Anatomy of dialogue in out-of-hospital cardiac arrest resuscitation

Research on medical teams constantly recognise the crucial value of communication. Studies on various medical teams, such as surgery and trauma, provide evidence for how communication either affects or is affected by a range of outcomes and variables. Nevertheless, much of this work has focused on in-hospital communication. Less is known about the patterns of communication amongst medical practitioners in high-stakes emergency care outside of the hospital. This thesis presents an investigation of dialogue during pre-hospital resuscitations when paramedics are responding to out-of-hospital cardiac arrest (OHCA). A bespoke dialogue annotation system, called the Dialogue Annotation for Resuscitation coding scheme (DARe), is developed for this purpose. DARe is used to annotate four simulated and 40 real-life OHCA resuscitation attempts by paramedics who are based in Edinburgh, Scotland. We examine (1) the distributions of communicative functions and subject matters (threads); (2) specific statements used by team members to align themselves; (3) the prevalence and forms of mitigated directives; (4) the verbal manners of planning; (5) the occurrence of closed-loop communication and other structures of verbal communication loops; and (6) the prevalence of socioemotionally-related utterances. For the real-life resuscitation dialogues, the study additionally investigates (7) the correlations between the distributions of the dialogue patterns with the assessed performance of resuscitation team leaders and with the time taken to successfully deploy a mechanical chest compression device (AutoPulse). Analysis for the simulation dialogues was performed from the start of simulation until the end or near the end of the procedure, whilst analysis for the real-life dialogues concentrated on the first five minutes. Despite this difference in timing, the results showed that simulated and real-life OHCA dialogues comprised similarly high frequencies of statements, directives, acceptances, and acknowledgments. Both simulated and real-life dialogues also contained sociolinguistic influences from the linguistic context that these were derived from, i.e. Scottish English. In considering the threads across both settings, the largest proportion of threads revolved around planning and execution of tasks, followed by threads on patient history and related instrument/equipment. Dialogues during real-life OHCA resuscitations differed from the simulated resuscitations in the additional presence of two communicative techniques, namely Alerters (used to attract hearer’s attention) and Affective performatives (used to convey affective or socioemotional statements). Additionally, real-life resuscitation dialogues contained a larger proportion of threads pertaining to patient positioning due to the use of the AutoPulse. Resuscitation team members often used a statement structure called State-awareness to align themselves with one another in terms of their current state or task. Directives were frequently mitigated, with strategies ranging from simple use of softeners (e.g. please) to less straightforward directive structures (e.g. suggestion). Plans were verbalised in temporal clusters, i.e. distinguishable in terms of the immediacy of the task to be performed. Few verbal affective behaviours (e.g. humour, gratitude, compliments) were observed. Team members also used very few exchanges that resembled the standard, three-level closed-loop communication structure typically required from professionals in other high-stakes dialogue environments. Correlation analyses revealed that the frequencies of both the communicative functions and threads were associated with the performance scores of resuscitation team leaders. Teams led by higher rated leaders (the ideal score group) showed higher proportions of Alerters, Affective performatives, State-awareness, and Plan of action in their dialogues compared to teams led by lower rated leaders (the low score group). There were also variations in the concentrations of chest compressions, patient history, and rhythm threads in the two groups, indicating that both discussed the same threads but at different junctures of the procedure. Meanwhile, the time taken to deploy the AutoPulse was positively correlated with the communicative function Acknowledge and the threads Patient history and Movement other than patient, and negatively correlated with the communicative function Open-option and the threads Ventilation and Airway access. Based on these results, several potential measures for optimising OHCA resuscitation are proposed: the use of sewn-on name badges for paramedics; shorter time dedicated for the extraction of patient history; verbal reports of vital points throughout the procedure; the use of non or less mitigated directives; and standardisation of resuscitation phrases. Each suggestion is also discussed in terms of anticipated challenges and possible solutions. The results presented in this thesis provide grounds for further research on the features of pre-hospital resuscitation dialogues. DARe has been demonstrated to be useful in discriminating linguistic patterns, suggesting that dialogue annotation analysis can be utilised to further investigate this area and ultimately contribute to resuscitation performance

Pragmalinguistic differences between proficient and less proficient Malay learners of English in request.

