Whose turn is it anyway? Latency and the organization of turn-taking in video-mediated interaction

An Investigation into Student Dietitians' Professional Development through Video-Mediated Communication Training on Patient Counselling

The aim of the study is to describe a student dietitian's professional development process in a video-mediated communication skills training cycle designed for undergraduate nutrition and dietetics education and including activities such as simulated and real patient counseling, feedback, and reflection. The design of the training cycle is inspired by (reflective) interventionist Conversation Analysis (CA) through researcher and trainer collaboration, and the data comes from the screen-recordings of video-mediated meetings. CA is used to analyze the video-mediated interactions on a moment-by-basis and trace the student dietitian's interactional change over time. CA examination of the data showed that the trainer identified listenership in simulated sessions as an improvable practice (i.e. due to repetitive overlaps and cutoffs) and used it as the basis for the intervention. In the post-intervention period, the student dietitian observably improved her listenership both in simulated and real patient counseling sessions. The video-mediated, interventionist, reflective, and data-led cycle played a role in the development of the interactional and professional practice of the student dietitian in ways transferrable to real patient counseling. The training cycle with evidence-based lectures, data-led interventions, and simulated/real patient counseling can be integrated to dietetics education curricula both for clinical communication training and preparing for future teleconsultation practices.

The Interactive Work of Implementing Synchronous Video-Conference Calls-A Qualitative Study Within Early Intervention for Infants With Childhood-Onset Neurodisability

INTRODUCTION

This study explores the 'peripandemic' implementation of synchronous videoconference calls during COVID-19 for delivering physiotherapy early intervention services to families of infants with childhood-onset disability. The interactional experience of conducting early intervention through videoconference calls is under researched. We aimed to understand parents' and therapists' experiences of communication and learning within early intervention sessions for infants with cerebral palsy conducted via video conference calls.

METHODS

Data were collected through interviews, video case studies and focus groups involving 15 parents and 16 therapists. We used qualitative analytical methods inspired by grounded theory and multimodality.

RESULTS

Undertaking early intervention sessions via synchronous videoconference calls creates complexities and disrupts communication norms between parent, therapist and infant. These audio-visual constraints have implications for developing shared understanding and learning. Resolving these challenges necessitated increased interactive work within the parent-therapist partnership. The onus placed on parents to have additional logistical roles in some circumstances created strain, which diverted attention from optimal learning.

CONCLUSION

The post-pandemic healthcare landscape pushes for digital innovation challenging traditional therapy models. Our contribution outlines that while videoconference calls may improve efficiency, they also add cognitive load and interaction challenges, which require modification to routine in-person session designs. We provide recommendations for adaptive implementation strategies for videoconference calls that will benefit from further iterative codesign cycles.

PUBLIC AND PATIENT CONTRIBUTION

We partnered with parents through public and patient involvement. Parents (n = 9) who were previous NHS early intervention service users formed the Parent Advisory Group (PAG). These parent partners came from a variety of backgrounds and provided their unique perspectives to directly contribute and guide decision-making throughout the project. Their contribution influenced approach to recruitment and consent; the participant information and consent form development; topic guide development; considerations of the use of video in the project design and sense checking of analytical interpretations.

Cross-neurotype communication from an autistic point of view: Insights on autistic Theory of Mind from a focus group study

BACKGROUND

The conceptualisation of autism as a disorder where Theory of Mind (ToM) and pragmatics are fundamentally impaired has prompted a wealth of research on autistic deficits, most of which is characterised by two main assumptions: first, that autistic people would display said deficits, if present, with any conversation partner and in any situation; second, that neurotypical people do not present these deficits, regardless of the conversation partner. However, this is not necessarily reflected in autistic accounts of the way they experience social cognition and pragmatics.

AIMS

The present paper aims to investigate the autistic experience of communication with both autistic and neurotypical people, with a particular focus on their perception of the ability of autistic and neurotypical people to understand their communicative intentions.

METHODS & PROCEDURES

Participants, 23 adult Italian autistic people without intellectual disability or language disorders, were recruited online. Two virtual focus groups of 2 hours each were conducted, transcribed and analysed through thematic analysis with a descriptive phenomenological approach by two independent researchers.

