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Volume 27 (3)

Volume 27, Issue 3, Summer 2007line
J Contin Educ Health Prof 2007; 27(3):149
ORIGINAL RESEARCH

Representational fluency in HIV clinical practice: A model of instructor discourse
Banach MA, Gifford BR, Holodniy M

A b s t r a c t

Introduction: Clinicians treating human immunodeficiency virus (HIV) patients are expected to stay up-to-date with rapidly changing knowledge and practice. Continuing medical education (CME) programs are one source of new knowledge about HIV clinical management. Little is known about instructor-participant discourse in HIV CME programs and whether or how instructors model their decision-making strategies.
Methods: Discussions about clinical cases between instructors and participants in attendance at a HIV CME program were videotaped, transcribed, segmented, and coded, focusing on the participants' questions and the instructor's responses.
Results: Twenty-four case studies involving four instructors and 45 participants (54% infectious disease clinicians and 46% general practitioners) were analyzed. Five case studies are presented herein to illustrate how the instructors use the participants' questions and case studies to model cognitive processing and decision making in HIV treatment practice.
Discussion: This article provides a model of interactive and practice-based teaching discourse in the context of an HIV CME activity. Throughout this discourse the instructors model the fluent use of representations for the CME learners and provide a safe environment where participants can share their misunderstandings.

Lessons for Practice
  • Instructors model the discourse of representational fluency to show the clinicians how to apply and integrate the concepts that they have learned in this CME experience to their practice.
  • Instructors encourage the participants to use strategies of metacognition to unpack the entire case study, providing examples of how to unpack their patient case studies.
  • Instructors show how a learner’s question can launch and ground the educational discourse and the fluent use of representations.

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