Practitioners' Noticing and Know-How in Multi-Activity Practice of Patient Care And Teaching and Learning

Developing a sound ability of noticing is a crucial competency for both teachers and medical professionals in the respective professional and disciplinary communities. In this article, we investigate noticing in practice-how members of a professional community in the high-tech modern medicine specialty of Advanced Heart Failure use this ability toward developing and sustaining what it means to be a competent practitioner and what counts as a relevant practice of noticing in their moment-to-moment training. A multimodal analysis of videotaped practice is conducted on professionals' interactions who are simultaneously engaged in multiple activities:patient careandteaching and learningin graduate medical education. Toward this end, we expand the concept of noticing to (1) include a relational aspect, attending to and caring for the Other (students, patients); and (2) shift the analytic focus from an observer's interpretation of a scene to a concerted production of the scenic features to make sense ofnoticing in practice.