OUTCOMES & RESULTS

Six themes were developed from the analysis, the most relevant being Autistic-Autistic communication and Autistic ToM. The results, in line with the Double Empathy theory, suggest there seem to be important differences between neurotypical and autistic people's ToM. These appear to make it easier for autistic people to communicate with one another, as well as to create difficulties for neurotypical people to understand autistic people, not just the other way around.

CONCLUSIONS & IMPLICATIONS

These results seem to confirm that challenges in cross-neurotype communication are better interpreted as mutual miscomprehension and reciprocal differences in ToM rather than deficits on the autistic part. This calls for a reframing of ToM and/or the need for autistic ToM as a construct, of which neurotypical people seem to be lacking. Moreover, these insights should be taken into account for speech and language therapy and clinical practice in general, advocating for a neurodiversity-informed view of co-constructed communication as well as for a broader societal change in which therapists can play a crucial role, through participatory approaches or raising awareness in their daily practice.

WHAT THIS PAPER ADDS

What is already known on the subject Autism is conceived as characterised by social cognition and communication difficulties, often linked to Theory of Mind (ToM) deficits. However, recent research suggested variations in ToM abilities within the autistic population and proposed alternative theories like the Double Empathy theory. Nevertheless, only a few studies examined how autistic individuals perceive communication across neurotypes. What this study adds Autistic individuals seem to find it easier to communicate with other autistic people, and they identify specific characteristics of neurotypical communication that hinder successful communication. Moreover, neurotypical people are perceived as having difficulties in autistic ToM, which seems to emerge as a relevant and needed construct in light of the Double Empathy problem. What are the clinical implications of this work? These findings can inform speech and language therapy and clinical practice about the potential gains of raising awareness on the Double Empathy problem and the higher communication ease inside the autistic community, alongside individualised support. Participatory approaches and closer collaboration with the autistic community also seem to be crucial for therapists to help improve communication experiences for autistic individuals.

Ten tips to carry out video consultations in nephrology

Video consultations have seen increasing use in nephrology since the COVID-19 pandemic with an aim to address constraints in F2F outpatient capacity and also patients' concerns around risks of infection when attending healthcare facilities. Nephrologists have learned through experience to use video consultations for providing routine follow up and also for ad hoc triage of unwell patients. Advantages of video consultations include convenience, cost savings through avoiding clinic overheads, and reducing the carbon footprint of care. The last is increasingly relevant as nephrologists consider climate change and its implications. Video consultations are not a panacea to overcome challenges in nephrology and risks also exist for example when it comes to redesigning pathways and maintaining access to F2F assessments when required. It is equally important to consider practical aspects such as reimbursement, prescribing, and documentation. Some clinicians may wish to carry out video consultations from home to save time spent commuting but this, too, requires careful thought. Another consideration is the digital divide and support should be provided for patients who are less IT literate or who have no access to the digital world. Patients with special needs such as those with visual or hearing impairment and those with language issues also require consideration. We view video consultations as a developing and growing part of the portfolio of renal care. We see their main role in providing routine follow up to stable and IT literate outpatients, particularly where there is provider continuity and where care is provided across a large geographical area.

A Corpus Study on the Difference of Turn-Taking in Online Audio, Online Video, and Face-to-Face Conversation

Daily conversation is usually face-to-face and characterized by rapid and fluent exchange of turns between interlocutors. With the need to communicate across long distances, advances in communication media, online audio communication, and online video communication have become convenient alternatives for an increasing number of people. However, the fluency of turn-taking may be influenced when people communicate using these different modes. In this study, we conducted a corpus analysis of face-to-face, online audio, and online video conversations collected from the internet. The fluency of turn-taking in face-to-face conversations differed from that of online audio and video conversations. Namely, the timing of turn-taking was shorter and with more overlaps in face-to-face conversations compared with online audio and video conversations. This can be explained by the limited ability of online communication modes to transmit non-verbal cues and network latency. In addition, our study could not completely exclude the effect of formality of conversation. The present findings have implications for the rules of turn-taking in human online conversations, in that the traditional rule of no-gap-no-overlap may not be fully applicable to online conversations.