In the teaching and learning of a second language, more often than not emphasis is placed on grammatical accuracy and language fluency, while aspects of pragmatics take back seats. Ideally, the higher the proficiency, the higher the pragmalinguistic ability of selecting acceptable politeness strategies and language-specific means from a language's existing resources. This study sought out the pragmalinguistic differences between proficient and less proficient Malay learners of English in making requests. The objectives of this study were to find out: (1) the different pragmalinguistic strategies employed by the two groups of respondents in making requests, and (2) whether more proficient Malay learners of English apply higher amount of pragmalinguistic strategies compared to the less proficient learners. Data for this study was obtained through Discourse Completion Test (DCT) questionnaires and interviews of 10 Malay secondary school students in Malaysia. The results indicated significant differences in both the types and amount of pragmalinguistic strategies employed by the proficient and less proficient groups. Surprisingly, the more proficient group did not display the expected politeness in their requests

Adequacy of benefits, distributive justice and individual attitudes and behaviors: a case of public community colleges staff

This study was conducted to examine the indirect effect of distributive justice in the relationship between adequacy of benefits and individual attitudes and behaviors (i.e., job satisfaction and organizational commitment) using 190 usable questionnaires gathered from employees in Malaysian public community colleges (MPCOLLEGE sector). The outcome of stepwise regression analysis showed that the inclusion of distributive justice in the analysis had increased the effect of adequacy of benefits on job satisfaction and organizational commitment. Furthermore, this finding confirms that distributive justice does act as a full mediating variable in the benefits program model of the organizational sector sample. In addition, implications and limitations of this study, as well as directions for future research are discussed.Peer Reviewe

Congruence between Language Proficiency and Communicative Abilities

AbstractReports in mass media and narratives of people in authority as well as the lay person in the street attribute unemployment of graduates to their poor communicative abilities and, in the same breath, poor proficiency in English. This raises questions for applied linguistics to address through empirical studies. This paper reports students’ views of the congruence between language proficiency and communicative abilities. The specific aspects examined are whether students conceptualise these two constructs as the same, overlapping or different; and whether students think their language proficiency and communicative ability affect their chances of employability. Semi-structured interviews were conducted with university students with different English proficiency levels. The preliminary results indicate that students see both English proficiency and communicative ability as important factors affecting their employability but they can tease apart the two constructs. The students view communicative ability as going beyond language proficiency to encompass ability to take account of other viewpoints and clarity in thought patterns during communication. The findings suggest that strategies to improve undergraduate communicative abilities cannot target English proficiency alone

EMPLOYERS’ VIEWS ON IMPORTANCE OF ENGLISH PROFICIENCY AND COMMUNICATION SKILL FOR EMPLOYABILITY IN MALAYSIA

Employability of graduates is a concern in many countries, including Malaysia, and the high unemployment rate among graduates is often attributed to their lack of English proficiency and communication skills. These two distinctive elements are often collated, and it is important to find out which is more important to employers. The study examined the employers’ views on the importance of English proficiency and communication skill for graduates to be employed in the Malaysian private sector. The data were from semi-structured interviews conducted with 10 employers in the private sector who were in the position to recruit staff. The 21,433-word interview transcripts were analyzed. The results revealed that employers in the Malaysian private sector view language proficiency and communication skills as separate qualities. The employers are willing to consider employing candidates with average English proficiency if they have good communication skills, except for jobs which require more communication in English such as customer service and marketing. The results also revealed that good communication skills can increase employability and opportunities for career advancement. The findings highlight the communication skills that universities need to emphasize so that their graduates have the necessary skills to perform well in employment interviews and in their work

Closed-loop communication during out-of-hospital resuscitation:Are the loops really closed?

