Managing conversational issues in information exchange between house officers and senior doctors during paediatric ward rounds

Effective interprofessional communication during ward rounds is essential for patient safety and medical education, yet conversational breakdowns frequently occur in hierarchical clinical settings. Research on communication issues and repair practices between junior and senior doctors remains limited in paediatric contexts, particularly in Asian teaching hospitals. This study investigated the types of conversational issues arising between house officers (first year junior doctors) and senior doctors during paediatric ward rounds, and examined the repair strategies used to manage these interactional challenges. Using a qualitative discourse analytic design informed by Conversation Analysis (CA), nine audio-recorded paediatric ward rounds conducted in a Malaysian teaching hospital were analysed. The analysis followed Drew, Chatwin, and Collins’ four-stage CA framework, with triangulated coding among three trained analysts enhancing rigour. A total of 86 issue sequences were identified, of which 60 were interactional, with speaking-related difficulties being the most frequent ( n = 47). Self-initiated self-repair (SISR) through repetition and replacement predominated among house officers, whereas senior doctors employed other-initiated self-repair (OISR) via open-class initiators and candidate formulations to prompt clarification. These findings demonstrate that speaking difficulties are the most prevalent challenge and highlight the adaptive yet reactive nature of junior doctors' repair practices. By systematically applying CA in a Malaysian paediatric setting, this study contributes to understanding how hierarchical relationships are manifested in clinical discourse. In practical terms, the findings support structured communication training for house officers to enhance anticipatory clarity and systematic case presentation, alongside faculty development to foster psychologically safe feedback environments during ward rounds.