Tailoring communication practices to support effective delivery of telehealth in general practice

BACKGROUND

The unprecedented increase in telehealth use due to COVID-19 has changed general practitioners' (GP) and patients' engagement in healthcare. There is limited specific advice for effective communication when using telehealth. Examining telehealth use in practice in conjunction with perspectives on telehealth as they relate to communication allows opportunities to produce evidence-based guidance for optimal use of telehealth, while also offering practitioners the opportunity to reflect on elements of their communicative practice common to both styles of consultation. The objective of this research was to develop evidence-based resources to support effective, person-centred communication when GPs and patients use telehealth. This included examination of interactional practices of recorded telehealth consultations, exploration of GP and patient perspectives relating to telehealth, and identifying priorities for guidance informed by these analyses as well as participant co-design.

METHODS

This study involved recording telehealth consultations (n = 42), conducting patient surveys (n = 153), and interviewing patients (n = 9) and GPs (n = 15). These were examined using interaction analytic methods, quantitative analysis, and thematic analyses, to create a robust, integrated picture of telehealth practice and perspectives. The process of research translation involved a co-design approach, engaging with providers, patients, and policy makers to facilitate development of evidence-based principles that focus on supporting effective communication when using telehealth.

RESULTS

Three key themes relating to communication in telehealth were identified across the different analyses. These were relationship building, conversational flow, and safety netting. The draft best practice principles drawn from these themes were modified based on co-design feedback into five Best Practice Principles for Communication between GPs and Patients using Telehealth.

CONCLUSIONS

Effective communication is supported through relationship building and attention to conversational flow in telehealth consultations, which in turn allows for safety netting to occur. In telehealth, GPs and patients recognise that not being co-present changes the consultation and use both intuitive and strategic interactional adjustments to support their exchange. The mixed-method examination of experiences through both a detailed analysis of telehealth consultations in practice and comparative exploration of GP and patient perspectives enabled the identification of principles that can support effective communication when using telehealth. Co-design helped ensure these principles are ready for implementation into practice.

Empathy, working alliance, treatment expectancy and credibility in video and face-to-face psychotherapeutic first contact

Objective Video-based therapy has been used increasingly since the onset of the COVID-19 pandemic. Yet, video-based initial psychotherapeutic contact can be problematic due to the limitations of computer-mediated communication. At present, little is known about the effects of video first contact on important psychotherapeutic processes. Method: Forty-three individuals (nvideo = 18, nface-to-face = 25) were recruited via an outpatient clinic waiting list and were randomly assigned to video or face-to-face initial psychotherapeutic sessions. Participants rated treatment expectancy before and after the session, and the therapist's empathy, working alliance, and credibility after the session and several days later. Results: Empathy and working alliance ratings of patients and therapists were high and did not differ between the two communication conditions after the appointment or at follow-up. Treatment expectancy increased to a similar extent for the video and face-to-face modalities from pre to post. Willingness to continue with video-based therapy increased in participants who had video contact, but not in those with face-to-face contact. Conclusion: This study indicates that crucial processes related to the therapeutic relationship can be initiated via video, without prior face-to-face contact. Given the limited nonverbal communication cues in video appointments, it remains unclear as to how such processes evolve.Trial registration: German Clinical Trials Register identifier: DRKS00031262..

Video analysis of communication by physiotherapists and patients in video consultations: a qualitative study using conversation analysis

OBJECTIVES

To investigate the challenges of doing physical examinations and exercises by video, and the communication strategies used by physiotherapists and patients to overcome them.

DESIGN

A qualitative study of talk and social actions, examining the verbal and non-verbal communication practices used by patients and physiotherapists. Video consultations between physiotherapists and patients were video recorded using MS Teams, transcribed and analysed in detail using Conversation Analysis.

SETTING

Video consultations were recorded in three specialist settings (long-term pain, orthopaedics, and neuromuscular rehabilitation) across two NHS hospitals.

PARTICIPANTS

15 adult patients (10 female, 5 male; aged 20-77) with a scheduled video consultation.

RESULTS

Examinations and exercises retain-->were successfully accomplished in all 15 consultations. Two key challenges were identified for physiotherapists and patients when doing video assessments: (1) managing safety and clinical risk, and (2) making exercises and movements visible. Challenges were addressed by through communication practices that were patient-centred and tailored to the video context (e.g., explaining how to frame the body to the camera or adjust the camera to make the body visible).

CONCLUSIONS

Video is being used by physiotherapists to consult with their patients. This can work well, but tailored communication strategies are critical to help participants overcome the challenges of remote physical examinations and exercises.

