Going “ old school ” : From bedside manner to deskside manner

Interaction between tertiary educators and students, we contend, improves trust and betters student responses to emotional distress while at university. Therefore, we introduce the “Deskside Manner Framework” as an emerging practice in the tertiary teaching and learning context to aid student transition success. Based on concepts and practice that originated primarily in the medical profession and later in other high credence professional contexts, the deskside manner framework includes: show respect, critical listening, the four Bs and follow up. Deskside manner is transferrable and we aim to facilitate it through workshops and by developing a digital repository of educator-student interaction stories. *This ‘New Idea and Emerging Initiative’ was first presented at the 2015 STARS Conference in Melbourne, Australia in July 2015 and was selected by the Conference Committee as one of the toprated reports. The authors have kindly given their permission to have this report published in the conference issue of the Journal and it has undergone a further review by the editors to confirm it aligns with the Journal format. Please cite this article as: Fleischman, D. & Imaz-Marial, O. (2015). Going “old school”: From bedside manner to deskside manner. Student Success, 6(2), 81-86. doi: 10.5204/ssj.v6i2.287 Student Success: A journal exploring the experiences of students in tertiary education This work is licensed under a Creative Commons Attribution 4.0 Licence. As an open access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings. ISSN: 2205-0795 Going “old school”: From bedside manner to deskside manner 82 | Student Success, 6(2) August, 2015 Introduction When I ask an educated person, what is the most significant experience in your education? I almost never get back an idea, but almost always a person (Tosteson, 1979, cited in Weissmann, Branch, Gracey, Haidet, & Frankel, 2006, p. 661). From the above quote and our experience, human interaction, trust and emotion are important facet of the tertiary education experience. Interaction with the educators is one of the most tangible features of the student experience. However, some argue that tertiary educators are researchers who teach, not teachers who research. For modern tertiary students, especially those transitioning from secondary to higher education, the humanistic interaction with educators may be the reason students choose to engage, stay enrolled or attrit. Thus, we pose the following question: How can human interaction between tertiary students and educators be enhanced to help increase emotional stability and trust in the tertiary education experience, whilst assisting in increasing engagement and reducing attrition? Through a derivative of “old school” bedside manner, we explore the concept of deskside manner as an emerging practice that can help foster enhanced stability for tertiary students, particularly in the transition phase. While bedside manner research is established within the medical context and deskside manner in the law context, to our knowledge, the practice of deskside manner has not been discussed in the tertiary education context. In this paper, we contend that bedside manner, in the form of deskside manner, is applicable to the tertiary education context as an emerging practice to help deliver a better quality, more holistic service to students in the transition phase. Accordingly, the paper is organised as follows. First, the contextual background guiding our conceptualisation of deskside manner is provided. A framework for deskside manner is then presented and discussed. Next, we offer ideas for implementing the framework. The paper concludes with suggestions for the suitability of deskside manner across institutions and questions for consideration. Contextual background The concept of deskside manner builds on existing practice in a variety of professional domains where human relations are salient. Our concept of deskside manner is guided by three professional contexts—medicine, law and general services provision. Each of these contexts is subsequently overviewed with connections drawn to tertiary education. Within the medical context, bedside manner has a long history as a component of practicing effective medicine. Although bedside manner remains somewhat difficult to define, it is commonly conceptualised as a professional relationship between a doctor and patient that is built on trust, empathy and patience through clear and genuine interpersonal communication (see Hunt, 1957; Iobst, 2013; McFadden, 2013). Its importance is underpinned by the humanistic element it adds to improve the overall treatment of a patient (Anderson, Barbara & Feldman, 2007). Hellin (2002) postulates, “...one of the essential qualities of clinicians is interest in humanity, for the secret of the care of patients is in caring for the patient” (p. 453). The notion is that bedside manner helps doctors give better holistic care to their patients by creating a level of empathy that builds a more trusting relationship, improving the overall outcome of the treatment prescribed to the patient (Hunt, 1957). Although some argue that bedside manner is disappearing due to the emphasis of business objectives in medical practices (Iobst, 2013), some medical schools and professional practices continue to incorporate bedside manner skills programs (McFadden, 2013; Weissmann et al., 2006). Thus, we suggest that the salience bedside Fleischman & Imaz-Marial Student Success, 6(2) August, 2015 | 83 manner holds in medicine is also fitting in tertiary education. Like tertiary education students, medical patients experience a variety of emotions such as anxiety, fear, self-pity, sadness, distress and discomfort (McFadden, 2013). These types of emotions are widely noted as an important consideration in the tertiary student experience. For example, emotions such fear, stress and excitement, are common in the tertiary student transition experience (Kahu, 2013; Krause & Coates, 2008). Tertiary educators need not only to be aware of these feelings, but also to make a conscious effort to alleviate them to establish some comfort and stability in the student experience just as a doctor with good bedside manner would provide. Resultantly, practicing deskside manner may help reduce attrition rates and improve the student engagement while transitioning into tertiary education. Within the law context, a search of the literature revealed evidence of deskside manner, albeit somewhat dated. Akin to this paper’s premise, the law research suggests applying the concept of bedside manner, as a basis for deskside manner in the context of legal services (Schwartz, 1985). Sternlight and Robbennolt (2008) contend that lawyers establish rapport with clients during interviewing and counselling sessions, and this assists the lawyer’s ability to provide and obtain information, and effectively counsel the client in the future. Legal situations can be very sensitive. Laredo-Fromson (1995) opines, people tend to seek legal advice as a result of negative circumstances. Effective people skills, in the form of deskside manner, help create a comfort in an unfamiliar environment for law clients (Baker, 1999). While on the whole, tertiary education is not a negative experience; implications can be drawn from the law context. The transition of bedside manner from the medical to the law context, demonstrates the potential for the transfer of deskside manner to the tertiary education context as a practice help enhance the quality of the student transition experience. Along with medicine and law, other high credence services embed aspects of deskside manner into their service provision. Research on service quality has validated the constructs of empathy and assurance (Parasuraman, Zeithaml, & Berry, 1988) in various high credence contexts such as finance, healthcare and IT. Empathy is defined as caring, individualised attention the service provider gives to service users; and assurance is defined as knowledge and courtesy of the service provider that establishes trust and confidence with service users (p. 23). For example, in the financial planning context, service users are motivated to continue a professional relationship when assured credence in the planners’ abilities develops. Service users assess credence by “how” the service is delivered and how courteous, caring, and professional the service provider is. Due to its high credence nature, we maintain a similar approach via deskside manner to enhance the tertiary education transition. In the transition period, students are emotionally sensitive and may experience heightened levels of stress, anxiety and/or fear (Kahu, 2013). Despite suggestions of the importance of student emotions, empirical research remains limited and yields little evidence of how emotion influences the tertiary student experience and engagement (Kahu, 2013; Miller & Donlan, 2014). Regard for student emotions via exploring deskside manner may help generate insight towards managing student emotions in the transition experience. We therefore posit the following definition of deskside manner as guided by the latter contexts: An educator’s ability to communicate and interact with students in a manner that establishes stability in the university experience through the creation of trust, comfort Going “old school”: From bedside manner to deskside manner 84 | Student Success, 6(2) August, 2015 and confidence in an ongoing professional relationship with students. A deskside manner framework Drawing from the contexts above and our experience interacting with students in tertiary education, we have developed a framework for deskside manner that consists of four components: 1) show respect, 2) listen critically, 3) the four “Bs” and 4) follow-up. Figure 1 illustrates our deskside manner framework.


