For this analysis, we drew on 40 video recordings of hour-long ‘Learning from Experience’-sessions at all eight Dutch General Practitioners specialty training institutes. These recordings were collected for the project on teacher facilitation of ‘Learning from Experiences’ (van Braak, 2021). The sessions constituted an integral part of Dutch GP training. They were scheduled weekly during training days at the educational institute, and approximately ten GPs in training discussed recent experiences from practice under supervision of one (15 groups) or two (25 groups) teachers. An anonymized overview picture of one session is presented in Figure 1.

Teachers in the recordings were experienced GPs (35), specialist physicians (1) and behavioral scientists/psychologists (29), who supervised 14 first year, 12 s year, and 14 third year groups. Among others, the shared experiences concerned clinical cases, medical questions, training issues, and the interface between professional and personal life. The sessions’ aim was “creating educational value for future practice based on past experiences shared and discussed in the group” (van Braak et al., 2021; Veen and van Braak, 2022). Furthermore, the sessions offered space for trainees to discuss professional norms, which included talking about the effect experiences could have emotionally (van Braak et al., 2021; Rydén Gramner, 2022). The 40 sessions were recorded between 2017 and 2019 with two or three fixed cameras per session. Participants gave informed consent prior to recording; afterwards, they could request (partial) deletion of the recording. The Dutch Association of Medical Education provided ethical permission to conduct this study (NVMO, case number 829).

We analyzed the data in a conversation analytic collection study. Conversation analysis (CA) is an analytic approach that originates in sociology (Goodwin and Heritage, 1990). Closely linked to ethnomethodological approaches (ten Have, 2004), CA describes the interactional procedures that people use to do things in daily life. Through interaction, we construct the social world around us, and the conversation analyst attempts to answer what linguistic forms achieve at particular positions in interaction (Sidnell, 2013).

We conducted the analysis in several steps. After data collection, all video recordings were transcribed verbatim. Building on insights from five BA-thesis projects on ‘inviting emotion talk’ in these data (Dral, 2022; Houben, 2022; Mees, 2022; van der Horst, 2022; van Dolder, 2022), MvB and SS organized four data sessions (see Sidnell, 2013) to explore practices that teachers and residents used to invite talk about the emotional side of an experience. Data sessions were based on detailed transcripts following Jefferson conventions and subsequent refinements of those (Hepburn and Bolden, 2013; silences between turns are unmarked if representing a beat of silence, and otherwise represent an absolute measure of silence, see Hepburn and Bolden, p. 61). Sessions were attended by the authors, fellow conversation analysts and interested communication researchers. First, these preliminary analyses provided interactional evidence that teachers in these sessions oriented to the importance of emotion talk for reflection, and that (not) being emotionally affected can be a concern. Second, there was interactional evidence that GP teachers and residents (un)successfully pursue emotional leads in resident stories. In short, we found how teachers and residents must manage the delicacy of how to invite emotional talk. Although we noticed multiple ways to pursue emotional leads, the elicitation that builds on the word ‘raken’ (i.e., being affected) was a particularly salient way in our data that was used to explore displayed emotions. Therefore, MvB and SS focused exclusively on this form, and identified how different sequential positions and turn constructions contribute to the progress of exploring emotions within this educational setting. Our final collection consisted of 13 excerpts containing a form of ‘being affected’. All transcripts are presented in Dutch (gray) and English. Speakers designated with an A are the residents who share their experience in that Excerpt (A1 for Excerpt 1, A2 for Excerpt 2, etc.), speakers designated with a T are teachers, other speakers (B, C, etc.) are co-residents. Each participant is designated with a unique identifier (letter, number added for tellers and teachers).

In this section, we present evidence that participants in the Learning from Experience sessions are interactionally concerned with being ‘affected’. When someone in the session ‘does being affected’, or presents themselves as ‘having been affected’, it is often picked up and proffered as a topic for discussion. Pursuits around signs of someone ‘being affected’ are another piece of evidence suggesting the relevance of ‘being affected’ to participants in Learning from Experience sessions. Such participant orientation on the relevance of discussing ‘being affected’ is visible in Excerpt 1.