CONTRIBUTION OF THE PAPER

This paper is a first to use video-based analysis to determine the challenges of video consulting for doing remote assessments and exercises in physiotherapy settings. It demonstrates how patients and physiotherapists use communication strategies to raise concerns around safety and visibility and how they overcome these concerns.

How Informal Carers Support Video Consulting in Physiotherapy, Heart Failure, and Cancer: Qualitative Study Using Linguistic Ethnography

BACKGROUND

Informal carers play an important role in the everyday care of patients and the delivery of health care services. They aid patients in transportation to and from appointments, and they provide assistance during the appointments (eg, answering questions on the patient's behalf). Video consultations are often seen as a way of providing patients with easier access to care. However, few studies have considered how this affects the role of informal carers and how they are needed to make video consultations safe and feasible.

OBJECTIVE

This study aims to identify how informal carers, usually friends or family who provide unpaid assistance, support patients and clinicians during video consultations.

METHODS

We conducted an in-depth analysis of the communication in a sample of video consultations drawn from 7 clinical settings across 4 National Health Service Trusts in the United Kingdom. The data set consisted of 52 video consultation recordings (of patients with diabetes, gestational diabetes, cancer, heart failure, orthopedic problems, long-term pain, and neuromuscular rehabilitation) and interviews with all participants involved in these consultations. Using Linguistic Ethnography, which embeds detailed analysis of verbal and nonverbal communication in the context of the interaction, we examined the interactional, technological, and clinical work carers did to facilitate video consultations and help patients and clinicians overcome challenges of the remote and video-mediated context.

RESULTS

Most patients (40/52, 77%) participated in the video consultation without support from an informal carer. Only 23% (12/52) of the consultations involved an informal carer. In addition to facilitating the clinical interaction (eg, answering questions on behalf of the patient), we identified 3 types of work that informal carers did: facilitating the use of technology; addressing problems when the patient could not hear or understand the clinician; and assisting with physical examinations, acting as the eyes, ears, and hands of the clinician. Carers often stayed in the background, monitoring the consultation to identify situations where they might be needed. In doing so, copresent carers reassured patients and helped them conduct the activities that make up a consultation. However, carers did not necessarily help patients solve all the challenges of a video consultation (eg, aiming the camera while laying hands on the patient during an examination). We compared cases where an informal carer was copresent with cases where the patient was alone, which showed that carers provided an important safety net, particularly for patients who were frail and experienced mobility difficulties.

CONCLUSIONS

Informal carers play a critical role in making video consultations safe and feasible, particularly for patients with limited technological experience or complex needs. Guidance and research on video consulting need to consider the availability and work done by informal carers and how they can be supported in providing patients access to digital health care services.

Quality framework for remote antenatal care: qualitative study with women, healthcare professionals and system-level stakeholders

BACKGROUND

High-quality antenatal care is important for ensuring optimal birth outcomes and reducing risks of maternal and fetal mortality and morbidity. The COVID-19 pandemic disrupted the usual provision of antenatal care, with much care shifting to remote forms of provision. We aimed to characterise what quality would look like for remote antenatal care from the perspectives of those who use, provide and organise it.

METHODS

This UK-wide study involved interviews and an online survey inviting free-text responses with: those who were or had been pregnant since March 2020; maternity professionals and managers of maternity services and system-level stakeholders. Recruitment used network-based approaches, professional and community networks and purposively selected hospitals. Analysis of interview transcripts was based on the constant comparative method. Free-text survey responses were analysed using a coding framework developed by researchers.

FINDINGS

Participants included 106 pregnant women and 105 healthcare professionals and managers/stakeholders. Analysis enabled generation of a framework of the domains of quality that appear to be most relevant to stakeholders in remote antenatal care: efficiency and timeliness; effectiveness; safety; accessibility; equity and inclusion; person-centredness and choice and continuity. Participants reported that remote care was not straightforwardly positive or negative across these domains. Care that was more transactional in nature was identified as more suitable for remote modalities, but remote care was also seen as having potential to undermine important aspects of trusting relationships and continuity, to amplify or create new forms of structural inequality and to create possible risks to safety.

CONCLUSIONS

This study offers a provisional framework that can help in structuring thinking, policy and practice. By outlining the range of domains relevant to remote antenatal care, this framework is likely to be of value in guiding policy, practice and research.

