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Solicited audio diaries in longitudinal narrative research: A view from inside

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Abstract

The use of solicited audio diaries in longitudinal qualitative enquiry is rare. Moreover, an understanding of the unique insights that these diaries might give the qualitative researcher has largely been absent in our consideration of appropriate methods for data collection. This article aims to address this deficit by providing a critical reflection on the use of solicited audio diaries in longitudinal narrative research from practical, theoretical and analytical perspectives. The data is drawn from a longitudinal study investigating medical students' professional identity formation. In an attempt to reach the broadest audience, both structural aspects and communicative elements of talk within the data are considered alongside ethical issues and emotional work that the longitudinal audio-diary researcher might encounter. In addition to presenting extracts from a variety of diary entries, a single event narrative is presented in full, alongside an analysis, in order to demonstrate the powerful utility of this underused method.
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Qualitative Research
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DOI: 10.1177/1468794108098032
2009 9: 81Qualitative Research
Lynn V. Monrouxe
Solicited audio diaries in longitudinal narrative research: a view from inside
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DOI: 10.1177/1468794108098032
Qualitative Research
Copyright © 2009
SAGE Publications
(Los Angeles,
London, New Delhi,
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Washington DC)
vol. 9(1) 81–103
Q
R
L Y N N V. M O N RO U X E
Division of Medical Education, School of Medicine, Cardiff University, UK
A RT I C L E 81
Solicited audio diaries in longitudinal
narrative research: a view from inside
A B S T R A C T The use of solicited audio diaries in longitudinal qualitative
enquiry is rare. Moreover, an understanding of the unique insights that
these diaries might give the qualitative researcher has largely been
absent in our consideration of appropriate methods for data collection.
This article aims to address this deficit by providing a critical reflection
on the use of solicited audio diaries in longitudinal narrative research
from practical, theoretical and analytical perspectives. The data is drawn
from a longitudinal study investigating medical students’ professional
identity formation. In an attempt to reach the broadest audience, both
structural aspects and communicative elements of talk within the data
are considered alongside ethical issues and emotional work that the
longitudinal audio-diary researcher might encounter. In addition to
presenting extracts from a variety of diary entries, a single event
narrative is presented in full, alongside an analysis, in order to
demonstrate the powerful utility of this underused method.
K E Y W O R D S : identity formation, longitudinal, narrative analysis, selves, professionalism,
solicited audio diary
Introduction
Stories enable us to make sense of events and actions in our lives. They are
powerful social tools that we use to construct an identity of ourselves in the
world: who we are, who we were and who we might be (Holstein and Gubrium,
2000; McAdams, 1993; Ricoeur, 1992; Sarbin, 1986). It is not surprising,
therefore, that researchers interested in understanding identity formation
have been drawn towards narrative methodologies (Diaute and Lightfoot,
2004). By attending closely to the way in which we narrate our stories, in
addition to the content of those stories, insights can be gained into the rich cul-
tural resources that are drawn upon in this sense making process (Diaute and
Lightfoot, 2004; Holstein and Gubrium, 2000).
While Atkinson and his colleagues have argued for the need to broaden our
methods of data collection, the preferred choice of method for the narrative
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Qualitative Research 9(1)
researcher frequently remains the semi-structured interview (Atkinson, 2005;
Atkinson et al., 2003; Atkinson and Silverman, 1997). Occasionally, unso-
licited diaries and focus groups have been employed. However, the use of
solicited diaries in narrative enquiry is relatively rare (Milligan et al., 2005).
Moreover, while audio diaries have been used in a limited way within qualita-
tive research (Hislop et al., 2005) there have been no studies to date that have
used the audio diary method within a narrative enquiry. Part of the problem is
that a deeper understanding of the unique insights that solicited audio diaries
might give the researcher has largely been absent in our consideration of
appropriate methods with which to understand identity formation.
I aim to address this deficit by providing a critical reflection on the use of
solicited audio diaries in longitudinal narrative research from practical, theo-
retical and analytical perspectives. In doing so, I not only wish to illustrate the
rich seams that this novel research method opens up, but I also wish to embed
this method within a wider perspective of symbolic interactionism and the
work of Mead (1934). The data is drawn from a study investigating medical
students’ professional identity formation over time and was designed to exam-
ine how individuals narrated their developing medical identities as they nego-
tiate their way through medical school.
It is acknowledged that there is no single definition of ‘narrative’ nor what
it means to analyse a narrative. So, in an attempt to reach the broadest audi-
ence, both the structural aspects (i.e. the macro level) and the communicative
elements of talk (i.e. the micro level) within the data obtained using this
method will be considered. At the same time, other considerations of the lon-
gitudinal solicited audio-diary method including ethical issues and emotional
work for the researcher will be commented on, and extracts from a variety of
diary entries will be presented in order to give breadth to this discussion. Before
more detailed aspects of the talk from this audio diary data are presented,
although not exhaustive, a number of key points about narrative structure,
grammatical and interactional resources used in identity work will be briefly
outlined in order to allow a comparison between traditional forms of data col-
lection and the audio diary method. It should be noted, however, that while the
focus here is towards the narrative researcher, other qualitative researchers
will hopefully recognize the utility of the solicited audio diary method for use
within their own research methodologies.