Introduction
When I ask an educated person, what is the most significant experience in your education? I almost never get back an idea, but almost always a person (Tosteson, 1979, cited in Weissmann, Branch, Gracey, Haidet, & Frankel, 2006).
From the above quote and our experience, human interaction, trust and emotion are important facet of the tertiary education experience. Interaction with the educators is one of the most tangible features of the student experience. However, some argue that tertiary educators are researchers who teach, not teachers who research. For modern tertiary students, especially those transitioning from secondary to higher education, the humanistic interaction with educators may be the reason students choose to engage, stay enrolled or attrit. Thus, we pose the following question: How can human interaction between tertiary students and educators be enhanced to help increase emotional stability and trust in the tertiary education experience, whilst assisting in increasing engagement and reducing attrition?
Through a derivative of "old school" bedside manner, we explore the concept of deskside manner as an emerging practice that can help foster enhanced stability for tertiary students, particularly in the transition phase. While bedside manner research is established within the medical context and deskside manner in the law context, to our knowledge, the practice of deskside manner has not been discussed in the tertiary education context. In this paper, we contend that bedside manner, in the form of deskside manner, is applicable to the tertiary education context as an emerging practice to help deliver a better quality, more holistic service to students in the transition phase. Accordingly, the paper is organised as follows. First, the contextual background guiding our conceptualisation of deskside manner is provided. A framework for deskside manner is then presented and discussed. Next, we offer ideas for implementing the framework. The paper concludes with suggestions for the suitability of deskside manner across institutions and questions for consideration.

