Fiction is used for educational purposes in various fields such as engineering, law and higher education. In medical education, the theories of medical humanities and narrative medicine propose that engaging with fictional works can provide opportunities for medical students and physicians to develop central professional skills such as emotional awareness and empathy, which can help mitigate the documented empathy decline which occurs during medical training. Despite extensive research about fiction inclusion in medical education, there is very limited research on the in-situ processes of fiction use, and how emotional aspects of the medical profession can be conceptualised in fiction discussions. This thesis investigates the intersection of fiction, interaction and emotion in medical education. The purpose of the study is to contribute knowledge on the ways emotion can be constructed in medical education as affective stances and as professional emotions that medical students need to learn how to manage. Discursive psychology (DP) forms the theoretical and methodological framework to analyse 58 hours of video- and audio-recorded fiction seminars from two Swedish medical schools. Emotion from a DP perspective is understood not as a reflection of an inner experience, but as an interactionally achieved phenomenon, deployed in the formation of social action. Results show that reflection and reflective practices are imbedded in fiction seminars, and that affective stances are constructed as a student resource to manage intensity, control, assessment and accountability. Furthermore, the professional emotions of physicians are constructed as emotional labour which students need to prepare for, and the feeling rules of the medical profession are constructed as calibrations of emotions which are both fluid and changeable. The task of learning professional emotion is oriented to as troublesome by students as it might interfere with their focus on managing student identities.

Although there is a large body of research about emotional labour in workplace settings, such as the health professions and the service industry, less is known about the empirical processes through which emotional labour is taught in higher education and professional education. Using medical education as an example, a discursive psychological (DP) approach is used in this paper to detail how the feeling rules of the physicians profession are constructed by students and tutors in fiction, film, and poetry seminars. From a data set of 36 video- and audio-recorded fiction seminars from two medical schools, 29 sequences of discussions about emotional challenges for physicians were found. These examples have been transcribed in detail and analysed using DP. Analysis shows that students and tutors construct feeling rules as fluid, negotiable and changeable. Feeling rules are defined as the calibration of emotion to suit different situations as well as different physicians with different levels of emotionality. Students deploy constructions of feeling rules to manage student identities, and students and tutors construct emotion as a separation between subjective experience and observable behaviours, where the subject-side experience should be managed or controlled in the way it manifests externally.

In medical education, reflection is widely considered to be an important skill for physicians, and thus an important skill for medical students to learn. There is however no consensus on how reflection should be taught, and empirical research on in-situ reflective practices in medical education is fairly uncommon. This paper uses discursive psychology (DP) as theoretical and methodological framework to uncover how reflection is interactionally achieved in fiction sem-inars, which are used in medical education as a means to teach professional skills such as reflection and emotional awareness. In the data set of 58 h of video-and audio recordings from fiction seminars in two medical schools, 24 examples were found where students reflect on the possible learning outcomes of discussing fiction. Analysis shows that reflective practices are imbedded in fiction seminars, and that reflection is collectively achieved by students listening to each other, building on each others reflections and challenging each others viewpoints. These practices allow students to construct both resistance and learning while still adhering to the aims of the seminars of doing reflection.

Fiction is understood to have unique qualities that emotionally engage the reader, making it suitable as a didactic tool in medical education to help students prepare for the emotional aspects of their future profession. To date, however, little is known about the processes through which talking about fiction, film or poetry can help medical students to co-construct emotional reactions as affective stances and how that might contribute to their professional development.

Using a discursive psychology approach, video recordings from 36 fiction seminars collected from 2016 to 2018 were analysed regarding how affective stances related to reading were constructed by medical students. The findings illustrate how students use subject–object relations to account for affective stances, meaning that they attribute their emotional reaction either to an aspect of the book (object-side explanations), or to personal characteristics (subject-side explanations). The way students enact and account for their affective stances can provide opportunities for tutors to create teachable moments for the students. This study contributes to discursive psychology and reader-response research, as well as medical education research.

Vocational training programmes in higher education encompass, as learning objectives, the development of relational skills and professional judgement, especially in welfare professions such as policing, teaching and healthcare, where know-how about managing close contact with people is a prerequisite. Based on a cross-professional analysis, the current article explores how students from three different professional education programmes – teacher education, police training and medical education – construct professional judgement in group discussions and interviews. The results show that participants construct professional judgement as relationships between three different dimensions: personal ethics, educational standards, and professional practice. When discussing professional dilemmas, students utilise these three different dimensions to argue for the moral or ethical soundness of their choices. The results of the study shed light on the importance of providing students with opportunities to reflect openly on professional judgement in different ways, even though such reflections may not always be formally assessed. Furthermore, the analysis demonstrates similarities between the three programmes that we analysed, as well as similarities in students’ reflections regarding essential aspects of the professions.