Abstract/Summary

Background: Communication issues among patient-health professionals persist, prompting the need for better communication training and assessment, such as through the use of Objective Structured Clinical Examinations (OSCEs). Politeness Theory (PT) considers how to deal with potentially sensitive situations, regarded as Face Threatening Acts (FTAs), which can embarrass patients (referred to as positive FTAs) or make people feel imposed on (referred to as negative FTAs). Failure to recognise and address FTAs may upset patients and reduce the effectiveness of the interaction. Studies that examine health professionals’ communication with patients rarely address this topic. Aim: To explore how pharmacy students use language to maintain (or not) patient face needs, using PT and Conversation Analysis (CA). Method: A scoping review examined the usefulness of two established methods (Roter’s method versus CA) in exploring real-time interactions within pharmacy practice. Then, nineteen OSCE video recordings of pharmacy students (2018-2019 and 2019-2020) interacting with simulated patients were examined. The videos were transcribed using ELAN software based on the Jeffersonian transcription system. The students’ utterances were categorised using PT into a) Types of FTAs and b) Politeness strategies applied, if any. The sequence organization of CA was used to assess simulated patients’ responses as preferred or dis-preferred responses. Chi-square was used to find out variables that might affect patient responses and pharmacy student feedback. Findings: CA is a useful tool for investigating the finer details of communication, and Roter's method can provide a general description of communication. In consultations, speech acts can interfere with the patient’s face needs (for example, receiving a diagnosis can feel embarrassing, or being given advice can feel imposing). Various type of politeness strategies were applied by students that ease a potential embarrassment to the patient (e.g. avoiding disagreement, expressing understanding), and maintain their autonomy (e.g. being indirect, using hedging or minimising the imposition). However, the pharmacy students studied mainly focussed on avoiding impositions, rather than preventing embarrassment to their patients. Patients' dis-preferred responses were more likely to occur when they were disclosing unhealthy behaviour, and paradoxically, these were less likely to receive positive feedback from students. Conclusion: Programs for enhancing health professionals’ communication skills do not generally focus on easing patients' embarrassment (i.e. maintaining patients' positive face needs). Developing teaching methods regarding this is crucial to preparing students for effective rapport-building. This thesis lays out several methods for further studying and improving the communication skills of pharmacy students and other health professional trainees.