Narrative structure
Although we experience events, the events themselves are not stories. We
choose which aspects of those events we wish to convey and which to omit, we
create plots from disordered experience and give meaning to events. Moreover,
the interplay between how we convey a story and how each narrative unfolds
sheds light onto the development of self coherence and diversity (Holstein and
Gubrium, 2000). Ochs and Capps (2001) contrast the concept of a ‘narrative’
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Monrouxe: Solicited audio diaries in longitudinal narrative research 83
with the understanding of a conversational narrative. The first is a cognitive
and discursively complex genre typically containing a description, chronology,
some evaluation and an explanation. Indeed, Labov and Waletzky (1967) sug-
gest that narratives typically have a formal structure comprising six common
properties: a summary of the essence of the narrative (the abstract), an indica-
tion of the time, place, people etc. (the orientation), the sequence of events (the
complicating action), the meaning and significance of the events and what the
speaker thinks about them (the evaluation), what finally happened (the resolu-
tion) before the speaker returns the story to the present situation (the coda).
Conversational narrative, however, is an interactionally discursive complex
genre that includes additional genres of discourse: description questions,
chronology challenges, evaluation clarifications and explanation speculations
(Ochs and Capps, 2001). Furthermore, Ochs and Capps (2001) identify a
number of narrative dimensions and a continuum of possibilities that may
characterize narrative which might shift during the process of a single narra-
tive’s telling. These dimensions are Tellership (from a single active teller to mul-
tiple active co-tellers), Tellability (whether they provide sequential reportable
events and make rhetorically effective points), Embeddedness (the extent to
which they are detached or embedded within the turn-taking activity of con-
versation), Linearity (from a closed to an open temporal and causal order) and
a Moral stance (from a certain and constant stance to an uncertain and fluid
stance). In research settings these conversational narratives are frequently
found in interviews with a researcher or group facilitator.
Grammatical and interactional resources
Some theorists comment on the grammatical resources we use within our nar-
rative structure that can be evoked as a form of rhetorical persuasion.
Consider Burke’s (1945) notion of an attitude frame: through talk, we can stir
attitudes in ourselves and in others and even take on the attitude of the other.
Indeed, closely related to Burke’s idea of an attitude frame, the presence of the
other in the way in which we narrate our own identity is crucial to a relational
view of communication and has immediate relevance to the notions of footing
(Goffman, 1981) and face (Goffman, 1967). Footing refers to the shifts in
‘alignment, or set, or stance, or posture, or projected self (1981: 128) as
demonstrated in the way we present our selves to others through talk.
Whereas face refers to those positive social qualities individuals lay claim to
during interaction. For both footing and face work, narrators may draw on a
number of different resources in order to construct an identity of themselves
for others. For example, quoting the words of others (direct reported speech
(DRP), cf. Holt and Clift, 2007) to stress an idea or opinion, or to take an oppos-
ing stance is commonplace. Furthermore, it has been argued that DRP is a
rhetorically powerful device in story telling that enables the hearer to draw
their own conclusions regarding the message conveyed by the speaker (Labov,
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1972). Similarly, reporting the inner thoughts of one’s own mind during the
narrating of personal events can act as a way of presenting a positive face.
While the notions of footing, frame and face have long been considered in talk-
in-interaction contexts, to my knowledge these have not been explored within
the context of a spoken monologue.
Holstein and Gubrium (2000) highlight how coherence and meaning are
developed through the linkages made from the biographical resources of the
narrator and into the narrative construction of the self. So, there is an element
of sequentiality and ‘making a point’ in the composition of a good story
(Gergen and Gergen, 1986; Labov, 1972). Such linkages can also be made ret-
rospectively, giving rise to further ways in which the narrative plot might
develop and providing hints of ‘alterative selves. Sometimes speakers display a
type of slippage between the way in which they story themselves and the cul-
turally accepted way in which prototypical storylines develop (Holstein and
Gubrium, 2000). Furthermore, in conversations with another, the trajectory
of storytelling shifts to ensure that specific points have been made and heard,
speakers explicitly talk around the processes involved in their telling and the
others’ interpreting of a story; they ‘step out’ of their stories attending to the
hearer’s perspective and edit their stories to adopt different viewpoints
(Riessman, 1990). Thus, attending to the discourses developed around such
narrative linkages, slippages and editing can further advance our understand-
ing of identity construction. Additional linguistic resources open to the narra-
tor (and thus to the analyst) include changes in pitch, tone, pauses, false starts,
laughter, anger and other emotional work (Antaki and Widdicombe, 1998;
Atkinson and Heritage, 1984; Cutting, 2000).
So against this background a number of questions emerge. For example,
does the act of telling our stories, away from others, differ greatly from telling
stories to another who is present? Who is the audience: ourselves or others or
are they both for the personal and the social (Mead, 1934)? Do we structure
those stories differently? Are these stories like the conversations we hold with
ourselves which have a single ‘teller,’ (Labov and Waletzky, 1967) or are they
like the conversations we hold with others with potential multiple ‘co-tellers’
(Ochs and Capps, 2001)? When narrating events in the quiet of our room
would we laugh out loud and use paralinguistic aspects of language such as
intonation and pitch in order to convey further meaning? And what of other
linguistic devices such as reported thoughts and direct reported speech that
link to footing, frame and face work (Burke, 1945; Goffman, 1967, 1981)?
Finally, what can these stories tell us about the developing professional identity
of tomorrows’ doctors?
Context of the research
In October 2005 I began a longitudinal research project with a clinician-
researcher colleague, Dr Kieran Sweeney. We are particularly interested in
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Monrouxe: Solicited audio diaries in longitudinal narrative research 85
how medical students arrive at medical school with an essentially ‘human’
gaze on the world, and leave a number of years later, with a predominately
‘medical’ gaze on the world. Building on previous work looking at medical stu-
dents’ epistemological talk (Knight and Mattick, 2006), our main questions in
this study centred on the following issues: what is the nature of medical stu-
dents’ epistemological talk during medical school and how do medical stu-
dents narrate their developing professional identity?
