Organic or organised: an interaction analysis to identify how interactional practices influence participation in group decision meetings for residency selection

Lokke Gennissen, Anne de la Croix, Karen Stegers-Jager, Jacqueline de Graaf, Cornelia R M G Fluit, Matthijs de Hoog

Research output: Contribution to JournalArticleAcademicpeer-review


OBJECTIVES: This study aims to shed light on interactional practices in real-life selection decision-making meetings. Adequate residency selection is crucial, yet currently, we have little understanding of how the decision-making process takes place in practice. Since having a wide range of perspectives on candidates is assumed to enhance decision-making, our analytical focus will lie on the possibilities for committee members to participate by contributing their perspective.

DESIGN: We analysed interaction in seven recorded real-life selection group decision meetings, with explicit attention to participation.

SETTING: Selection meetings of four different highly competitive specialties in two Dutch regions.

PARTICIPANTS: 54 participants discussed 68 candidates.

METHODS: To unravel interactional practices, group discussions were analysed using a hybrid data-driven, iterative analytical approach. We paid explicit attention to phenomena which have effects on participation. Word counts and an inductive qualitative analysis were used to identify existing variations in the current practices.

RESULTS: We found a wide variety of practices. We highlight two distinct interactional patterns, which are illustrative of a spectrum of turn-taking practices, interactional norms and conventions in the meetings. Typical for the first pattern-'organised'-is a chairperson who is in control of the topic and turn-taking process, silences between turns and a slow topic development. The second pattern-'organic'-can be recognised by overlapping speech, clearly voiced disagreements and negotiation about the organisation of the discussion. Both interactional patterns influence the availability of information, as they create different types of thresholds for participation.

CONCLUSIONS: By deconstructing group decision-making meetings concerning resident selection, we show how structure, interactional norms and conventions affect participation. We identified a spectrum ranging from organic to organised. Both ends have different effects on possibilities for committee members to participate. Awareness of this spectrum might help groups to optimise decision processes by enriching the range of perspectives shared.

Original languageEnglish
Article numbere026424
Pages (from-to)e026424
JournalBMJ Open
Issue number12
Publication statusPublished - 3 Dec 2019

Bibliographical note

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.


We identified a spectrum of possible ways to structure residency selection group decision-making meetings, ranging from organic to organised, and identified which effects these structures could have on the participation of selection committee members. Although our data showed a wide variety of possibilities and our results did not offer one clear cut most effective solution, these insights allow groups to consciously structure their group decision-making in order to benefit from more opinions and viewpoints in the decision-making. Group decision-making will benefit from further empirical work to unravel the practical implications for this complicated process. We are very grateful to all of the selection committee members for their cooperation in our research. We would like to thank Marloes Duitsman for her help in the beginning of data analysis. We would like to thank Peter de Hoog for editorial assistance. AdlC and KS-J contributed equally. Contributors LG is a female medical doctor by training and is a PhD student in medical education, focusing on recruitment and selection for a future diverse and adequate workforce, with a Dutch background. Her interest in the topic originated from her own career experiences while studying medicine and a longstanding interest in education. KS-J is a female educational scientist and works as an associate professor at the institute of Medical Education Research Rotterdam. Her research focuses on diversity in the selection for medical education. AdlC is a female linguist. She works as a teacher and researcher (using Conversation Analysis) in higher and medical education. CRMGF is a female medical doctor currently working as associate professor and educational researcher with expertise in feedback in workplace learning. JdG is a female programme director and professor at the internal medicine department. MdH is a male programme director and professor at the pediatric department. LG, AdlC, KS-J, CRMGF, JdG and MdH contributed to the design of the study and interpretation of the data. LG observed and recorded the group discussions. LG and AdlC were responsible for the main data analysis. LG, AdlC, KS-J, CRMGF, JdG and MdH contributed to and approved the final manuscript. Funding This work was supported by the Dutch Ministry of Health, Welfare and Sports; Project Dedicated Schakeljaar. Competing interests None declared. Patient consent for publication Not required. Ethics approval This study has been approved by the Dutch Association for Medical Education Ethical Review Board (NVMO-ERB), dossier number 421. Selection committee members gave informed consent for sharing of anonymised data. Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Additional anonymized data available from the main author upon request. This work was supported by the Dutch Ministry of Health, Welfare and Sports; Project Dedicated Schakeljaar.

FundersFunder number
Ministerie van Volksgezondheid, Welzijn en Sport
Ministry of Health, Labour and Welfare


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