Purpose: The tension experienced in multidisciplinary health care teams is often thought to originate in a fundamental lack of understanding between professionals trained in medical practices and those trained in social work.  This tension seems to be based in the values, differential power, supervisory strategies and language of the professions.  We studied the exchanges in social work supervision relationships between social work students and practica instructors, and also the exchanges in case presentations by medical students and faculty, to explore how language reflects and reproduces professional realities. Nowhere is this use of language more important then when teaching across boundaries between teachers and learners of diverse backgrounds. Two members of a diverse Canadian research team, comprised of personnel from university departments of English, optometry, medicine and social work, will report their perspectives of the findings.  The results are part of those of a larger study of the role of situated language practices in clinical health education settings (Schryer, C., Lingard, L., Spafford, M. & Campbell, S. L.).

Methods:  Twelve social work supervision sessions, involving social work learners and practicum supervisors, were audio-taped, transcribed and analysed for emerging themes and oral teaching strategies. In a similar way, sixteen case presentations by medical interns and physicians were taped, transcribed and analysed.  We also interviewed participants and transcribed those interviews.  Data was analysed at meetings of the multidisciplinary research team using a consensus model.

Results:  The study reveals differential communication patterns in meetings between social work and medical supervisors/teachers and novice learners in health settings. Five thematic areas emerged and provided information about the language social workers use in supervision sessions to socialize students and to pass values from expert to novice. An analysis of the language use within social work practica supervision sessions, when compared to the language use evident in case presentations by medical students, provided concrete evidence of specific differences in the two professional contexts.  Physicians and social workers use language strategies differently when teaching.  In addition to describing, defining and exemplifying these distinctions, we also extend the micro language differences, with the consideration of parallel processes, to postulate new ways of understanding the relationship between micro communication patterns, the tension that exists in health teams and the broad practice of medicine and social work professionals.

Implications for Practice or Policy:  This work illuminates our understanding of social work teaching skills on a word-by-word basis.  The new knowledge suggests a new level of practice interpretation for social workers in health care and provides clear language tools to define our work for others.  At this micro level, we will now be able to tease out those specific factors that may play a role in the development of tensions in health care settings and add to the body of social work knowledge which differentiates the social model and the medical model.  This will help us to better understand how we are perceived by others.