Revisiting discourse analysis in medical education research

Medical education researchers increasingly recognise the potential of discourse analysis to explain salient as well as underlying patterns and dynamics in learning interactions pertaining to clinical and social contexts.2 Close examination of interactional processes in settings, such as problem-based learning, communication training, feedback conversations, interprofessional practice, and the debriefing process in simulation-based education, may yield more multi-faceted evidence and afford valuable insights into teaching and learning.3 Despite its potential as an analytical tool in health professions education research, its application is still quite limited. Discourse analysis approaches and key concepts Discourse analysis is a methodological approach to describe people's lived experiences through interaction from a language-in-use perspective, such as what the written or spoken text is about, who is involved, and how the text is organised and functions in a specific context, such as a problem-based learning classroom, or a bedside tutorial.4 Specifically, it is concerned with language use beyond the boundaries of a 138 sentence, interrelationships between language and society and the interactive properties of everyday communication, which is different from a conversation analytical approach that focuses on speakers' social action itself through language.5 Discourse-oriented studies range from a macro-level analysis of societal institutions (e.g. curriculum documents in policies for selection), meso-level analysis of discourse practice (e.g. verbal behaviours and learning in a context of PBL classroom) to micro-level analysis of texts in a specific context (e.g. patient-provider interactions), influenced by various disciplines, including anthropology, cultural studies, linguistics, psychology, and sociology.6 Depending on the aims and foci of the studies, different types of written and spoken data are collected, and different approaches to discourse analysis are adopted. [...]it has been used to identify dominant ultrasound discourses,10 and utilised in the contexts of interprofessional collaboration and learning systems,11,12 professional identity of clinical students in cross-cultural settings,13 and accreditation standards.14,15 This approach mainly analyses written texts, interviews, and narrative data to identify discourses that are important to particular social constructions and to uncover power relations between discourses.9 Specifically, we elabo