Contextual background
The concept of deskside manner builds on existing practice in a variety of professional domains where human relations are salient. Our concept of deskside manner is guided by three professional contexts-medicine, law and general services provision. Each of these contexts is subsequently overviewed with connections drawn to tertiary education.
Within the medical context, bedside manner has a long history as a component of practicing effective medicine. Although bedside manner remains somewhat difficult to define, it is commonly conceptualised as a professional relationship between a doctor and patient that is built on trust, empathy and patience through clear and genuine interpersonal communication (see Hunt, 1957;Iobst, 2013;McFadden, 2013). Its importance is underpinned by the humanistic element it adds to improve the overall treatment of a patient (Anderson, Barbara & Feldman, 2007). Hellin (2002) postulates, "…one of the essential qualities of clinicians is interest in humanity, for the secret of the care of patients is in caring for the patient" (p. 453). The notion is that bedside manner helps doctors give better holistic care to their patients by creating a level of empathy that builds a more trusting relationship, improving the overall outcome of the treatment prescribed to the patient (Hunt, 1957). Although some argue that bedside manner is disappearing due to the emphasis of business objectives in medical practices (Iobst, 2013), some medical schools and professional practices continue to incorporate bedside manner skills programs (McFadden, 2013;Weissmann et al., 2006). Thus, we suggest that the salience bedside manner holds in medicine is also fitting in tertiary education.
Like tertiary education students, medical patients experience a variety of emotions such as anxiety, fear, self-pity, sadness, distress and discomfort (McFadden, 2013). These types of emotions are widely noted as an important consideration in the tertiary student experience. For example, emotions such fear, stress and excitement, are common in the tertiary student transition experience (Kahu, 2013;Krause & Coates, 2008). Tertiary educators need not only to be aware of these feelings, but also to make a conscious effort to alleviate them to establish some comfort and stability in the student experience just as a doctor with good bedside manner would provide. Resultantly, practicing deskside manner may help reduce attrition rates and improve the student engagement while transitioning into tertiary education.
Within the law context, a search of the literature revealed evidence of deskside manner, albeit somewhat dated. Akin to this paper's premise, the law research suggests applying the concept of bedside manner, as a basis for deskside manner in the context of legal services (Schwartz, 1985). Sternlight and Robbennolt (2008) contend that lawyers establish rapport with clients during interviewing and counselling sessions, and this assists the lawyer's ability to provide and obtain information, and effectively counsel the client in the future. Legal situations can be very sensitive. Laredo-Fromson (1995) opines, people tend to seek legal advice as a result of negative circumstances. Effective people skills, in the form of deskside manner, help create a comfort in an unfamiliar environment for law clients (Baker, 1999). While on the whole, tertiary education is not a negative experience; implications can be drawn from the law context. The transition of bedside manner from the medical to the law context, demonstrates the potential for the transfer of deskside manner to the tertiary education context as a practice help enhance the quality of the student transition experience.
Along with medicine and law, other high credence services embed aspects of deskside manner into their service provision. Research on service quality has validated the constructs of empathy and assurance (Parasuraman, Zeithaml, & Berry, 1988) in various high credence contexts such as finance, healthcare and IT. Empathy is defined as caring, individualised attention the service provider gives to service users; and assurance is defined as knowledge and courtesy of the service provider that establishes trust and confidence with service users (p. 23). For example, in the financial planning context, service users are motivated to continue a professional relationship when assured credence in the planners' abilities develops. Service users assess credence by "how" the service is delivered and how courteous, caring, and professional the service provider is. Due to its high credence nature, we maintain a similar approach via deskside manner to enhance the tertiary education transition.
In the transition period, students are emotionally sensitive and may experience heightened levels of stress, anxiety and/or fear (Kahu, 2013). Despite suggestions of the importance of student emotions, empirical research remains limited and yields little evidence of how emotion influences the tertiary student experience and engagement (Kahu, 2013;Miller & Donlan, 2014). Regard for student emotions via exploring deskside manner may help generate insight towards managing student emotions in the transition experience. We therefore posit the following definition of deskside manner as guided by the latter contexts: An educator's ability to communicate and interact with students in a manner that establishes stability in the university experience through the creation of trust, comfort and confidence in an ongoing professional relationship with students.