Communication in Telehealth: A State-of-the-Art Literature Review of Conversation-Analytic Research

We provide a state-of-the-art review of research on conversation analysis and telehealth. We conducted a systematic review of the literature, focusing on studies that investigate how technology is procedurally consequential for the interaction. We discerned three key topics: the interactional organization, the therapeutic relationship, and the clinical activities of the encounter. The literature on telehealth is highly heterogeneous, with significant differences between text-based care (e.g., via chat or e-mail) and audio(visual) care (e.g., via telephone or video). We discuss the extent to which remote care can be regarded as a demarcated field for study or whether the medium is merely part of the "context," particularly when investigating hybrid and polymedia forms of care involving multiple technological media.

'When the visible body is no longer the seer': The phenomenology of perception and the clinical gaze in video consultations

Video technology enabled professionals and patients to conduct consultations during the COVID-19 pandemic when in-person health care was minimised to reduce the spread of the virus. We present findings of a study of video-consulting through in-depth qualitative remote interviews with 40 health professionals, managers, support staff and 10 patients in health-care services across the UK from 2020 to 2021. Drawing on Foucault's concept of the clinical gaze, Merleau-Ponty's work on the phenomenology of perception and Ihde's postphenomenology we interpreted the ways in which remote consultations shaped patient-professional interactions, mediating and framing what was seen, revealed and known. We found that participating in video consultations not only involved creative adaption and adjustment to a virtual clinic but also changed how professionals and patients saw and were seen. We argue that this mode of consulting can transform boundaries and perceptions, alter aspects of clinical presence, knowledge and embodiment and thus both change and incorporate the clinical gaze.

How video calls affect mimicry and trust during interactions

Many social species, humans included, mimic emotional expressions, with important consequences for social bonding. Although humans increasingly interact via video calls, little is known about the effect of these online interactions on the mimicry of scratching and yawning, and their linkage with trust. The current study investigated whether mimicry and trust are affected by these new communication media. Using participant-confederate dyads (n = 27), we tested the mimicry of four behaviours across three different conditions: watching a pre-recorded video, online video call, and face-to-face. We measured mimicry of target behaviours frequently observed in emotional situations, yawn and scratch and control behaviours, lip-bite and face-touch. In addition, trust in the confederate was assessed via a trust game. Our study revealed that (i) mimicry and trust did not differ between face-to-face and video calls, but were significantly lower in the pre-recorded condition; and (ii) target behaviours were significantly more mimicked than the control behaviours. This negative relationship can possibly be explained by the negative connotation usually associated with the behaviours included in this study. Overall, this study showed that video calls might provide enough interaction cues for mimicry to occur in our student population and during interactions between strangers. This article is part of a discussion meeting issue 'Face2face: advancing the science of social interaction'.

On the Multimodal Resolution of a Search Sequence in Virtual Reality

In virtual reality (VR), participants may not always have hands, bodies, eyes, or even voices—using VR helmets and two controllers, participants control an avatar through virtual worlds that do not necessarily obey familiar laws of physics; moreover, the avatar’s bodily characteristics may not neatly match our bodies in the physical world. Despite these limitations and specificities, humans get things done through collaboration and the creative use of the environment. While multiuser interactive VR is attracting greater numbers of participants, there are currently few attempts to analyze the in situ interaction systematically. This paper proposes a video-analytic detail-oriented methodological framework for studying virtual reality interaction. Using multimodal conversation analysis, the paper investigates a nonverbal, embodied, two-person interaction: two players in a survival game strive to gesturally resolve a misunderstanding regarding an in-game mechanic—however, both of their microphones are turned off for the duration of play. The players’ inability to resort to complex language to resolve this issue results in a dense sequence of back-and-forth activity involving gestures, object manipulation, gaze, and body work. Most crucially, timing and modified repetitions of previously produced actions turn out to be the key to overcome both technical and communicative challenges. The paper analyzes these action sequences, demonstrates how they generate intended outcomes, and proposes a vocabulary to speak about these types of interaction more generally. The findings demonstrate the viability of multimodal analysis of VR interaction, shed light on unique challenges of analyzing interaction in virtual reality, and generate broader methodological insights about the study of nonverbal action.