In Excerpt 1, resident A1 presents an experience from his residency in Africa, during which he performed a medical procedure on a patient who soon thereafter passed away. He contrasts the significance of the event with the apparent absence of an emotional response. The teacher’s (T1) uptake of this contrast, using a form of ‘being affected’, is very immediate (line 16–18).

After the resident’s negatively formulated assessment of his reaction to an intense situation (no emotional distress, lines 1–3), the teacher immediately and in overlap formulates (Heritage and Watson, 1979; Knol et al., 2020) the teller’s (A1) concern in terms of (1) being worried and (2) not being affected. This provides a slot for T1’s confirmation (line 16–18). The mention of ‘concern’ in combination with ‘being affected’ draws attention to the personal emotional stake displayed here (cf. Flinkfeldt, 2020). The teller shows immediate alignment with this focus (“yes,” lines 17, 19), and upgrades the formulation into not only not being affected, but unrightfully being unaffected: “it perhaps does too little to me.” Next, he invites others with a query of recognition, redirecting attention from the topicalized personal stakes to similar experiences of others (lines 24–26). The main takeaway of the quick timing of the teacher’s move toward ‘being affected’, as well as the immediate pick-up for further discussion, is that participants orient to ‘being affected’ as a professional norm and genuine concern (Edwards and Potter, 2017; Kristiansen and Grønkjær, 2018).

With in Excerpt 2, we provide further evidence for the orientation of participants to the relevance of discussing ‘being affected’. Here, an emotional response by resident F to the story of resident A2 becomes part of a procedural negotiation about the session’s proceedings. Resident A2 is telling her experience when resident F interrupts her. She has her arms folded and tears up while talking. With a self-observation that is packaged as a warning, she displays personal emotional stake: “I notice that I feel very strange just now” (not shown). F also displays signs of emotional distress through sudden crying (not shown). F then accounts for her sudden emotional reaction by suggesting she is familiar with A2’s case, knowing the situation privately as an invested bystander (partly displayed, lines 1–6). One resident invites F to expand on her feeling (line 12), while the teacher (T3) proposes to postpone that exploration (lines 14–15):

In resident F’s account for her interruption of resident A2’s telling, she leaves the options open as to what will happen next (line 10). However, her turn closings (line 6 and 10), produced partly with shaky voice, mark the importance of her final statement. She foregrounds and intensifies the importance of her sudden and severe emotional reaction. The ambiguity about unpacking the emotional potential of what was just shared, is visible in the two different uptakes (lines 12–15): while one goes along with the unpacking project, the other acknowledges its relevance. Subsequently, two procedural options are proposed: to discuss ‘being affected’ now or later. As Muntigl and Horvath (2014) notice, affectual displays like crying mobilize response, but they do not make the absence of a receipt accountable. Crying may be designed to invite a receipt (Hepburn and Potter, 2007), but does not need to be treated in that way. Thus, the divergent responses are licensed by the production of F’s turn (line 6, 10).

Then, the participants engage in a negotiation about the session’s proceedings. Throughout the interaction, F every now and then wipes tears from her face:

Teacher 3 reformulates the procedural engagement as a moment of “consideration” for resident F (line 16), and offers F the candidate solution to leave the room (“do not want to attend,” in lines 19–21). F remains undecided in her response. Teacher 2’s reaction to that is noticeable, since it does not directly respond to the dilemma that is collaboratively constructed by teacher 3 and F (lines 16–23). Instead, teacher 2 redirects the attention to resident F ‘being affected’. In objective terminology (Potter et al., 2020) and referencing F in the third person, teacher 2 emphasizes the visible urgency of the dilemma (line 25). In a conclusive fashion, teacher 2 notes that F is very affected and “that is clear” for all to perceive. This teacher move explicitly refocuses the interaction toward F’s personal emotional stake, highlighting the need for all participants to do something with the fact that F is visibly affected. Excerpt 2 thus illustrates that ‘being affected’, even if it originally was not the main focus of this Learning from Experience interaction, is topicalized by the resident herself. Furthermore, once it became observable to others, it was attended to by other participants, and started playing an important procedural role in the interaction. Eventually, resident F stayed in the room, but did not join the conversation. After the case discussion was concluded, teacher 2 returned to F and asked “how was this for you to hear?” (not shown). The fact that participants return to the topic after having postponed the matter for quite some time, shows participant orientation to the importance of attending to visible distress.