The setting for this research is a newly developed medical school which
places an emphasis on developing ‘patient-centred’ doctors. The first two years
of the 5-year curriculum is delivered from two main university sites and
utilises a problem based learning (PBL) method with the emphasis across all
years on self directed learning. During the last three years, learning is pre-
dominately based in clinical sites situated across a large geographical area
within the South West of England. During these years students work in pairs
and rotate around different clinical departments.
The researchers involved in the project (LVK & KS) had minimal involve-
ment with medical students at the school and no involvement in the assess-
ment of any participants in the study. LVK was responsible for some workshops
in Evidence Based Practice at one university locality, delivering a number of
non-compulsory human science plenaries that were telematically linked
across two main geographical locations and was also personal tutor to a num-
ber of students (not in the study). KS had no direct or indirect teaching
involvement with students in the first two years and runs Special Study Units
for small groups of students in years 3–5. The medical school ethics commit-
tee gave approval for this research.
Seventeen first-year medical students accepted our invitation to participate.
We met in groups at the beginning of the study and gave them one request:
‘Please tell us a story about something that has happened to you since the last
time you left a message and how it has affected the way you think about your-
self now and your future role as a doctor. While data is also collected through
individual interviews and group discussions, this article we will only consider
data from the primary method of data collection: the audio diary.
Fifteen of the seventeen participants use the audio diary as their preferred
method of recording. Participation in the recording of diary entries differed both
across and within individuals. For example, some participants make regular
weekly recordings, although these tend to stop during university vacation times.
Other participants leave longer intervals between recordings and, at times, make
more than one recording in a day. For the purpose of this research therefore, a
‘diary entry’ is defined as ‘a recording or group of recordings by any one individ-
ual participant in a single day. In the first 18-month period between 15October
2005 and 15 April 2007 we received 255 diary entries which comprised 408
recordings. The recordings varied in length from a short as 20 seconds, to longer,
discursive recordings (up to 13:57). Short recordings typically highlighted diffi-
culties individuals were having at the time and often in the form of a ‘rant.
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When looking at this data it was hard not to be impressed with the richness
and diversity of the recordings, the ways in which the everyday and the extra-
ordinary events experienced by these medical students became plotted into
evocative constructions of their own developing professional narratives.
Additionally, we are also struck by the positioning of researched and
researcher, even within these apparently undirected and ‘solo’ narratives. My
aim in the following section of this article is not to provide a full and compre-
hensive analysis of these factors. This is beyond the scope of the present arti-
cle. Rather, I wish to provide brief insight into various aspects of the ways in
which these messages were composed, and the narrative elements that embod-
ied them, before presenting a single diary entry which brings these elements
together in one narrative. As you read on, you are invited to take on the per-
spective of a researcher using this method for the first time, trying to make
sense of the data before you. Additionally, consider the context within which
you listen to these audio diary recordings: just as these recordings are made in
solitude in the quiet of a room, so they are listened to in a similar context.
Positioning of the researcher
In conversation, appropriate linguistic devices are used in order to introduce a
story, to mark the ending of a story and to demonstrate relevance of the story
to the listener (Jefferson, 1978). In an audio diary recording, however, there is
no listener present. So how do participants introduce their stories? How do
they conclude their stories? Who are they talking ‘to’ in their narratives and
what does the entrance and exit talk reveal about the role of the researcher?
One of the most notable aspects of the beginnings and endings of the record-
ings themselves is the way in which participants frequently directed their diary
entry to the researcher through their opening and closing utterances
1
:
‘Hi Lynn- Doug here (.) uh (.) uhm (.) no-nothing major- just sort of funny devel-
opment (.) I- just now when I was searching some information on the internet I
found myself- uh I found myself...I just immediately dismiss it without reading any
further- uh (.) and it seems to be working- it’s quite strange that (.) okay (.) thanks
(.) bye. (Doug, 9 November 2005)
As the project went on, and more diary entries were made, a further develop-
ment in the framing of beginnings and endings of the diary entries became
apparent. This shift in alignment (cf. Goffman, 1981) highlighted the way in
which the relationship between myself and individual participants was begin-
ning to develop: many recordings continued to begin with a hello, but then often
went into a recognition of time passing, and the diary entries had the feeling
that I was about to ‘catch-up’ on their news and events. At times, participants
apologized for the absence of diary entries and some felt the need to give detailed
explanations for this. Additionally, continuing the longitudinal feel to the diary
entries and the developing relationship between researched and researcher,
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Monrouxe: Solicited audio diaries in longitudinal narrative research 87
there were frequent exits within which participants returned to their marking
of time with statements of intent to be in touch again in the future in doing so
they frequently qualified this statement of intent with the word probably:
‘Right- hello (.) it’s the 5th of February and it’s been a week and a bit since I last
left a message so I thought I’d just- you know- catch- fill you in on what’s going on
(.) and yeah (.) after the AMK
2
...I’ll probably get back to you in about a week or so-
right (.) bye-bye. (Paul, March 2006)
One further notable aspect of entrance talk in these examples above is the way
in which participants introduced the story part of their diary entries with yeah
or right. In conversations with another the introduction of a newsworthy
event can be generated interactionally and mutually though a sequence of talk
beginning with an initial topic elicitor (Button and Casey, 1984). However, in
these diary recordings, there is no opportunity for this mutual acceptance of a
story. Indeed, participants often reported during catch-up interviews that they
sometimes felt awkward speaking to no-one and this often led to avoidance in
recording diary entries or to a certain difficulty in getting started with the
story: the use of words such as yeah therefore took on a signifying role sug-
gesting that a topic was about to be discussed and were used both at the begin-
ning of recordings and also part-way through messages to identify a shift in
footing or storyline (cf. Goffman, 1981).