Synthesis of the Evidence on What Works for Whom in Telemental Health: Rapid Realist Review

BACKGROUND

Telemental health (delivering mental health care via video calls, telephone calls, or SMS text messages) is becoming increasingly widespread. Telemental health appears to be useful and effective in providing care to some service users in some settings, especially during an emergency restricting face-to-face contact, such as the COVID-19 pandemic. However, important limitations have been reported, and telemental health implementation risks the reinforcement of pre-existing inequalities in service provision. If it is to be widely incorporated into routine care, a clear understanding is needed of when and for whom it is an acceptable and effective approach and when face-to-face care is needed.

OBJECTIVE

This rapid realist review aims to develop a theory about which telemental health approaches work (or do not work), for whom, in which contexts, and through what mechanisms.

METHODS

Rapid realist reviewing involves synthesizing relevant evidence and stakeholder expertise to allow timely development of context-mechanism-outcome (CMO) configurations in areas where evidence is urgently needed to inform policy and practice. The CMO configurations encapsulate theories about what works for whom and by what mechanisms. Sources included eligible papers from 2 previous systematic reviews conducted by our team on telemental health; an updated search using the strategy from these reviews; a call for relevant evidence, including "gray literature," to the public and key experts; and website searches of relevant voluntary and statutory organizations. CMO configurations formulated from these sources were iteratively refined, including through discussions with an expert reference group, including researchers with relevant lived experience and frontline clinicians, and consultation with experts focused on three priority groups: children and young people, users of inpatient and crisis care services, and digitally excluded groups.

RESULTS

A total of 108 scientific and gray literature sources were included. From our initial CMO configurations, we derived 30 overarching CMO configurations within four domains: connecting effectively; flexibility and personalization; safety, privacy, and confidentiality; and therapeutic quality and relationship. Reports and stakeholder input emphasized the importance of personal choice, privacy and safety, and therapeutic relationships in telemental health care. The review also identified particular service users likely to be disadvantaged by telemental health implementation and a need to ensure that face-to-face care of equivalent timeliness remains available. Mechanisms underlying the successful and unsuccessful application of telemental health are discussed.

CONCLUSIONS

Service user choice, privacy and safety, the ability to connect effectively, and fostering strong therapeutic relationships need to be prioritized in delivering telemental health care. Guidelines and strategies coproduced with service users and frontline staff are needed to optimize telemental health implementation in real-world settings.

TRIAL REGISTRATION

International Prospective Register of Systematic Reviews (PROSPERO); CRD42021260910; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260910.

Implications of video chat use for young children's learning and social-emotional development: Learning words, taking turns, and fostering familial relationships

Parents of young children use video chat differently than other screen media, paralleling expert recommendations (e.g., American Academy of Pediatrics Council on Communications and Media, 2016), which suggest that video chat, unlike other screen media, is acceptable for use by children under 18 months. Video chat is unique among screen media in that it permits contingent (time-sensitive and content-sensitive) social interactions. Contingent social interactions take place between a child and a partner (dyadic), with objects (triadic), and with multiple others (multi-party configurations), which critically underpin development in multiple domains. First, we review how contingent social interaction may underlie video chat's advantages in two domains: for learning (specifically learning new words) and for social-emotional development (specifically taking turns and fostering familial relationships). Second, we describe constraints on video chat use and how using chat with an active adult (co-viewing) may mitigate some of its limitations. Finally, we suggest future research directions that will clarify the potential advantages and impediments to the use of video chat by young children. This article is categorized under: Linguistics > Language Acquisition Psychology > Learning Cognitive Biology > Social Development.

Agency and the telephone: Patient contributions to the clinical and interactional agendas in telehealth consultations

OBJECTIVE

Patient-centredness is central to providing safe care and is achieved, in part, through involving patients in developing the agenda of the consultation. Medical consultations have changed significantly over the last two years as a result of COVID-19 and thus understanding how patients contribute to the clinical and interactional agendas within a telehealth consultation is important to supporting quality care.

METHODS

A collection (15) of consultations (in English) between specialists (3) and patients (14) were recorded in a metropolitan gastrointestinal clinic in Australia. These recordings were closely examined using conversation analysis, which focuses on the structural and sequential organisation of interaction.

RESULTS

Patients used a variety of interactional approaches to contribute to the agenda throughout the consultations. This was achieved in collaboration with the doctors, whose responses generally allowed for these contributions. However, there were few doctor-driven, explicit opportunities provided to patients to contribute to the agenda.

