients and also aware of how a lawyer may look at their liability in any possible patient outcomes. Second, the medical school has several ways that members can communicate with each other. For example, everyday medical students meet in a large group with doctors to discuss and present patients to one another; this meeting is called a table round where Steve works. Presenting in a medical context refers to students providing information about a patients aliments to other students. Also, medical students write notes to one another or to attending physicians and resident doctors throughout the day. In note writing students demonstrate that there is a hierarchy involved because notes to other medical students are informal while notes to attending physicians and resident doctors must always be formal. Third, medical students are provided new information and feedback as well as a chance to speak as a part of its intercommunications. For example, during the table round the attending physician verbally quizzes the medical students and provides them with any new information they need to know, Steve referred to this as trial by fire. Since it is a medical school, key members of the

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permanent medical staff write evaluations of the medical students, and the school assigns them a grade based on their performance and written tests. For the students themselves, the hospital department provides a clinical coordinator to allow the students to express any grievances or accolades concerning other students or doctors. Fourth, medical school has easily recognizable genres of texts. The 1450 page pathology book which Steve uses is only one example of a book that is used by medical students. In the hospital, medical students must be able to read X-rays, MRI scans, EKGs, and a variety of other media that function as a necessity for members of the medical field. Even the notes that medical students write to one another follow a specific format that is recognizable as being of the medical genre. Fifth, medical school and students use very specific lexis. In their notes to other medical students and doctors, medical students must use the proper lexis for the medical field. For example, the letters SOB stand for shortness of breath, and CR means chest x-ray. These and many other abbreviations are commonly used by medical students and the medical community, and members in the discourse community know their meaning instantly when they come across them. When a medical student diagnoses someone, say at the table round, the terminology the students use will be in the form of the medical lexis. Steves example, a high white blood cell count with newly produced white blood cells indicating an active infection is called leukocytosis with left shift. When talking to a patient a doctor would focus on the idea of active infection, but when talking to other members of the medical field the words left shift would convey all the necessary information. Sixth, there is a threshold level for members to understand relevant content. Steve described the membership levels as a pyramid where the proverbial fecal matter rolls downhill. The threshold level for a student comes in his first year of his medical training; as the years go by a student moves by too concerned with his duties to notice how far he has come until confronted with a person at the

MEDICAL SCHOOL AS A DISCOURSE COMMUNITY threshold level. For Steve this moment recently came when he found himself explaining

important information to a first year medical student. Steve now considers himself a full member of the community because he has reached a point where members of the medical staff talk to him in the same manner they would a more experienced doctor while at the same time not talking down to him. As his education and experience continue to grow so too will his level of membership in the medical community. As to the communication style that medical students must use, the style is both derived from book smarts and social intelligence. As adequately described above a doctor must have a good deal of book smarts to communicate ideas like leukocytosis with left shift to other medical students. However, this phrase will mean little to patients who want to know what is affecting them. In Steves medical school a part of his training involves bringing in a patients family and discussing the patients condition with them. If a doctor cannot move beyond his books and technical training, then he will be of little comfort to the patient and his family. At the same time, a doctor must make sure his non-verbal body language does not communicate things that could affect the conversation. A patient might lose faith if his doctors body language gave off signs of ignorance, or a patient might lose hope if a doctor gave off signs indicating doubt. If the doctor recognizes any non-verbal cues from a patient, the doctor may be able to address an underlying issue that the patient may be too afraid to start a conversation about. For the doctors part he has to be able to switch from a formal communication style to an informal one and back again as the situation demanded. A doctors ability to communicate clearly with other doctors will determine how a doctors medical ability is gauged, whether it is accurate or not. Medical students must also learn a variety of literacies to operate effectively in the hospital. Some forms of literacy begin to be taught in book form, but to become masters of these