However, while the majority of diary entries began with this welcoming
hello introduction, significant others took on a more direct tone, thus framing
the subsequent narrative differently (cf. Burke, 1945):
‘My mother died a few days ago (1.0) she died during the night between the [date]
and the [date] and she’d been an alcoholic for a very long time (.) and her liver finally
failed on her… there had to be an autopsy (.) and I haven’t seen the autopsy report (.)
and at first I thought I wanted to- I thought I wanted to know exactly what the report
said… the conflict between the idea that as a
DOCTOR I need to understand but as a
member of the
FAMILY it’s all very well to know this stuff in the abstract but to actu-
ally think of it as happening to someone who’s such a large and important part of
your life is- um (1.0) I’m not sure that I really wanted to know that much about it (.)
so I just thought I’d mention that conflict as well. (Katie, 6 January 2006)
A number of issues, both analytically and ethically, became apparent upon the
receiving and listening to a diary entry framed in this way. Rhetorically, this
message begins with a noticeably different footing to that of previous messages
from this participant, both in what is said and in the paralinguistic aspects of
pitch and tone (Cutting, 2000), thus making demands on the hearer to take
particular notice. This message is intended to convey important issues of con-
flict that the speaker wished to highlight as directly relevant to her developing
professional identity.
Furthermore, while the audio diary method appears to comprise an
essentially one-way conversation, in practice this is not the case. The longi-
tudinal nature of the study in combination with personal disclosure
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through a narrative monologue (sometimes conveyed in a highly intimate
manner through paralinguistic aspects of talk) entails an engagement with
the participants that is different from other forms of research which, in
turn, brings forth different ethical issues. For example, the researcher-
participant relationship can develop to include a heightened feeling of
responsibility of care on the part of the researcher and with little opportu-
nity to negotiate this in the moment. Further aspects of the audio diary
method that develop and define this relationship for the researcher are dis-
cussed in the next section, but on listening to this particular message in
which the emotional frame of the narrative had been set in the first breath,
a number of conflicting and difficult thoughts and feelings emerged for me.
Some were situational whereas others were of an ethical nature.
Firstly, in this study, whenever a diary entry is received, it is acknowledged
within 24 hours by an e-mail to the participant, thanking them for sending the
recording and informing them that I will be in touch over the next few days
once I had listened to the message. This aspect of the study provides an impor-
tant contact between the participants and researcher and acts as a form of
closing the feedback loop between participants and researchers, acknowledg-
ing the contribution that the participant has made and aiding their continued
involvement in the study. Occasionally, however, it is not possible to listen to
the message immediately resulting in a week or two passing before it is heard.
Unprepared for this message, and for the immediate feelings of sadness and
helplessness that resulted, led to an emotionally difficult time personally as a
number of ethical and practical aspects of the situation came into play. For
example, this temporal lapse makes it more difficult to go back to the partici-
pant to let them know their story has been heard. Moreover, there can be a ten-
sion between the idea that contact should be in the dispassionate role of a
researcher thanking them for their interesting reflection and the desire for
it to be in the impassioned humanistic role of someone who was touched by
their story and the inner conflict they reported. Since receiving this diary mes-
sage, a number of other emotionally difficult diary entries on subjects such as
death, illness and divorce have been recorded. The relationship between
researcher and participant that the solicited audio diary method develops,
therefore, can become an intimate association: one in which participants feel
comfortable to share their most difficult and intense experiences. Researchers
contemplating the use of this method should take this aspect into account.
Lists, prototypical narratives and small stories
Not all diary entries were constructed by way of a canonical narrative.
Some comprised brief up-dates of what had happened, effectively taking
the form of a list or brief description. The vast majority of recordings,
however, took the form of prototypical narratives and small stories
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(Bamberg, 2006). Thus, prototypical narratives are personal stories of the
tellers past experiences that have not been shared by the current inter-
locutor. An example of a prototypical narrative is presented in the latter
part of this article. Such narratives can be contrasted with small stories
that include tellings of on-going events, future or hypothetical events,
shared (known) events, re-tellings, allusions to tellings, deferrals of
tellings and refusals to tell (Georgakopoulou, 2007). To date, there have
been no examples of refusals to tell within our data, which can be partly
explained by the absence of an interlocutor and thus the absence of direct
requests to tell. However, the longitudinal audio diary method does appear
to capture a number of other types of small stories:
‘It’s going to be a tough week (.) I’ve got about six maybe seven days to my SSU-
well- just over six (1.0) I need to get my priorities in the right order- less socialising
(.) more working (1.0) This [SSU] research has been really difficult for my SSU- I’ll
have to stay on top of it- well I’m off to the IT suite now so I’ll chat to you later.
