The first steps towards professional distance: A sequential analysis of students’ interactions with patients expressing emotional issues in medical interviews

•Emotional sequences of talk were commonly preceded by patient initiatives.•Questions were most often limited to medical aspects of the emotional concern.•Students mainly expressed empathy with minimal encouragement or acknowledgment.•Students’ expressions of understanding gave little room for further elaboration.•Students’ advice and information addressed emotional concerns as medical issues. Explore sequential patterns in students’ interactions with patients expressing emotional concerns in a medical interview. Concepts and principles from conversation analysis (CA) were used to examine the turn-by-turn sequential organization of student actions in eleven video-taped medical interviews. We used results from an earlier coding with an interaction analysis system (VR-CoDES) in a previously published paper as a point of reference. By using CA instead of VR-CoDES as our primary investigative method we observed that student turns previously coded as elicitations to simulated patients’ expressions of emotion were often preceded by subtle patient initiatives. Students encouraged further elaboration by displaying their understanding of the emotional issue as a story telling still in progress. Students’ expressions of understanding however, gave little room for further elaboration. Finally, students often addressed emotional issues as a medical issue and offered professional advice. Students’ actions seemed specifically designed to display interest in the patients’ initiatives to talk about emotional experiences without departing from their initial interview task or violating norms for professional conduct. Educators and practitioners should reconsider how the medical interview may shape expectations for professional conduct and can thereby unintentionally restrict students’ empathy development.