CONCLUSION

Many patients and doctors are adept at managing the interactional challenges of telehealth consultations but there are clear opportunities to extend this advantage to those patients with less agency.

PRACTICE IMPLICATIONS

Providing an explicit space for patients to ask questions within the consultation would support those patients less inclined or able to assert themselves during a telehealth consultation.

Using Linguistic Ethnography to Study Video Consultations: A Call to Action and Future Research Agenda

Video consultations are a rapidly growing service model, particularly in secondary care. Studies, mainly using trials and post-hoc surveys, have routinely documented that they can be a safe and effective means to deliver care at a distance. While video offers new opportunities to provide health services, it also constrains how patients and clinicians can interact, raising questions about feasibility, quality, and safety-questions that cannot be adequately addressed with prevailing methods and approaches. To support successful and appropriate implementation, use and spread of video consultations, we need to investigate how video changes the interaction. In this article, we use two worked examples to demonstrate how Linguistic Ethnography, a methodological approach combining ethnographic with linguistic analysis, enables a detailed understanding of how communication in video consultations works, providing an evidence base to support patients and clinicians with using this service model.

Telepsychiatry: learning from the pandemic

This article draws on research and clinical experience to discuss how and when to use video consultations in mental health settings. The appropriateness and impact of virtual consultations are influenced by the patient's clinical needs and social context, as well as by service-level socio-technical and logistical factors.

Social interaction is a catalyst for adult human learning in online contexts

Human learning is highly social.^1-3 Advances in technology have increasingly moved learning online, and the recent coronavirus disease 2019 (COVID-19) pandemic has accelerated this trend. Online learning can vary in terms of how "socially" the material is presented (e.g., live or recorded), but there are limited data on which is most effective, with the majority of studies conducted on children^4-8 and inconclusive results on adults.^9,10 Here, we examine how young adults (aged 18-35) learn information about unknown objects, systematically varying the social contingency (live versus recorded lecture) and social richness (viewing the teacher's face, hands, or slides) of the learning episodes. Recall was tested immediately and after 1 week. Experiment 1 (n = 24) showed better learning for live presentation and a full view of the teacher (hands and face). Experiment 2 (n = 27; pre-registered) replicated the live-presentation advantage. Both experiments showed an interaction between social contingency and social richness: the presence of social cues affected learning differently depending on whether teaching was interactive or not. Live social interaction with a full view of the teacher's face provided the optimal setting for learning new factual information. However, during observational learning, social cues may be more cognitively demanding¹¹ and/or distracting,^12-14 resulting in less learning from rich social information if there is no interactivity. We suggest that being part of a genuine social interaction catalyzes learning, possibly via mechanisms of joint attention,¹⁵ common ground,¹⁶ or (inter-)active discussion, and as such, interactive learning benefits from rich social settings.^17,18.

Effects of Transmission Delay on Client Participation in Video-Mediated Group Health Counseling

In face-to-face group counseling, active client participation contributes to the counseling agenda by a variety of social processes, but little is known about how video mediation shapes client participation. In this article, we use conversation analysis to investigate how transmission delay affects client participation in video-mediated group counseling through shaping the resolution of overlapping talk. Data are video recordings from three video-mediated group health counseling sessions recorded simultaneously in the two participating locations. The delay changes the timing of the overlapping turns and pauses at each end of the mediated counseling, making it difficult to interpret who should take the turn after the overlap. This may pose obstacles to client participation. While mediated counseling services can increase access to services and thus improve client participation at a macro level, transmission delay can pose threats to active client participation at the micro level of interaction.

Teaching via Zoom: Emergent Discourse Practices and Complex Footings in the Online/Offline Classroom Interface

The COVID-19 pandemic caused educational institutions across the world to face a new reality: when teachers and students do not share the same physical space (fractured ecologies), drastic changes in the everyday procedures and routines of teaching become an immediate necessity. In this paper, we trace some of the effects of this new situation in online classes of three experienced university teachers in the early days of the pandemic. We zoom in on dimensions of the classroom interface such as: turn-taking procedures, socialization, peer scaffolding and feedback; strategic footing changes across institutional and conversational roles; joking and humor. Not surprisingly, we found that the systematic absence of multimodal contextualization cues like gaze direction and tracing the origin of sound/speech were a trouble source in these online multiparty settings. We also saw, however, that teachers and students were successful in reinventing themselves and in devising new ways to deal with the changed circumstances. We end the paper with a number of implications for research into the classroom interface, both online and offline.