(Anwar, 20 March 2006)
‘I sort of talked about- in the past (.) the pressure that other people’s good wishes
put you under and in the last week I’ve heard from an old friend…’ (Katie, 2
February 2006)
‘Hello Lynn- a couple of things- three things I think this week (.) anyway I’ll start
(1.5) the first thing is that (1.0) first occurrence actually was during your lecture
early this week about the psychological development of children- I don’t know if
I’ve ever told you... (Charles, 20 October 2006)
Through these diary recordings, and in particular the receiving of small sto-
ries, a relationship has developed (at least on the part of myself) whereby par-
ticipants are identified with, known and intimately personalized. This goes
beyond what typically happens in the one-to-one interview and group set-
tings that have comprised the interactional settings of my previous qualita-
tive work. These small stories evoke the feeling of knowing a person and the
developing of an intimacy that might bring forth further emotions. For exam-
ple, as time goes on, sometimes participants suffer personal difficulties such
as parental divorce, personal or family illnesses and even the death of a loved
one. These occurrences, whilst ‘outside’ the research context are often nar-
rated within the research arena. This might be particularly so because of the
nature (longitudinal, personal incident narratives) and the context of the
research (medical settings and the development of a medical professional
identity). So, following the sense of familiarity that small stories foster, when
I later listen to a ‘troubled’ prototypical narrative, feelings of sadness, unease,
confusion, helplessness and sometimes joy may rise. However, even when not
directly narrated within the audio diaries themselves, sometimes these diffi-
culties are discussed within the participant-researcher relationship. Once
again, these stories evoke personal feelings within me and my role as a
researcher that need to be considered and negotiated.
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Humour and laughter
one funny thing that happened earlier this week that I thought I’d mention it
because it sort of- it is funny…I was sitting in the life sciences private study room
and [laughs] I was just doing stuff…’ (Katie, 2 February 2006)
The elegantly timed rendition of events accomplished through the strategic
and skilfully managed pauses, repetitions, humour and the outcome of actions
give some of the diary entries a light-hearted frame (Burke, 1945). Such
rhetorical framing can be felt early on in some diary recordings. In others,
rhetorical framing shifts and changes with the use of humour developing as
participants negotiate their way through difficult stories. Indeed, humour is
not necessarily about making people laugh, it has psychological and relational
functions and can be used as a mechanism for dealing with difficult situations
such as stress, uncertainty and pain (Hay, 2000; Martin, 2004). Moreover,
within the context of medicine, gallows humour has been identified as a coping
mechanism for dealing with traumatic and difficult events (Crawford, 2003;
Saraglou and Anciaux, 2004; Sinclair, 1997). One participant in particular
displays a continual use of humour and laughter in his diary entries, this
sometimes is achieved through his choice of words, intonation in his voice, the
pitch of his voice and his own laughing out loud:
‘Just been watching that anatomy of ‘life of death’ thing on Channel 4- it’s now
about five-past midnight and- it’s really odd… he’s talking about the infarctions
and how the blood stops flowing into different organs… there’s a sort of part of me
that thinks- this should- you- you should find this really ugly- you know this man
is up to his wrists in people’s organs and entrails but then a huge part of me finds
that [deepens voice] really fascinating hummm (.) I dunno- it- it but it somehow
feels wrong
and another part of it feels soo good and looks so interesting so- I
dunno, it’s weird (1.0) I wonder if that’s what- all
doctors should feel like [laughs].
(Rory, 17 January 2006)
‘The next person I meet with high blood pressure- hypertension- is going to die
-
I’m going to put my hand round their throat and choke them until every last drop
of life is gone (2.0) if I have to learn one
more diuretic somebody’s gonna catch it
from me.’ (Rory, 9 February 2006)
What is particularly difficult, therefore, is knowing how to ‘read’ some of these
diary entries. There were obvious rhetorical devices used by some participants
that included the use of irony, sarcasm and ‘dead-pan’ humour. However, the
circumstances within which this humour was used was far from typical: as
previously demonstrated, the researcher is clearly an interactional partner in
the minds of the participants, yet unlike face-to-face situations the researcher
has no role in negotiating how and what is said. This therefore entails that the
participants have no opportunity to ‘repair’ any misconceptions and misun-
derstandings that sometimes occur in the moment. Occasionally, concerns
regarding the mental health of participants, the potential danger to other
students or, indeed, patients are raised when listening to a recording in which
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participants have used humour in this way. Sharing concerns with a second
researcher, negotiating strategies to ensure the wellbeing of participants and
of others with whom we, as researchers, have responsibility has become an
essential aspect of the audio diary method.
Reported thoughts and reported talk
We continually use talk in interactions when reporting the speech of ourselves
and others, attempting to mimic the voice of the other and often reflecting
emotional affect (Holt and Clift, 2007). While reported speech and reported
thoughts have been identified as a set of linguistic and discourse practices for
talk-in-interaction, this is the first time it has been highlighted as an important
aspect of diary making:
‘...just suddenly got this really huge wave of fear thinking ‘oh my god- what have I
missed out on the last four case studies?’ you know what... (Jeff, 6 February 2006)
‘...well (.) a lady came in and she was pregnant- heavily pregnant in fact she’s
er- er due next week and we were allowed to er- touch uh- well feel for the- for the
fundus of the uterus...and it was pretty pretty impressive and
GREAT- really makes
you feel like
YES, this is definitely what I want to do”... (Andy, 21 October 2005)
‘...we had a teacher who’s talking about voice production...our voices are distinc-
tive because of the shapes of the passages in canals within our head and face and
the sinuses and they affect the way the sound comes out and er- but he actually
said something like ‘
STUPID SINUSES’ or ‘they’re pretty USELESS apart from voice pro-
duction’ and that kind of annoyed me because... (Tre, 19 November 2006)
The participants’ strategic use of reported thoughts and reported speech, with
the intonation, pitch and pace of their own and other’s voices helps them to set
up, maintain and sometimes reinforce the attitudinal framing of their narratives.
Kath’s narrative
While it is important that we deconstruct the audio diary recordings to gain an
understanding of the detailed way in which participants produce their narratives,
it is also important that we consider the bigger picture: how it all fits together in
the telling of a single event narrative and what that provides for the researcher
interested in narrative identity formation. To this end I now reproduce in full one
single event narrative that was recorded as part of a diary entry. In order to pro-
vide a holistic experience for the reader, the narrative is presented in full, before I
offer a brief interpretation to demonstrate the powerful utility of the audio diary
method for narrative researchers. As this interpretation is necessarily incomplete
(for reasons of both space and of focus) as you read this excerpt you are invited to
bring forth your own rich understanding of the unfolding narrative.
