A Tale of Two Inquiries (or, Doing Being Competent in a Clinical Skills Exam)

Timothy Koschmann, Richard Frankel, Janet Albers

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Phenomenon: In high-stakes evaluations of communicative competency, data-gathering skills are commonly assessed through the use of standardized patient encounters. This article seeks to document inquiry practices in 2 such encounters in a setting designed to emulate a consequential, clinical skills examination. Approach: Drawing on the methods and findings of Conversation Analysis, we examine selected fragments seeking to understand how, in the ways in which they are organized, they produce quite different outcomes. Findings: In the first encounter, the topic of the patient's history of depression arises naturally in the course of the interview. It happens to be a checklist item for the case and the examinee receives credit for having elicited it. In the second encounter, though the examinee was the more clinically experienced, the topic does not come up and the examinee fails to receive credit. Insights: When we examine how the two inquiry sequences develop on a turn-by-turn basis, it becomes clear that the differences between inquiry practices that carefully constrain patient responses and those that leave space for patient elaboration are subtle but evident. Both types of practice, however, are presumably a part of competent clinical performance. We argue that looking carefully at how specific interactional practices operate within clinical interviews can enable us to become more articulate as to what might count as communicative competence in the clinic.

Original languageEnglish (US)
Pages (from-to)258-269
Number of pages12
JournalTeaching and Learning in Medicine
Issue number3
StatePublished - May 27 2019


  • USMLE Step 2 CS
  • communicative competence
  • standardized patients

ASJC Scopus subject areas

  • Education

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