Leadership reflections a year on from the rapid roll-out of virtual clinics due to COVID-19: a commentary

COVID-19 changed the way we delivered care to our patients at our Hospital. Prior to the pandemic, no patient facing video clinics and only a small number of telephone clinics were held. In this paper, we share our experience of rapidly implementing virtual clinics (VCs) due to COVID-19. This commentary is based on focused discussions between hospital leaders and provides a reflective account and commentary on leadership lessons learnt from our experience of deploying VCs. We outline success factors (being able to capitalise on existing strategy, having time and space to establish VCs, using an agreed improvement framework, empowering a diverse and expert implementation team with a flat hierarchy, using efficient decision pathways, communication and staff willingness to change), technical challenges (patient capability and skills to use technology, patient connectivity and platform capacity) and considerations for the future (sustaining new ways of working, platform selection, integration, business continuity and commissioning considerations, barriers regarding capability and communication, effectiveness and clinical outcomes). Finally, we provide an overview of the leadership lessons from this project and identify key areas of focus for delivering successful change projects in future (the vision, allocation of resources, methodology selection and managing the skills gap).

Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics

Establishing and running remote consultation services is challenging politically (interest groups may gain or lose), organizationally (remote consulting requires implementation work and new roles and workflows), economically (costs and benefits are unevenly distributed across the system), technically (excellent care needs dependable links and high-quality audio and images), relationally (interpersonal interactions are altered), and clinically (patients are unique, some examinations require contact, and clinicians have deeply-held habits, dispositions and norms). Many of these challenges have an under-examined ethical dimension. In this paper, we present a novel framework, Planning and Evaluating Remote Consultation Services (PERCS), built from a literature review and ongoing research. PERCS has 7 domains-the reason for consulting, the patient, the clinical relationship, the home and family, technologies, staff, the healthcare organization, and the wider system-and considers how these domains interact and evolve over time as a complex system. It focuses attention on the organization's digital maturity and digital inclusion efforts. We have found that both during and beyond the pandemic, policymakers envisaged an efficient, safe and accessible remote consultation service delivered through state-of-the art digital technologies and implemented via rational allocation criteria and quality standards. In contrast, our empirical data reveal that strategic decisions about establishing remote consultation services, allocation decisions for appointment type (phone, video, e-, face-to-face), and clinical decisions when consulting remotely are fraught with contradictions and tensions-for example, between demand management and patient choice-leading to both large- and small-scale ethical dilemmas for managers, support staff, and clinicians. These dilemmas cannot be resolved by standard operating procedures or algorithms. Rather, they must be managed by attending to here-and-now practicalities and emergent narratives, drawing on guiding principles applied with contextual judgement. We complement the PERCS framework with a set of principles for informing its application in practice, including education of professionals and patients.

Assessing the quality of support and discovering sources of resilience during COVID-19 measures in people with intellectual disabilities by professional carers

BACKGROUND

During COVID-19 measures face-to-face contact is limited and professional carers have to find other ways to support people with intellectual disabilities. COVID-19 measures can increase stress in people with intellectual disabilities, although some people may adapt to or grow from these uncertain situations. Resilience is the process of effectively negotiating, adapting to, or managing significant sources of stress and trauma. The current study aims to provide professional carers with new insights into how they can support people with intellectual disabilities.

METHOD

An online survey was shared through the social media and organizational newsletters of MEE ZHN (a non-governmental organization for people with disabilities). The resilience framework by Ungar (2019) was adapted to fit to people with intellectual disabilities during COVID-19 measures. Statistical analyses were performed in SPSS statistics version 26.

RESULTS

Results show that professional carers applied diverse and distal methods to maintain contact with people with intellectual disabilities during the COVID-19 measures. Professional carers reported a significant decrease in the quality of contact with clients with intellectual disabilities, but overall high levels of resilience in the same clients.

IMPLICATIONS

Online methods of communication are possibly insufficient for professionals to cover all needs of people with intellectual disabilities. During this pandemic professionals should be aware of stress but also of resilience in people with intellectual disabilities.