The event concerns a medical students’ first experience of witnessing death:
something that all doctors encounter at some point during their training. This
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TABLE 1
1 I’ve recently had a profound experience (1.0)
2 I was visiting my friend- erm- yeah my friend- he’s an [job] I mean I’ve had
3 time off for- doing my SSU and I was visiting my friend who’s an [job] in
4 A & E of all places [softly laughs] and I was waiting for him- erm- this was
5 up in [city]and I was waiting for him to finish his shift
6 and he was about to go and everything seemed fine
7 when they brought in- there was like a car accident or something and they
8 were bringing in- sorry it wasn’t a car accident it was motor vehicle
9 accident- there was a guy- a collision involving a motorbike and I think it
10 was some sort of a big truck or lorry and as you can imagine very (.) kind of (.)
11 messy and anyway what happened was (.) of course- my friend was like- kind
12 of- he couldn’t really leave so he asked me would I mind waiting around and
13 because- you know- I’m doing medicine I was kind of interested (.) so I kind
14 of stood back and I asked him like- well can I d- well I asked them- well I
15 asked him not really his superiors because they were very very busy- would
16 he mind if I just waited and like kind of- not sure if it was proper that I
17 stayed there but I did anyway and like he just said (.) basically (.) if I kept out of
18 the way I wouldnt get in trouble or whatever- but I- the point of my little
19 story is that erm (.) there was- I- I saw someone die-
20 and I mean I’ve seen- I’ve seen autopsies done and I mean I’ve seen like
21 people who are dying and I’ve seen people who are like a few hours from
22 death- erm- but I’ve never actually seen the act of it itself (.) and I mean I’d
23 always thought that- actually- I don’t know what I actually had thought (.)
24 I mean I hadn’t exactly expected it to be like fireworks or anything and
25 screams and you know a very big excitement but I mean it wasn’t like all
26 that spectacular and the closest really I can describe it as it would be like a
27 drift (.) kind of a deflation and I mean I know a deflation (.) okay well they’ve
28 stopped breathing and that it makes- you know they’re gonna- well deflated
29 the air’s literally expired from their chest- but I think it’s more than that it’s
30 just- I mean i-it it seemed so empty- I mean the guy who died today was a
31 young chap
32 he’d just been thrown off a motorbike and he had- erm (.) suffered a
33 subarachnoid brain haemorrhage- and I mean (.) the team had thought they
34 had stabilised him and I was standing maybe 10- 15 feet away from the bed
35 watching and sort of looking straight at his face- he’s kind of- he’s kind of
(Continued)
Qualitative Research 9(1)
event was narrated by Kath and the extract presented lasts 10:48 (the full
recording lasts 13:55). At the time of the recording, Kath was nineteen-years-
old and had been at medical school six months. She begins her message with a
brief and solemn summary sentence, establishing a footing reminiscent of
Katie’s narrative of her own mothers’ death:
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TABLE 1 (Continued)
36 semi conscious and when the ECG monitor started bleeping and [long
37 breath out: 2.0]
38 it honestly it seemed almost like as if the doctors were disturbing him by
39 attempting the resuscitation (.) it was almost like someone disturbing a
40 child’s sleep (.) really it was such a profound experience but I think (.) since
41 I was so unprepared to see it and honestly I’ve not really encountered death
42 in such close proximity (1.0) I- I- I wasn’t fully alive to the mystery
43 unfolding before my eyes (.) I mean I’ve seen like- I’ve seen- well- I’ve had
44 close members of my family die but I was never actually there when they
45 did the actual moment of death (.) it was- I mean- a-as doctors we can
46 define and limit- I mean the miracles of the womb and a lot of the processes
47 of the body and all these marvellous things it does- but after that (.) the
48 second of that release I mean (.) we don’t know (.) we can describe the
49 deterioration of the physical body but (.) I’m not a spiritual person but it seems
50 so empty just to be there and gone (1.0) and I mean where does it begin and
51 where does it end? That second (.) that release (.) like does it exist? I mean
52 they were there for like half an hour trying to resuscitate him and I mean (.)
53 when is enough enough? He looked so young- so healthy he was a kid (.) it’s a-
54 one of his arms was- was like hurt- it was bleeding and it looked- I think
55 they suspected it to be broken and they were about to wheel him down to-
56 they were waiting for the x-ray department to free up or get him in quickly
57 to check his arm (.) but they really had thought he was okay (1.0) he was semi
58 conscious and like they were moving onto more extreme cases and just- just
59 the alarm started- well the alarm- the beeping of the ECG started to say that
60 basically he’s dead and- well his heart had stopped
61 I mean he just looks like any sort of guy who I’d chat to in a club or bar and
62 it seemed- it seemed- it almost seemed like a theft (.) a robbery of his youth
63 (2.0) I think that there’s something that as a doctor I’ll encounter a lot but it
64 such a profound experience that I don’t think one can ever really come to
65 terms with it (.) I mean its something that happen- will happen to every one of
66 us but I’ve always thought of it as kind of an abstraction (.) I mean I know a
67 lot of people they say (.) okay (.) they want death to become- oh” they say “oh
68 I wish I was dead-” “I’d rather be dead than do this exam-” “I’d rather be
69 dead than (.) like go to that club” or- really like it’s fine to talk about death as
70 an abstraction but as soon as he’s in the next room (.) if his touching you he
71 becomes so- so- so solid and it’s frightening (2.0) people get scared (2.0)
72 and other members of my family who work with death a lot (.) like they work
73 with patients who are like [disease] sufferers and stuff like that- one of my
74 [family] (.) she’s a doctor who works with- like what I say infectious disease
75 and that’s her specialty and she works on the [disease] ward- well semi
(Continued)
Monrouxe: Solicited audio diaries in longitudinal narrative research
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76 infectious disease ward but obviously she sees a lot of people with [disease]
77 and stuff like that and the high mortality rate on her ward (.) and I see with
78 her (.) even her she’s worked for the best part of 25 years and like- well 20- 25
79 years [softly laughs] sorry better flatter her (.) but it doesn’t seem to get any
80 easier for her- it’s just- its like as if I want to be climbing this mountain that
81 I’m not sure that I’ll ever be able to fully reach the top and (.) then again
82 would I ever want to reach the top? would I ever want to accept death that
83 much that I’d be so desensitized to it but- I just- wouldn’t be totally affected
84 (1.0) and I think that is (.) it is a subject that we all have to encounter but I
85 mean it’s so taboo (.) I mean we can talk about things that happen everyday (.)