In sum, Excerpts 1 and 2 provide evidence that residents and teachers explicitly orient to ‘being affected’ as a professional concern that makes further unpacking relevant. When ‘being affected’ becomes visible (Excerpt 1) or topicalized (Excerpt 2), it is treated by the participants as legitimizing instant unpacking, and even temporary abandonment of the primary topic. The excerpts signal that ‘being affected’ is an intricate part of the norms that underlie how reflection sessions are done. In the next sections, we put some flesh on the bones of this orientation on the importance of unpacking ‘being affected’. We first show how explicit invitations with ‘being affected’ are interactionally performed in ways that successfully invite elaboration on the emotional dimension; afterwards, we show how it is less successful.

In this section, we show that invitations to explore ‘being affected’ that initiate emotion talk, hinge on the degree to which the invitations build on personal stakes displayed in the inferential substrate of preceding talk (Haugh, 2022). If a resident constructs an experience in terms of personal stakes, the resident highlights emotional commitment and thus creates potential for unpacking the emotional dimensions of the experience. We saw that participants commonly portray their personal stake in one of two ways. First, participants explicitly describe their own relation to a situation in loaded, subjectively invested (Potter et al., 2020) terminology (“difficult,” “personally feel,” “afraid,” “tricky”). Second, participants show further emotional investment through non-verbal displays such as sniffling and creaky voice (Hepburn and Potter, 2012).

In Excerpt 3, we show how the combination of subjectively invested terminology and emotional displays establish a personal emotional stake, which makes attention to it relevant. In preceding talk to the “what affects you now”-invitation that constructs the inferential substrate, resident A3 speaks about having successfully supported a patient in a palliative phase, independently of her supervisor. Nonetheless, she constructs her experience as an instance of being out of place, being “just a youngster,” being inexperienced, and being an intruder (not shown). She foregrounds her subject-position in a situation that is almost too heavy to deal with (partly shown). In doing so, she emphasizes her struggles as a young person taking up responsibility as a doctor (partly shown). Teacher 4 (T4) picks up on A’s existential questions (Haugh, 2022):

Teacher 4 summarizes A3’s struggles as a central question: “who am I,” and highlights the importance of asking that question (lines 6–21). She works toward formulating a suggestion that may help A3 to find her way in the profession. Up to this point, resident A3 can be seen struggling to hold back her tears, until she starts visibly crying and audibly sniffing (line 26). As Hepburn and Potter (2012) note, sniffing can function as a floor holder, suggesting that the speaker is about to speak but cannot, due to being upset. Indeed, the emotional display prompts teacher 4 to halt her summary, thus allowing for the display to unfold and simultaneously create context for an account of this display.

Crying in itself has been described as doing mobilizing work (Muntigl and Horvath, 2014; Muntigl et al., 2023); crying often gets empathic or sympathetic responses (Heritage, 2011; Ford and Hepburn, 2021). In this case, the crying receipt is done in the form of an invitation to account for the crying, formatted as a “what affects you now” invitation (line 24). This “what affects you now”-formulation topicalizes the emotion, while it is also ‘doing recognition’ of it, as a sign of being affected (Voutilainen et al., 2010). The recognition responds to the disruption of the interaction by making it accountable, which works similarly as crying: “adult crying, and perhaps especially the disruption it causes to the progressivity of sequences, may be accountable (…).” (Hepburn and Potter, 2012, p. 207). While still displaying distress, resident A3 shows alignment with the teacher’s project in her multi-unit turn on identity (“yes, that is very much what this is about,” line 30), and expands on the issue in the following interaction by introducing self-confidence.

