ISSA Proceedings 2010 – Argumentation Standards In The Assessment Of Clinical Communication Competence

• by: Kara Gilbert, Gordon Whyte and Andrea Paul - Monash University, Australia

1. Introduction
Clinical reasoning, clinical knowledge and clinical skills, which include clinical communication, are essential components of clinical competence recognized internationally in high level policy documents (PSA, 2003; CPMEC, 2006; GMC, 2009). Consequently, communication skills training (CST) has developed as an integral component of medical curricula (Brown, 2008). However, while clinical schools provide general outlines of their CST curricula, content, skills criteria and delivery modes in CST appear to vary across the sector (Bird, Gilbert et al., 2008).
Recently, clinical communication specialists have been calling for new parameters of communication that might draw on inter-disciplinary knowledge and experience to inform how healthcare communication is conceptualised (Skelton, 2008, p.154). In recent work by Gilbert and Whyte (2009; 2010), linguistic and argumentation (viz. critical reasoning) frameworks show how clinical reasoning might be made explicit in communication.   The work supports recent perspectives on clinical competence in which not merely expertise in specialised clinical knowledge but also the ability to effectively use clinical knowledge in discourse is regarded as essential (Nguyen, 2006).

In medical education, a student’s ability to effectively integrate content knowledge and clinical reasoning is demonstrated via his/her communication strategy associated with the performance of clinical skills in an oral examination, the Objective Structured Clinical Examination (OSCE). In a conventional OSCE format, a candidate is required to convey medical knowledge and/or demonstrate clinical skills by enacting scenarios with real or simulated patients (viz. actors) or performing specific tasks at several short stations of 8-15 minutes duration. The so-called standardized clinical task is performed under the observation of one or two examiners who score the candidate’s performance on a standardized marking sheet. Thus, the checklist based marking enhances inter-rater consistency and the testing of students’ performances on multiple stations increases the number and range of competencies tested. Read more

ISSA Proceedings 2010 – Is “Argument” Subject To The Product/Process Ambiguity?

• by: G.C. Goddu - University of Richmond

1. Introduction
In recent work, Ralph Johnson raises several problems for the adequacy of the Logic/Rhetoric/Dialectic trichotomy and for its alleged basis–the argument as product/process/procedure trichotomy. My concern here is not with Johnson’s worries – rather it is with what Johnson leaves unchallenged. While Johnson ultimately has some reservations about argument as procedure, he leaves the product/process distinction untouched. He writes: “The distinction between product and process seems to me fairly secure. It has a longstanding history here and in other disciplines. In logic, for instance, the term ‘inference’ is understood as ambiguous as between the process of drawing an inference and the inference that results from that process.”(Johnson 2009, p. 3)

Despite its longstanding history and foundational role in argumentation theory, I am not so confident about the security of the product/process distinction as it applies to “argument” or even “inference”. I shall first articulate the conditions required for “argument” to be subject to the product/process ambiguity, and then argue that not all of the conditions are met. Finally, I shall show that some arguments for the ontological or intellectual priority of one aspect of argument over another fail given that “argument” is not subject to the process/product ambiguity. Read more

ISSA Proceedings 2010 – Argumentation On Sustainability In Small Island Communities

• by: Peter Goggin - Arizona State University

1. Introduction
This essay explores oceanic island locales as rhetorical and material places/spaces and discourses on environmental sustainability. The purpose of this essay is to tease out some of the complexities not only in addressing the concept of sustainability itself, but how discourses and arguments on sustainability, particularly environmental sustainability, are shaped, constrained, constructed, and disseminated as rhetorics of place in the humanities. The first part of the paper reports on my early study on environmental remediation. The second part discusses sustainability as a rhetorical concept. The final part provides an overview of some of the initial field observations that will guide the next phase of research and analysis.

2. Bermuda: Environmental Remediation
My current work on islands and rhetorics of sustainability emerges from an earlier project involving argumentation and environmental remediation (Goggin, 2003). In 1995, the US military base on Bermuda was abruptly and unceremoniously shut down and a growing controversy over environmental clean-up of the former baselands between the US Pentagon and the Bermuda government came to a head. The negotiations between these institutions had evolved – one might also say “devolved” – into a rhetorical stalemate as each side staked out a position on its civic, legal, and environmental responsibilities that rendered effective argumentation towards resolution all but impossible. The U.S. maintained a position of caretaker of the land on the basis that it had made huge investments in American taxpayer money for over 50 years in building and maintaining both a military and civilian airport and the supporting infrastructure of roads, buildings, water reservoirs, and utilities that Bermuda, as a beneficiary, inherited at little cost. For its part, Bermuda refused to accept a position of beneficiary and instead claimed a position of landlord to the property, claiming that as a tenant, the U.S. was under no obligation to improve the leased territory and that it made temporary investments in the baselands for its own military purposes, not for local residential use, and was therefore liable for existing and future risks to Bermuda’s fragile environmental structure and ecosystems. Read more