86 but like when death comes it just- people like shut up (.) they just clam up-
87 they just don’t talk about it (.) and I mean you know it’s something that’s
88 going to happen to us all- like I mean- you know (.) they’ve no problem about
89 joyously celebrating the fact that someone’s had a baby- like “a baby is
90 born” and ooh” like they don’t- when I die I know myself I don’t want
91 people to be mourning the fact that I’m dead (.) I want them to celebrate my
92 life- don’t want people to cry-
93 like I saw that- that boy (.) his mother- well mother- I- to be honest I don’t
94 know if his mother but somebody obviously who had a strong bond with
95 him possibly or someone who is strongly affected by his death at any rate (.)
96 like she could have been his mother- his Aunt- I don’t know (.) but the point is
97 she was so gutted about it
98 I mean how can you as a doctor be so upset about this person dying (.) seeing
99 death in front of you and you have to go on and still be strong like tell
100 people “look (.) the person you love so much is dead” and they’d be angry
101 and hurt and upset and I know there’s a good chance that they’ll take it out
102 on you and you have to take that- I mean where does the doctor- who
103 doctor’s the doctor? you know and all these emotions that are being fired at
104 you and your own emotions topping them all up- I mean where? I mean like
105 I’m not a system and I like to believe I’m a fountain (.) I’ll probably overflow
106 and in what direction? I mean you can’t keep bottling these things up (1.0) I
107 know there’s help lines and stuff like that for doctors but it’s not really
108 enough- I mean they give people counselling for- you know if you see
109 someone shot (.) that- you know if you’re a witness to a murder they often
110 give people like- oh they give them free counselling or whatever to
111 overcome it but I mean (.) as a doctor you’ll encounter death an awful lot
112 more frequently but you’re supposed to be able to keep so strong inside and
113 cold and hard against the onslaught of emotions (1.0) unsure of a death
114 world (3.0)
115 and speaking of difficult [softly laughs] well SSUs and all (.) they’re just
(Continued)
TABLE 1 (Continued)
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116 Over(.) well I’ve just- I submitted yesterday and that’s the reason why I
117 haven’t been able to get back to you Lynn with this tape recording and well
118 because I’ve been hell bent on SSUs- I did mine on [medical condition] and
119 I found it was very- again emotive …” Kath, 27
th
March 2006
Monrouxe: Solicited audio diaries in longitudinal narrative research 95
Following her brief summarizing sentence (line 1), Kath makes an immediate
shift in tone as she provides a short orientation to her story, drawing on a shared
understanding between researcher and participant as she acknowledges illegiti-
mate ‘time off during an element of her undergraduate programme, while softly
laughing at the irony of the setting she is describing to her as-yet untold story. She
then provides a signifying sentence (line 6) alerting the listener that she is about
to disclose the ‘complicating action’ (lines 7–19). In doing so, she invites further
shared understandings of the event by drawing on cultural images of a motor
vehicle accident arriving at an accident and emergency department: ‘as you can
imagine it was very (.) kind of (.) messy (lines 10–11) encouraging the listener to
conjure up an image of the event, thus drawing us emotionally closer into her
own experience. At this point in the narrative, and throughout the initial stages as
Kath discloses the complicating action, the researcher is clearly present and affect-
ing the way in which Kath constructs both the content and the telling of her story.
Indeed, she feels the need to legitimize her being (and remaining) present in the
accident and emergency department at this point in time (when a non-medic
would have been asked to leave) directly to the researcher because- you know- I’m
doing medicine I was kind of interested (line 13). Moreover, it appears that Kath’s
desire to legitimize her presence and to establish her behaviour as ethical in the
eyes of the researcher led to momentary incoherence in her story, displaying con-
fusion regarding the issue of consent he asked me if I’d mind waiting around (line
12) and I asked him like- well can I d- well I asked them- well I asked him…would he
mind if I just waited (lines 14–16). Thus, when narrating her story, Kath appears
to closely consider her audience even when the listener is not present. Moreover,
Kath continues with further justification he just said (.) basically (.) if I kept out of
the way I wouldn’t get in trouble (lines 17–18), suggesting that she was aware of
her limited legitimacy at the scene. Kath’s choice not to narrate this interaction
using reported speech (which would have entailed a shift in prepositional use from
I to you) gives the impression that this is what happened (rather than just a request
for it to happen) and that she did just watch and stay out of trouble’. At this point,
however, rather than continuing with the frame and situating her story around
consent issues and the ethics of her own actions, Kath shifts footing from impres-
sion management and legitimizing her own position to, once more, that of story-
teller as she quickly gets to the point of her little story’; her witnessing of a man’s
death. At this point Kath makes another shift (signalled by the phrase and I mean
line 20) into an evaluative frame as she begins an attempt to make sense of the act
of death.