Training for effective communication in high-stakes environments actively promotes targeted communicative strategies. One oft-recommended strategy is closed-loop communication (CLC), which emphasises three components – call-out, checkback, and closing of the loop – to signal understanding. Using CLC is suggested to improve clinical outcomes, but research indicates that medical practitioners do not always apply CLC in team communication. Our paper analyses a context in which speakers’ linguistic choices are guided by explicit recommendations during training, namely out-of-hospital cardiac arrest (OHCA) resuscitation. We examined 20 real-life OHCA resuscitations to determine whether paramedics adopt CLC in the critical first five minutes after the arrival of the designated team leader (a paramedic specially trained in handling OHCA resuscitation), and what other related communication strategies may be used. Results revealed that standard form CLC was not consistently present in any of the resuscitations despite opportunities to use it. Instead, we found evidence of non-standard forms of CLC and closed-ended communication (containing the first two components of standard CLC). These findings may be representative of what happens when medical practitioners communicate in time-critical, real-life contexts where responses to directives can be immediately observed, and suggest that CLC may not always be necessary for effective communication in these contexts

Adequacy of benefits, distributive justice and individual attitudes and behaviors: A case of public community colleges staff

This study was conducted to examine the indirect effect of distributive justice in the relationship between adequacy of benefits and individual attitudes and behaviors (i.e., job satisfaction and organizational commitment) using 190 usable questionnaires gathered from employees in Malaysian public community colleges (MPCOLLEGE sector). The outcome of stepwise regression analysis showed that the inclusion of distributive justice in the analysis had increased the effect of adequacy of benefits on job satisfaction and organizational commitment. Furthermore, this finding confirms that distributive justice does act as a full mediating variable in the benefits program model of the organizational sector sample. In addition, implications and limitations of this study, as well as directions for future research are discussed

THE IMPACT OF COVID-19 AMONGST INTERNATIONAL STUDENTS IN UNIMAS

The COVID-19 pandemic has altered the landscape of the education domain. It affects the way we teach, the way we learn, and imposes novel obstacles in the way institutions of higher learning conventionally manage themselves. While all students in higher learning institutions would certainly feel the impact, there is a need to focus on the experience of international students. In an effort to combat the pandemic, Malaysia has issued a directive for Movement Control Order (MCO), starting 18 March 2020. Amongst others, this directive directly affected all universities in the country. This study aims to explore the impact of COVID-19 amongst the international students in a higher education institution in Sarawak, Malaysia. Data was gathered via an online questionnaire adapted from the QS Survey Report 2020 on COVID-19. Our findings revealed that while most of the international students perceived their studies to be affected, most planned to continue with the programs that they were currently enrolled in. The students expressed deep concerns about the impact of the pandemic on their exams and classes and preferred reassurance in terms of updates on information related to academic matters

Resuscitation procedures as multi-party dialogue

Successful out-of-hospital cardiac arrest (OHCA) resuscitation relies upon effective team communication, which is evaluated as an aspect of non-technical skills. However, this communication has been largely neglected from a dialogue perspective. We propose addressing this issue by examining the structure of OHCA interaction and its characteristic dialogue features. We explore how speakers verbally signal and align their current states, and the possible trade-off between directness and politeness. Preliminary data suggests frequent use of Assertions in OHCA communication, as in other medical interactions, but that OHCA situations also involve distinctively high proportions of Action-directives. Current states are mostly signalled using explicit State-awareness utterances. Directives’ force is also mitigated by politeness features. We discuss how these findings advance our aim of understanding effective team communication in the OHCA context, and how future work might identify associations between linguistic behaviours and resuscitation outcomes

Input Type Effects On Students’ Written Narrative Responses

This pilot study examines the differences of second language learners’ written responses when they are given two different input types with similar content. One input was through written narrative or visual only input, where the learners need to read, and the other was a performed narrative or audio-visual input, where learners need to watch. Learners were then required to respond to the input by completing the narratives. Results showed that there were no major discrepancies in terms of complete/incomplete storylines, length, and number of dialogues, but revealed that the audio-visual input influenced learners more as their responses have a stronger correspondence to the traits in the performance rather than the written narrative