ISSA Proceedings 2010 – Drug Advertising And Clinical Practice: Establishing Topics Of Evaluation

• by: G. Thomas Goodnight - University of Southern California, Los Angeles, USA & Kara Gilbert - Monash University, Australia

1. Introduction
Preservation of patient autonomy in clinical decision-making is strongly advocated in Western models of medical practice. Ensconced in a physician’s legal and moral responsibility is a duty to ensure the patient receives objective and impartial information that will support his/her ability to make an informed choice. Yet, there is a subtle disparity between ‘presentational’ and ‘persuasional’ strategies of providing information on risks and benefits in therapeutic decision-making (Fisher 2001). The process of informed consent, while institutionally sanctioned, is subject to social and political influences (Goodnight, 2006).

Like all institutional practices, doctor-patient interactions feature bounded communicative rationality. In order to reach an informed agreement, participants in a discussion may in principle appeal to ideal norms of consensus formation. In the routines of reasonable practice, such norms are constrained by the conventions, boundaries, interests and customs of an institutionally regulated forum. In the case of medical consultation, the interests of time and resources engage provider and client in a reciprocal exchange of argumentation, but from quite different perspectives, with different risks at stake. At the ontological level, a patient has his or her health to consider. At the professional level, a doctor has a duty to do no harm, a practice to consider, as well as state of the art credentials backed by peer review and licensing. If the consultation is productive, different risks are minimized for both doctor and patient. Presumably, presumption – the right to question sufficiency of evidence and to say no – resides with the patient because his or her risks involve the less reversible outcomes of mortality. Best practices should be reviewed critically to evaluate communication norms, recognizing that such standards change over time because medical care evolves, state and private programs transform, and aspects of the human condition alter. Read more

ISSA Proceedings 2010 – A Formal Model Of Legal Proofs Standard And Burdens

• by: Thomas F. Gordon - Fraunhofer Fokus & Douglas Walton - University of Windsor

This paper presents a formal model that enables us to define five distinct types of burden of proof in legal argumentation. Four standards of proof are shown to play a vital role in defining each type of burden. These standards of proof are defined in a precise way suitable for computing in argumentation studies generally, but are based on a long tradition of their use in law. The paper presents a computational model based on these notions that represents a dialectical process that goes from initial claims where issues to be decided are set, and produces a justification for arriving at a decision for one side or the other that can withstand a critical evaluation by a particular audience. The role of the audience can be played by the respondent in some instances, or by a neutral third party audience, depending on the type of dialogue. The paper builds on previous work (Gordon, Prakken and Walton, 2007; Gordon and Walton, 2009) that has applied the Carneades model to studying burden of proof in legal argumentation. Read more

ISSA Proceedings 2010 – Binary Oppositions In Media Argumentation

• by: Kira V.Goudkova & Tatyana P.Tretyakova - Saint Petersburg State University

1. Introduction
This paper addresses the study of relations between descriptive and normative argumentation models. It examines persuasive tools in a modern media text by introducing cognitive binary oppositions into the analysis. These oppositions make a certain “reasoning scheme” that is lavishly used in the modern press. The approach taken in this paper might be called political linguistics; it aggregates diverse research programs mainly connected with the critical analysis of the language of politicians (speechwriters), journalists, TV presenters as well as the study of language in the decision making process, and types of persuasion and manipulation of the public. We argue that introducing binary oppositions into the analysis follows modern trends of complex approaches to linguistic data encompassing cognitive analysis, argumentation analysis and semantics.

In our introduction we deal with more basic foundations of the case study which is to follow in our main part. These bases deal with cognitive linguistics and structural semantics. At present, cognitive linguistics has achieved certain progress in defining mental spaces as small conceptual packets showing frames and scenarios as we think and engage in discourse; these conceptual packets map onto each other in intricate ways, and provide abstract mental structures for shifting viewpoints and directing our attention to very partial and simple structures. It has become possible to disclose an elaborate web of connections helping the memory for purposes of understanding and persuasion. These mental spaces are presented as very partial assemblies containing elements structured by frames and cognitive models that are interconnected and can be modified as thought and discourse unfold. From the cognitive point of view language is the process of real time perception and production of temporal signs and sequences that present discrete units but act in functional semantics as dynamic open systems. (Tretyakova 2006, pp.275-277). This type of analysis allows identifying language units in terms of dynamic procedures. Read more