In sum, in Excerpt 3 we see how the teacher’s contribution that allows the emotion display to unfold, is co-constructive toward the emotion being topicalized. The “what affects you now”-turn functions in the interactional space as a transformational move (Peräkylä, 2019). During her telling, resident A3 commented on the situation using rhetorical hypotheticals such as “who am I.” The proposed self-deprecating assessments like “I am just a youngster” in prior talk (not shown), are statements that mobilize her personal emotional stake. After the teacher’s invitation in line 24, the topic transforms gradually from a question about “who am I,” which she dismisses by stating that she does know who she is (line 41), to a lack of self-confidence (lines 51–52).

The main takeaways from Excerpt 3 are, first, that the non-verbal emotional distress of the resident was obvious for all to see, and that it was built up from invested personal stakes prior to the “how does that affect you”-invitation. Second, that it was given interactional space to develop. Third, that it got expanded on after the teacher topicalized it in a ‘being affected’-form. With Excerpt 4, we will show how distress can be less obvious, and only noted by some in a second instance. Nonetheless, even small verbal or non-verbal hints of emotional potential after personal stakes have been displayed, can be treated as a discussable or even urgent issue. Similar to Excerpt 3, the resident in Excerpt 4 uses subjectively invested terminology and shows emotional displays in her experience telling. The telling is about an elderly couple that resident A4 spoke to. The man had symptoms that would potentially fit a prostate cancer diagnosis. Over the weekend and prior to the consultation with A4, the couple was misinformed by an unknown GP colleague about the pending protocols to check if the man indeed had prostate cancer.

Resident A4 in Excerpt 4 tells the story about how she had to explain procedures and console the two misinformed patients. During the telling, A4 shifts perspectives between the patients’ fear of cancer (line 1), and her own compromised position (lines 4–8), which she assessed as “tricky” (line 11). This is a subject-centered formulation of a troublesome situation that expresses the personal load of the experience. She continues her turn by working toward the relevance of this situation for future practice: “you also think like what would you do yourself in the future” (lines 14–15). The production of this turn is increasingly tremulous and audibly unfinished when she pauses (lines 16–18). Such wobbly delivery can signal emotional or psychological distress (Hepburn, 2004). In fact, the silence, together with the creaky voice, indicates difficulty speaking and implicitly signals upset (Hepburn and Potter, 2012). While the teacher collaboratively constructs A4’s idiom with “later when you have grown up” (line 19), resident H attentively notices A4 struggling to withhold displays of emotion (line 18, 22) by enquiring “are you alright?” (line 23). Formatted as a closed yes/no request for information, it acknowledges the emotion display (Voutilainen et al., 2010), but only minimally invites further elaboration on the visible upset (Hepburn and Potter, 2012). This leaves room for not unpacking it. A4, however, treats it as a request for an elaborate clarification, while also reorienting the perspective from herself to the patients (line 25). It is only when the teacher poses the explicit invitation to explore the emotional dimension (“and what affects you now then?,” lines 35 and further) that the personal involvement of A4 is topicalized and is once more visibly and audibly present. How did this transformation come about?

By using “you” and “now” (line 33), the teacher anchors the observation firmly in the present, and treats the emotional display as something personal and observable (and with that, difficult to circumvent). The teacher acknowledges A4’s emotional stake and provides her with an opening to discuss it. A4 now relates the patient’s distress of being in limbo (line 45) to the re-establishment of her personal stake: “~I have chosen for the general practitioner profession because I thought, I want~ (.) to deliver patient care a:nd talk to those people” (lines 45–47). Her turn is produced in creaky voice and interspersed with sniffles. Thus, the teacher’s “and what affects you now then” functions as a pursuit of the fellow resident’s tentative topicalization of the subtly visible display of emotional distress. This teacher move transforms emotionally laden talk about the situation into explicit discussion of personal emotional stakes (Peräkylä, 2019). Before the teacher’s invitation (line 32–33), A4 referred to a generalized ideal about one’s future professional behavior; after the teacher’s invitation, the referred object transforms into an explicit reference to A4’s own professional identity and the personal choice she made in the past, expressed with lots of displays of emotion throughout.

