Dr Victoria Ekstrom, Consultant Gastroenterologist, Singapore General Hospital, Co-Lead (Narratives in Medicine), SingHealth Duke Medical Humanities Institute
As a busy physician working in a large public hospital, I wouldn’t have predicted that Conversation Analysis (CA) would become a central focus of my professional development. Yet there I was in March 2025, attending Prof Elizabeth Stokoe’s Conversation Analytic Role-play Method (CARM) training, fascinated by the microscopic examination of turn-taking patterns and subtle linguistic choices that shape our daily interactions.
My journey began during Prof Stokoe’s talk at The London School of Economics and Political Science (LSE) while completing my Behavioural Science master’s degree. Years of clinical practice had given me an intuitive sense that something crucial was happening in doctor-patient exchanges that standard communication training missed—those pivotal moments where a pause or word choice determined whether a conversation succeeded.
When I applied elements of CA to simulated patient interactions, these metrics failed to capture the dynamic nature of real communication. Following Prof Stokoe’s recommendation, I attended Dr Rebecca Barnes’ CA course at The University of Oxford before returning to CARM training, which transformed my understanding of how CA could create meaningful change in healthcare.
The CARM Difference: Research-Driven Communication Training
CARM radically differs from traditional approaches by grounding itself in recorded data from actual interactions rather than role-playing imagined scenarios or teaching abstract principles like “active listening”.
The online training room was filled with academics from around the world—this was, as I learned, the 11th year of CARM training for conversation analysts. Participants came from diverse countries including the UK, Belgium, Australia, Hong Kong, The Netherlands, Norway, Denmark, Germany, and Ghana. The group consisted primarily of researchers across various disciplines, career stages, and areas of focus, with a notable addition this year of two industry-based participants who work in Conversation Design, AI, and Voice technology.
What struck me about these industry participants was that they had found their way to CA not through academic papers but through Prof Stokoe’s science communication book ‘Talk: The Science of Communication.’ Their presence highlighted the importance of making research insights accessible and mobilizing knowledge in ways that can reach different audiences beyond academia.
As the session unfolded, we were guided through CARM’s development, from early research on neighbour disputes to its current applications across numerous sectors. Particularly fascinating was Prof Stokoe’s candid account of her own academic journey and how CARM emerged not as a pre-planned intervention but as an organic outgrowth of her research trajectory. Rather than setting out to create a training methodology, she described how her work on neighbour disputes and mediation calls gradually revealed patterns that had clear practical applications. Her trajectory illustrated how rigorous CA when allowed to speak for itself, naturally yields actionable insights that challenge conventional wisdom about effective communication.
From Research to Trainables: The Heart of CARM
The CARM Methodology: A Systematic Approach
The training offered a comprehensive breakdown of CARM’s methodological approach, revealing a carefully structured system that builds from foundational knowledge to practical application. The methodology begins with “CA 101” fundamentals and complementary materials, establishing a theoretical foundation before moving to organization-specific contexts. This foundation supports the hallmark of CARM’s approach—the meticulous line-by-line, turn-by-turn, block-by-block delivery that distinguishes it from more superficial communication training methods.
Throughout this granular examination, participants engage in guided discussion and feedback, with particular emphasis on next-line evaluation—anticipating what might follow in an interaction before seeing how it actually unfolds. This process culminates in the identification of specific communication practices (typically one to five per session) and their associated lessons, creating discrete, actionable insights rather than vague communication principles.
Types of CARM ‘Trainables’
Among the most valuable aspects of the training was the taxonomy of “trainables”—those discrete communicative practices that can be identified, taught, and implemented across various contexts. The presentation outlined four primary categories, each representing a different scale and focus of interactional intervention.
First are “easy outcomes” where changing a single word can produce significant results. Second are turning points in complex interactions, particularly in high-stakes environments. Third is addressing “institutional values” including how “-isms” manifest in interaction. Fourth are project and product implementations transforming “conversational products” like scripts or interfaces.