MEDICAL SCHOOL AS A DISCOURSE COMMUNITY literacies students must learn to go beyond the book. For example, medical books will introduce students to the ideas behind reading x-rays and MRIs, but students must learn to recognize

irregularities that are common in the real world. The notes that students use to communicate with each other and other doctors requires a form of literacy which is often only acquired in the trial by fire sessions held at the start of the day. Also, a form of literacy that is becoming more prominent is computer literacy. Doctors must be able to read a patients information from a computer as well having to be able to add to the information and change it when needed. This literacy has become so common that according to Steve doctors spend more time on computers than interacting with their patients. Steve found this to be a sad but true fact of the medical profession. Lastly, students must become aware of how their writings can be used by a lawyer wishing to pursue a legal case. The students do not have to become fully literate with a form of literacy that could be used in court, but the students must have enough awareness to understand how the legal system will interpret what they write and what they do not write. In order to cope with the stresses caused by the difficulty of medical school, students foster a sense of humor about their situation. For example, in Steves medical notebook there is a side note stating + 2 cookies from Jared if this is a test question! and another note stating Hi Stephan. Happy studying! Are you having fun? While these notes are small they can bring a smile to a medical students face as he copes with the difficulties of medical school. Also, of a nature that does not qualify as book smarts, medical students have fun with their lexis. For example, the three letters SOB might revert to its more common meaning among medical students discussing patients. Another example that Steve pointed out makes light of various medical departments that all medical students will have to study. Steve said, Orthopedic surgeons are meat heads, that pathologists are necrosthat internal medicines are fleas,

MEDICAL SCHOOL AS A DISCOURSE COMMUNITY OBGYNs are stupid, you cant take a pediatrician seriously, and psychiatrists are crazy. Each one has its own explanation, but only a medical student can get the full joke without any explanation. In this case, humor is the medical students own best medicine. Conclusion

The greatest conclusion I can come to is that my baby brother has come a long way from being afraid of a dab of blood coming from an ear piercing. Steve always had the book smarts and the social intelligence to do whatever he wanted in life, and I am proud to have a brother who will spend his life helping other people. As for the nature of the medical student discourse community, it certainly meets Swaless criteria for a discourse community. It also goes beyond many peoples notion of medical students only needing book smarts to advance in it. While book smarts is a key piece of the puzzle, medical students need the ability to communicate with a vast multitude of people in a variety of ways. The best doctors will be able to use their social intelligence to put their patients and their patients families at ease, and he will do so in part by understand his and his patients body language. The students must be literate, especially computer literate, if they are going to best handle their patients needs. In the end, the medical students need to develop a strong sense of humor to push past the stresses caused by medical school. Much of a medical students training begins in a medical textbook, but part of what a medical student needs to know to become a doctor can only be learned by leaving the textbook behind and experiencing the real world.

MEDICAL SCHOOL AS A DISCOURSE COMMUNITY Appendix A: Interview Questions 1. How do you communicate with other doctors and medical students in your community? 2. What kinds of texts do you read and write? memos/emails/notes? 3. What distinguishes these texts from writing you do outside of work/school?

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4. Do you consider yourself a full member of the medical school community? Why or why not? 5. Who has authority and how is it displayed? 6. How often do you write? 7. What kinds of texts do you write? Informal or Formal? 8. How does your role in the medical school community influence the writing you do in the community? 9. How do the various types of writing you engage in influence your role in the medical school community? 10. What sorts of literacies do members of the medical community possess? 11. What are the shared goals of the medical school community? 12. What mechanisms do members of the medical school community use to communicate with each other? 13. What are the purposes of each of the mechanism of communication asked in question 12? 14. What kinds of specialized language do group members use in their conversations? 15. How do newcomers learn the appropriate language and knowledge of the group? 16. Are members of the medical school community stereotyped in any way in regard to their literacy knowledge? If so, how and why? 17. How are members identities influenced by the writing or language use within the medical school community?

MEDICAL SCHOOL AS A DISCOURSE COMMUNITY References:

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Mirabelli, T. (2011). Learning to serve: The language and literacy of food service workers. In E. Wardle & D. Downs (Eds.), Writing about writing: A college reader (pp. 538-556). Boston, MA: Bedford/St. Martins. Swales, J. (2011). The concept of discourse community. In E. Wardle & D. Downs (Eds.), Writing about writing: A college reader (pp. 466-480). Boston, MA: Bedford/St. Martins.