In sum, with Excerpts 3 and 4 we have shown how residents establish personal emotional stake, often accompanied with emotional displays, and how invitations with ‘how did that affect you (now)’ hook onto the emotional potential that is constructed in the preceding interactional context. First, this move creates an interactional slot for further elaboration of the stakes and emotional dimension. Second, the invitation acknowledges the observable emotional stake, and the participant who is doing the invitation treats the stakes as something important to unpack. The invitations can then incite a transformation of referents (Peräkylä, 2019) that refocuses the interaction from the impersonal and situational to the personal and emotional.

In this section, we discuss two examples wherein the use of “being affected” did not cause any substantive transformative sequence of personal emotional stake. In both cases, the residents to whom the invitation was posed had not explicated any personal stake through loaded subjective terminology, or shown any emotional displays prior to the invitation. The position and form of the invitation using “being affected” is almost similar to those used in Excerpt 3 and 4; the difference here is the extent to which it is made relevant from the inferential substrate in prior talk (Haugh, 2022).

Excerpt 5 shows a “being affected”-invitation by the teacher, that builds onto a resident story that does not involve an explication of a personal emotional stake in any loaded terminology. Yet, the presented story represents a heavy medical case (a teenager with cancer); its heaviness is recognized in the way other residents respond to the crux of the story. While resident A5 explains how he discovered cancer with a young patient, the other residents in the room respond strongly (lines 10–13, line 21):

Throughout the case presentation, which is in part visible in lines 01–05, resident A5 solely focuses on the case’s procedural and medical dimension. Thus far, he has not verbally or non-verbally expressed any personal emotional involvement. His speaking manner is remarkably calm (steady rate, even intonation), serious (low intonation, soft speech), and factual (in terms of what happened, and what happened next). The story, however, does elicit several emotionally laden expressions from others (gasping, swear words and extreme case formulation about the intensity of the case, line 10–13, 21). The fellow residents’ intense responses prompt a format tying of “intense” by the telling resident, but he qualifies it in a downgraded way from “su::per intense” to “quite intense” (line 14). The rhythmic gaps in this turn give a sense of slowing down. Though hard to pinpoint, the increasingly slower pace may be what the teacher picks up on when formulating her follow-up invitation, formulated as a noticing (“it affects you also really”; Muntigl and Horvath, 2014) followed by the tag question “does not it?” (line 17).

What happens next is very different from the trajectories following the acknowledgement of ‘being affected’ in Excerpt 3 and 4. Resident A5 acknowledges that it was indeed “quite intense,” again referring to the situation, while explicitly neglecting the invitation to shift toward his personal state that was topicalized in “really affected you.” He continues his story with an orientation to the medical and procedural dimensions of the situation (lines 24–28). The expected outcome of this situation for this patient is interpreted as closure implicative and responded to with soft response cries (Goffman, 1978). Response cries can be seen as emotive interjections (Dingemanse, 2021) that align with the ladenness of an ongoing story (Goffman, 1978); however, no unpacking of any of that emotiveness follows. The first to continue the conversation is teacher 8, who aligns with A5’s procedural focus to elicit further detail on the case specifics: “have you seen her still?” (line 34).

