‘Hm no-one says anything, did you notice?’

Communication in the operating theatre amidst a hierarchy of expertise


  • Ged M. Murtagh Imperial College London
  • Jeff Bezemer UCL Institute of Education




communication, conversation analysis, expertise, hierarchy, intraoperative decision making, surgical teamwork


Effective teamwork is a critical feature of surgical practice and is based on shared expectations and understandings between team members. These shared understandings are intimately tied to a hierarchy of expertise pertaining to role, responsibility and participation status, and it has been suggested that this can sometimes negatively impact trainees’ experience of intraoperative surgical training. This paper examines this issue, exploring how surgeons and their trainees collaboratively manage decision making amidst the hierarchy of expertise. Our data set consists of audio and video recordings of surgical procedures, which are examined using conversation analysis. Our findings indicate that implicit in the interactions between consultant surgeons and trainees is the expectation that the lead surgeon is the authoritative expert and will therefore direct decision making. Trainees actively acquiesce to that order. Notwithstanding this, the analysis underscores some of the interactional practices used by surgeons and trainees which preserve, and on rare occasions, challenge that hierarchical relation. The paper concludes by considering the implications of the findings within the broader context of patient safety.

Author Biographies

Ged M. Murtagh, Imperial College London

Ged M. Murtagh is currently a Senior Lecturer in the Department of Surgery and Cancer, Imperial College London. He is one of the leads for the Clinical Communication Programme for Medical Undergraduates at Imperial and his main research interest is conversation analysis of communication practices in healthcare settings.

Jeff Bezemer, UCL Institute of Education

Jeff Bezemer is Professor of Communication and Co-Director of the Centre for Multimodal Research at UCL Institute of Education. He draws on videoethnographic methods to explore inter-professional communication and teamwork in healthcare. Recent book publications include Multimodality, Learning and Communication: A Social Semiotic Frame and Introducing Multimodality.


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How to Cite

Murtagh, G. M. ., & Bezemer, J. (2021). ‘Hm no-one says anything, did you notice?’: Communication in the operating theatre amidst a hierarchy of expertise. Communication and Medicine, 17(1), 17–31. https://doi.org/10.1558/cam.15138