Learning the Rhetoric of Professional Practice

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Learning the Rhetoric of Professional Practice

• Stephen Loftus Joy Higgs
• Education For Practice Institute
• Charles Sturt University

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Rhetoric and Professional Practice

• What is the relationship between rhetoric and
  professional practice?
• To what extent are professional reasoning and
  decision making rhetorical?
• Should we be teaching rhetoric in professional
  education?

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Assumptions 1
The mind is the brain. The mind is a biological
computer. Reasoning is a kind of computation.
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Assumptions 2
Language is a conduit by which meaning is
passively transmitted from one mind to another.
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Assumptions 3
Language use makes us human. Reasoning is the
internalisation of language use. Reasoning is a
dialogue we have with ourselves. Meaning is
constructed by people.
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Thought and Language 1

• Thought is not merely expressed in words it
  comes into existence through them. (Vygotsky)

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Thought and Language 2

• The limits of my language mean the limits of my
  world. (Wittgenstein)

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Thought and Language 3

• Language is not just one of mans possessions in
  the world rather, on it depends the fact that
  man has a world at all. (Gadamer)

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Research Settings

• A multidisciplinary pain clinic assessment teams
  of doctors, physiotherapists, and psychologists
  (sometimes dentists and psychiatrists)
• Problem-Based Learning tutorials students from a
  wide variety of backgrounds, including several
  health professions

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Research ApproachHermeneutic Phenomenology

• Phenomenology the study of a phenomenon via
  peoples experience of it.
• Hermeneutics the theory and practice of
  understanding.
• Hermeneutic phenomenology the study of a
  phenomenon via peoples interpretations of their
  experience.

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Rhetoric in Action

• Its just being able to say what you find, and
  be able to say that this person is in very dire
  straits. Its not making up stuff, but its being
  able to present it in a convincing and competent
  manner that they senior doctors can say All
  right, this requires my attention. (Loftus 2006
  p. 190).

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Rhetoric in Action

• youve got to get to the point now where you can
  lead us to where you want to go (Loftus 2006 p.
  192).

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Rhetoric in Action

• So I try and explain what the options are, what
  are the benefits and advantages as a rule I try
  and leave it up to them, unless I feel strongly
  that they should be steered in a certain
  direction. (Loftus 2006 p. 195).

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Rhetoric and Ritual

• I ran through the history and examination in a
  very sort of stylised way, I saw Mr X. His
  presenting complaint was and you know youve got
  the litany that you run through (Loftus 2006 p.
  176).

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Rhetoric and Education

• Traditional corridor chats vs one minute
  preceptorship model

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Traditional corridor chat

• Attention on work problem only
• Low level questions asked
• Mini lectures given to trainees
• Little or no feedback

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One Minute Preceptorship

• Get a commitment from the trainee
• Probe for supporting evidence
• Teach general rules (take home points)
• Reinforce with positive feedback
• Correct mistakes.

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One Minute Preceptorship

• Get a commitment 'What do you think is going on
  with this baby?' or 'What do you think the
  diagnosis is?

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One Minute Preceptorship

• Get a commitment 'What do you think is going on
  with this baby?' or 'What do you think the
  diagnosis is?
• In rhetorical terms, make a claim.

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One Minute Preceptorship

• Probe for supporting evidence 'What are the
  features that support this diagnosis?'

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One Minute Preceptorship

• Probe for supporting evidence 'What are the
  features that support this diagnosis?'
• In rhetorical terms, provide grounds and show how
  the grounds are a warrant for the claim.

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Rhetoric in Action
Warrant A scalp rash is often due to a bacterial
infection.
Claim This baby has impetigo.
Grounds This baby has a rash on the scalp.
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Is a profession an applied science or a practice?
Rhetoric vs Science?
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Whose ideas are useful to conceptualise practice?
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Rhetoric and Professional Practice

• What is the relationship between rhetoric and
  professional practice?
• To what extent are professional reasoning and
  decision making rhetorical?
• Should we be teaching rhetoric in professional
  education?