Although it is difficult to definitively conclude that due to the lack of personal stake, the invitation to elaborate on ‘being affected’ did not instigate an exploration of the emotional dimensions, it is markedly missing in Excerpt 5 when compared to Excerpts 3 and 4. Part of this lack of elaboration may also be due to the specific format of the invitation, which is odd in relation to the way the story is told. In telling the story, resident A5 shows no evidence of being affected; however, the teacher refers to him being moved in present tense, suggesting direct evidence in the moment (cf. emotional immediacy questions, Muntigl et al., 2023), and using the qualifier “really” to intensify the degree to which the resident was supposedly affected. It is hard to perceive as analysts what elements in the story or the way it was told justify the teacher’s observation. Possibly, the teacher orients to “socially shared expectations regarding emotional experiences and expressions” (Weatherall and Robles, 2021, p. 8; Edwards, 1999). The teacher may act upon the social expectations about the emotional status of someone involved in discovering cancer in a teen, and upon the other participants’ response cries (Goffman, 1978), instead of the emotional stance displayed by the resident (Stevanovic and Peräkylä, 2014). As Stevanovic and Peräkylä note, interactants can use sociocultural resources when interpreting the actions of others, and sometimes these result in a mismatch with the actual emotional stance. Alternatively, the teacher interprets “the objective, distant coolness” of the teller resident as representing his emotional stance; indeed, some could argue that such coolness may signal emotional stance (Stevanovic and Peräkylä, 2014; cf. Goffman, 1981; Bakhtin, 1986; Jaffe, 2009; Wilce, 2009). Nonetheless, the link between personal stakes and the role of topicalizing ‘being affected’ in projecting a sequence that initiates stepwise entry into exploration of emotional stance (cf. Muntigl and Horvath, 2014) seems deflated here.

Excerpt 6 shows another instance of a teacher reference to ‘being affected’, but it seems unrelated to the presented story and yields little (emotional) alignment. Thus far, resident A6 has shared an experience about a young mentally disabled girl who has been abused by her brother. A6 has not shown any explicit personal stake in loaded terminology or shown any emotional displays, and no unpacking of any emotional dimension ensued. The discussion of this experience is in its concluding phase. As is common in these sessions (Veen and de la Croix, 2017), the teachers formulate a ‘wrap up’ in the form of an evaluation question (lines 8–9). Similar to Excerpt 5, the ‘being affected’-invitation that constitutes this ‘wrap up’ does not instigate any unpacking of emotional stance. Furthermore, once the teacher suggests if the situation has affected resident A6, she explicitly shelves it (lines 10–12).

After teacher 9 concludes with the learning uptake (to check some details with Veilig Thuis; line 3), teacher 10 moves into closing with a wrap-up question: “what what what what what has moved you the most or eh (.) taught you the uh most (.) or something in this case?” (lines 8–9). First, what is striking are the many restarts (“what”), the repair (“or uhm”), and the “or something,” which all convey hesitations about the direction of the question. Second, this is a double-barreled question, which constructs a preferred reply to the second part about the learning uptake. Accordingly, resident A6 briefly addresses the first part (lines 10–12), while elaborating on the second (lines 14 and further). In succinctly addressing the inquiry about being affected, A6 disregards the description ‘being affected’ as too heavy a characterization (“really moved?” “did not really move me”). Instead, she comments that she found all of it “a bit odd” because she wasn’t really affected, although the case was quite awful (lines 10–11). This negative topicalization is similar to Excerpt 1: not being affected might also be an issue for residents. Resident A6 then closes the emotional topic by saying she does not “know why that is” (line 14), and replaces the issue of ‘being affected’ with a skills-related topic that was addressed earlier in the interaction (lines 16 and further).

In Excerpt 6, the main takeaway is that the double-barreled question could have allowed for the resident to expand on just the second part of it. However, the resident did not just leave the suggestion of ‘being affected’, instead she explicitly shelved it. There was no explication of any personal emotional stake throughout the case discussion; furthermore, when its presence was suggested, A6 disregarded it as an unjust description of her involvement in the case. The invitation thus remains mostly unsuccessful to elicit any extensive elaboration on why something did (not) affect resident A6. Consequently, there is also no real transformational sequence (Peräkylä, 2019) present regarding A6’s personal emotional stake. This is indicative of the importance of ‘being affected’ to be made relevant for unpacking.

In sum, Excerpt 5 and 6 show how cases that might be considered culturally heavy (and could be potentially emotional), such as the discovery that a young child has cancer or the abuse of a young child by her brother, might not yield substantive explorations of the emotional dimension. It seems that the unsuccessful nature of ‘being affected’-invitations to instigate emotion talk is linked to the lack of an explicated personal emotional stake in loaded terminology, or clearly observable emotional displays during the preceding story telling (Haugh, 2022). There seems to be a mismatch between the probes for emotion and the (lacking) displays of emotional potential that precede those probes.