Summary of the impact

The work in this Case Study details the impact of James Moir's research on communication across different institutional areas of public life, including, health consultations and pedagogical discourse in higher education. Specific impacts include influencing the way in which general practitioners in medicine are trained with respect to their discussions within medical consultations; and contributing to pedagogical debate and policy within the Higher Education sector, particularly in Scotland with respect to the discourse on graduate attributes.

Underpinning research

Moir's broad programme of work encompasses a study of the ways in which institutional discourse `works' across a range of areas in public life. His work focuses on the performative nature of these discourses but also functions as a critique of them in terms of their usage as a means of control. There is a strong focus across his work on impacting upon educational policy and pedagogy.

Roberston et al. (2011) explores some of the ways in which GPs, although ostensibly seeking to engage patients in shared decision-making during consultations, nevertheless control the trajectory of the interaction through various `discursive devices'. These, in effect, work against shared decision-making and close off patient involvement. A major finding of this work is that although patients may rate their consultations as participatory and involving an element of shared decision-making, the analysis of actual conversations between GPs and patients reveals that this is not the case.

This draws on collaborative work on medical consultations with colleagues at Tayside Centre for General Practice (TCGP) at the University Dundee School of Medicine, Ninewells Hospital in Dundee. Investigators were awarded a Chief Scientists' Office award (reference: CZS/1/8, Title: A discourse analysis of shared decision making in primary care, £45,279) involving a PhD studentship. This led to a better understanding of the ways in which GPs and patients communicate with one another in consultations and revealed the impediments to shared decision-making.

Another strand of work has focused on the discourse of graduate attributes and personalisation within higher education. The book chapter entitled "Hyperreal Higher Education" focuses upon the way in which higher education is now legitimated through a combination of discourses on graduate attributes and personalisation, particularly in relation to digital literacy. These conceptualisations are challenged and an argument is made for a more reflexive form of learning about the production and consumption of digital media. This work seeks to challenge the ways in which students are objectified by these discourses and how they can be reconceptualised as part of a reflexive project with respect to life in a world of digital media and learning. Much of this work has fed into consultancy work undertaken as part of the Scottish Enhancement Themes projects.

References to the research

Details of the impact

GP Communication in Medical Consultations

The impacts made following the publication of the research findings contained within the Health article include:

• influencing the communication training of GPs with respect to shared decision-making in consultations;
• contributing to a wider debate about the ways in which medics converse with patients and listen to their concerns

One of the main findings of this research is that GPs draw upon a range of discursive devices to effectively close off shared decision-making with patients. This work does not suggest that GPs do not wish to involve their patients in treatment decisions but rather that in the course of a time-limited consultation they adopt a conversational style that focuses on diagnosis and also upon controlling patient compliance. However, like other public services, government policy has involved medical work in treating patients as stakeholders who are required to be involved in the services they access. This necessitates that patients are not treated as passive recipients of a service but rather are active participants in decisions about their health. Whilst there is a range of policy initiatives to bring this about, our work indicated that this is largely a veneer that covers actual practices. As a consequence of this work, GP training and training in primary care now includes an element that examines how doctors converse with patients with the aim of making this more open and less controlling — see further work by Skelton¹.

Higher Education Policy and Pedagogy

The impacts relating to the work on the analysis and critique of pedagogic discourse in higher education include

• Policy-orientated research examining the changing nature of higher education in Scotland through the application of sociological concepts and literature.
• Influencing colleagues in higher education through consultancy work based on national workshops and conferences.

Moir's consultancy work for QAA (Scotland) through the Enhancement Themes projects,) has led debates (e.g. through policy documents, Enhancement Themes Steering Committee meetings, conferences and workshops) at both national and international level in terms of the sociological impacts of the changing higher education landscape. These and other areas of influence have included the widening of participation and issues of (in)equality, the focus on the personal, the engineering of graduate identities, the cultural changes associated with the blurring of formal and informal learning in the knowledge society, the impacts on staff and the management of change and, in relation to specific chapter cited, the linkages between digital literacy and academic literacy.

The reports are lodged with the national Enhancement Themes website, the authoritative source of national policy thinking and developments in Scottish higher education. Scotland's approach to the management of change in higher education through and enhancement-led approach has been much admired, both nationally and internationally. As such this website is not only consulted by senior HEI managers as well as teaching staff, but also has a wider reach in terms of informing colleagues in other parts of the world of the developments in Scottish higher education. For example, Scottish higher education has recently benefited from the exchange of ideas with Australian academics and senior HEI managers on policy and pedagogical developments in higher education — see for example, recent input to the Enhancement Themes by Professor Kerri-Lee Krause from Griffith University as well as other researchers and commentators at the 2013 International Enhancement Themes conference in Glasgow, June 2013:
http://www.enhancementthemes.ac.uk/docs/publications/post-conference-publication.pdf

Sources to corroborate the impact

• Professor of Clinical Communication, University of Birmingham
• Assistant Director, The Quality Assurance Agency for Higher Education

Reports

• First and foremost: Learner autonomy in the first year
• First things first: the first year in Scottish higher education
• The First Year: Back to the future
  http://www.enhancementthemes.ac.uk/enhancement-themes/completed-enhancement- themes/graduates-for-the-21st-century
• Staff and the Curriculum: Challenges and Changes
  http://www.enhancementthemes.ac.uk/pages/docdetail/docs/publications/developing-and- supporting-the-curriculum-challenges-and-changes-for-staff
• New Technologies, The Curriculum and Higher Order Skills
  http://www.enhancementthemes.ac.uk/docs/publications/post-conference-publication.pdf

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¹ Skelton, J. R. (2008), Language and clinical communication: this bright Babylon. Abingdon: Radcliffe Medical Press.
Skelton, J.R. (2008), Role-play and clinical communication: learning the game. Abingdon: Radcliffe Medical Press.