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Med Educ. 2004 Feb;38(2):168-76.

Expert and trainee determinations of rhetorical relevance in referral and consultation letters.

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  • 1Centre for Research in Education, University Health Network, University of Toronto, 200 Elizabeth Street, Eaton South I-605, Toronto, Ontario, Canada M5G 2C4. lorelei.lingard@utoronto.ca

Abstract

BACKGROUND:

Referral and consultation letters ferry patients among providers, negotiating co-operative care. Our study examined how "relevance" is signalled and decoded in these letters, from the perspective of both experts and trainees in three clinical specialties.

METHODS:

104 letters were collected from 16 physicians representing family medicine, psychiatry and surgery. Interviews were conducted with 14 of these physicians and 13 residents from the three specialties. All documents and transcripts were analysed for emergent themes.

RESULTS:

Six rhetorical factors influenced expert physicians' decisions about what material is relevant: educational, professional, audience, system-institutional, medical-legal, and evaluative. Each specialty placed different emphasis on these factors. Trainees reported having no instruction regarding how to construct rhetorically relevant letters, and they demonstrated awareness of only three of the factors identified by experts--professional, audience and evaluative. Experts and trainees differed in their understanding and application of these three factors.

CONCLUSIONS:

This research demonstrates that six rhetorical factors influence relevance decisions in letter writing, and that experts address these factors in tacit, dynamic and discipline-specific ways. Trainees share with experts an appreciation of the rhetorical functions of referral and consultation letters, but lack a comprehensive understanding of the influential factors and do not receive instruction in them. These findings provide a framework for instruction in this domain to equip novices to meet the expectations of their professional audiences successfully.

PMID:
14871387
[PubMed - indexed for MEDLINE]
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