The presentation emphasized that these categories often overlap and combine in practice, sometimes resulting in generalized “communication training” that addresses multiple aspects of interaction simultaneously. Yet what makes these trainables consistently effective is their specificity—rather than vague directives like “be more empathetic,” CARM identifies precise linguistic choices that demonstrably impact interaction outcomes.
The Problems CARM Addresses
The presentation thoughtfully addressed the shortcomings of traditional communication training approaches, highlighting issues that CARM was specifically designed to resolve. One particularly compelling slide presented research from Atkins et al. (2016, p. 1) that critiqued conventional role-play assessments:
“Candidates who can handle the social and linguistic complexities of the artificial context of assessed role-plays score highly – yet what is being assessed is not real professional communication, but the ability to voice a credible appearance of such communication… Fidelity may not be the primary objective of simulation for medical training, where it enables the practising of skills. However, the linguistic problems and differences that arise from interacting in artificial settings are of considerable importance in assessment, where we must be sure that the exam construct adequately embodies the skills expected for real-life practice.”
This critique resonated strongly with my own experiences in medical education, where simulated patient interactions often reward performative displays of “good communication” rather than the skills needed to navigate actual clinical conversations.
Additionally, the session addressed how “conversational products” like scripts, AI systems, and assessment tools often rely on intuitive rather than evidence-based understandings of communication—a gap that CARM specifically addresses through its empirical approach.
CARM Across Contexts: Versatile Applications
Although I came to CARM with healthcare applications in mind, the training demonstrated its remarkable versatility across different professional contexts from crisis negotiation and commercial environments to mediation services and healthcare. Findings from sequential analysis have been validated through randomized controlled trials and longitudinal assessments, establishing CARM as a methodology with demonstrable real-world efficacy.
The Workshop Experience: Learning Through Discovery
What made the CARM training particularly engaging was its interactive format. I especially appreciated how Prof Stokoe regularly paused throughout the sessions to check in with participants, creating space for reflection and ensuring the analytical points were resonating with the diverse academic backgrounds present. These check-ins transformed what could have been a unidirectional presentation into a genuine collaborative analytical exercise.
Equally fascinating were the contributions from other CA practitioners in the room. Hearing how researchers from different countries and institutional contexts approached similar interactional phenomena enriched the discussions immensely. Their methodological questions and analytical observations—whether about transcription conventions for multilingual data or the challenges of recording naturally-occurring interactions in sensitive settings—provided valuable perspectives that complemented the formal training content.
The training also provided practical guidance for recording and analysing interactions in various settings, addressing common challenges like obtaining consent, ensuring anonymity, and managing technological limitations. Prof Stokoe shared valuable strategies for overcoming institutional resistance to conversation-analytic approaches, drawing on her extensive experience implementing CARM across diverse organizations.
Reflection: From Sceptic to Advocate
As the CARM training concluded, I found myself excited about the possibilities for implementing this approach in my healthcare setting. The evidence presented throughout the workshop suggested that even small, targeted changes in communication practices could yield significant improvements in patient satisfaction, treatment adherence, and clinical outcomes.
The presentation included information about the growing community of CARM practitioners worldwide, highlighting opportunities for ongoing collaboration and professional development. The training emphasized that CARM isn’t just about individual practitioners improving their communication skills—it’s about transforming institutional practices based on empirical evidence of what actually works.
For conversation analysts interested in pursuing applied work, CARM offers a structured pathway from analytical findings to practical implementation—one that maintains methodological rigor while addressing real-world communicative challenges. The growing network of CARM affiliates demonstrates both the methodology’s versatility and its effectiveness across diverse institutional contexts.
Whether in crisis negotiation, commercial environments, mediation services, or healthcare settings, CARM exemplifies how CA can move beyond academic interest to create meaningful improvements in institutional interaction. By grounding communication training in empirical evidence rather than intuition or conventional wisdom, it offers a powerful model for evidence-based practice in interactional domains.
References
Atkins, S., Roberts, C., Hawthorne, K. et al. Simulated consultations: a sociolinguistic perspective. BMC Med Educ 16, 16 (2016). https://doi.org/10.1186/s12909-016-0535-2