Representational fluency in HIV clinical practice: a model of instructor discourse.
BACKGROUND
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.


CONCLUSIONS
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.
Banach
Mary A
MA
Stroke Sciences Group and the Clinical and Translational Science Institute, University of California San Francisco, San Francisco, CA, USA. mary.banach@ucsfmedctr.org
Gifford
Bernard R
BR
Holodniy
Mark
M
D002140:California; D002983:Clinical Competence; D003657:Decision Making; D004351:Drug Resistance; D004502:Education, Medical, Continuing; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D017146:Models, Organizational; D010818:Practice Patterns, Physicians'; D014743:Videotape Recording