A deskside manner framework
Drawing from the contexts above and our experience interacting with students in tertiary education, we have developed a framework for deskside manner that consists of four components: 1) show respect, 2) listen critically, 3) the four "Bs" and 4) follow-up. Figure 1 illustrates our deskside manner framework.

Show respect
Simple measures can be taken by tertiary educators that demonstrate their respect for students. Making eye contact with students, shaking hands, offering them a seat upon entering your office and thanking them for approaching you or emailing you (if communication is digital) constitute examples that exhibit respect. These measures help reduce the power distance and create a more egalitarian student-educator relationship. In turn, students feel more calm and comfortable which helps build trust in the information communicated by the educator.

Critical listening
There is a difference between hearing and critically listening. Critical listening entails processing and absorbing what is communicated. When a student attempts to communicate, it is important that the educator is not pre-occupied (e.g. answering emails). Each individual student has their own story that affects their tertiary experience. It is genuine and humanistic to listen critically while students tell their story. In doing so, the educator exhibits some empathy and assurance to students, and receives a better indication of how the student is progressing against the challenges in their experience.

The four "Bs"
Derived from the medical context (Ibost, 2013) the four "Bs"-be thorough, be clear, be honest and be firm-comprise another facet of the deskside manner framework. First, tertiary educators should try to be as thorough as possible with students. Encourage students to ask good questions. The better questions students ask, the better answer tertiary educators can provide, which helps create comfort and reduce uncertainty. Second, be clear and communicate in simple terms. Students are not discipline experts. Elucidate the course vocabulary with students. Clarify by summarising the main points of a discussion at the end of the conversation, especially if communicating digitally. Third, tertiary educators should aim to be honest with students. It may be just as beneficial to instruct students on what they do not need to know for an assessment, as it is for what they do need to know. Additionally, be honest about what institutional policies allow. Fourth, be firm with students. Let them know success is their choice. Deskside manner does not involve doing the work for them. It involves guiding and challenging students in an empathetic manner. Students have to do the work, just as medical

Follow up
The fourth component of the deskside manner framework is to follow up. When ending a conversation or finalising an email, ask students if what has been discussed was helpful. For instance, if a student sends an email and the educator replies to it and then recognises the student later in class, the educator should ask if the reply was understood. If a student raises a question or issue in class and the educator does not know the immediate answer, it would be helpful to follow up with an email after class. Finally, tertiary educators could encourage students to follow up with them about their professional endeavours after university.

Implementing the framework
To create awareness of deskside manner, we propose that an open seminar is advertised to all faculties, where a short presentation on the idea is given. Subsequent sessions could follow in forums such as Learning and Teaching week, allowing educators to participate in workshops for improving their deskside manner. Workshops could involve activities like role playing that are digitally taped. Educators could visually experience aspects of their deskside manner that could be improved. The sessions could also include embedding deskside manner into digital communication (e.g. mock email conversations). A repository of deskside manner experiences could also be developed for educators to draw on in the future. Finally, we have created a digital video clip that summarises this paper, which could be saved and viewed at an educator's convenience. We posit that our approach for implementing the deskside manner framework is transferrable across tertiary institutions.

Conclusion
Drawn from the medical, law and general service contexts, this paper presents the concept of deskside manner as a new and emerging initiative aimed at improving the tertiary student transition experience. Our deskside manner framework offers a straightforward pathway to more mindful student-educator experiences. In turn, deskside manner may assist in mitigating issues such as attrition of students in the transition period and enhance overall engagement. We consider deskside manner as an emerging practice that is adaptable across all Australian tertiary institutions. For future development of tertiary education deskside manner, we pose the following questions: Is deskside manner an important concept in the tertiary education context? Should deskside manner be taught to tertiary educators? How should it be taught? What types of experiences have you had that could have been improved via deskside manner?