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As Kath embarks on her sense-making activity, she does so for the other in
an attempt to explain why this event was so significant in comparison to other
events she has experienced. However, we can see how her sense-making moves
between an explanation for the other, and sense-making for herself, as multi-
ple shifts in footing occur. The most prominent shift begins as Kath realizes
that she had never really considered the actual moment of death before actu-
ally- I don’t know what I actually had thought (line 23). We can see from this sec-
tion of her narrative how the audio diary method appears to be capturing
Kath’s own sense-making-in-the-moment, as she struggles to find a reference
within herself for this ‘moment of death. It is acknowledged that other quali-
tative methods, such as semi-structured interviews, when employed by a
skilled narrative researcher do allow space for such ‘ponderings.’ However, the
possibility for prompting, questioning and directing the thoughts of partici-
pants (and indeed, the expectation on the part of the interviewee that they
might come) ultimately makes this sense-making process, driven purely by the
narrator, hard to capture outside the audio-diary method. Thus we can see
how, through her further use of the phrase I mean indicating her struggle
for meaning Kath’s explanation begins to take on a feeling of exploration as
she considers both the literal and the metaphorical aspects of the act of taking
one’s last breath (lines 27–30). Moreover, she contemplates this act as situated
in another, and not her own last breath, with her continual use of ‘they’ (lines
27–29). Through the use of the third-person pronoun, individuals can mark
social distance between themselves and others or depersonalize others (Dyer
and Keller-Cohen, 2000; Fortunet, 2004). Here, it seems that Kath is clearly
contemplating the act of death in the other that of the generalized patient.
Following this brief contemplation, Kath brings her narrative back to the par-
ticular: the guy who died today (line 30).
On a conceptual level the main shift that occurs at this point in her narra-
tive is between Kath’s contemplation of the metaphysical (lines 24–31) and
her sudden transition to more concrete, biomedical matters (lines 32–37)
drawing on the dominant discourse of medical professionalism that includes a
detached voice of authoritative certainty comprising technical medical termi-
nology, objective descriptions of physical symptoms, and the classification of
these within a reductionist biomedical model (Mishler, 1984). This shift in
footing brings her back into her description of the complicated action (line
32), filling in more detail around the events surrounding the young man’s
death. In doing so we can see the interplay between Kath’s developing profes-
sional identity which calls for a clinical and emotionally detached self and
which is developed and maintained by her careful use of medical terms
(Mishler, 1984): he had suffered a subarachnoid brain haemorrhage, and I mean,
the team thought they had stabilized him…’ (lines 32–33), and her identity as a
person with emotions and a vulnerable body of her own (lines 40–43).
With her evocable use of the metaphor ‘death as a sleep’ we can see how
Kath gently shifts her narrative back into evaluation talk (lines 38–40). The
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contrasting unexpectedness of the present death event is powerfully narrated as
Kath steps back into the moment, describing her own state of awareness during
the event ‘I- I- I wasn’t fully alive to the mystery unfolding before my eyes’ (lines
42–43). As she continues to make sense of these unexpected events, Kath uses
narrative linkage to make a further temporal shift (line 43) by contemplating
her own experiences with death in the past, one within which she had an ele-
ment of control over her interactions with death. Throughout her narrative, as
Kath grapples to make sense of events, she contemplates her personal relation-
ship with death itself whilst simultaneously reinforcing her medical profes-
sional identity. Here, Kath’s use of the inclusive pronoun we orients her firmly
within the medical profession, whilst simultaneously returning her narrative to
the present time I mean, a-as doctors we can define and limit (lines 45–46).
Kath continues her sense-making within this narrative with her potent use of
rhetorical questions about the moment of death: where does it begin and where
does it end? That second (.) that release (.) like does it exist? (lines 50–51). Her com-
ments on the man’s youth and health clearly define him as someone who she
finds hard to associate with death: a kid (line 53). Although Kath doesn’t say
how old he is, she herself is only 19 at the time. Immediately following these
rhetorical questions, Kath makes a further temporal and conceptual shift as
once again she abruptly moves her narrative from a consideration of the meta-
physical to a description of the biomedical, returning once again to the compli-
cated action (within evaluation), and ultimately the start of his death (line 54).
Kath’s abrupt shift in frame back to a biomedical description suggests a ten-
sion within her sense-making process. It suggests a need for her to bring her
narrative back to the known and the knowable. What is interesting here is how
she corrects herself to say his heart had stopped, rather than he was dead: the
very issue she was struggling with, the question concerning point at which
death begins the alarm started- well- the alarm- the beeping of the ECG started to
say that basically he’s dead and- well his heart had stopped. (lines 59–60).
Immediately following this declaration of his death, Kath makes another tem-
poral shift in frame (to another phase of evaluation) as she talks about the man
using the present tense he just looks like (line 61) highlighting her own pre-
sent identity: that of a young medical student, frequenting clubs and bars, and
destined to become a doctor who will inevitably need to cope with the death of
patients and ultimately of her own demise.
During this phase of evaluation, Kath repeats her powerful opening state-
ment that this had been such a profound experience of death (line 64). One
which she contrasts, through her rhetorical use of reported speech, as she mim-
ics different voices, with death as an abstraction (lines 67–69). Following this
change in frame, Kath proceeds to shift frame once more, elegantly bringing us
deeply and intimately into a world where death is a person rather than an
abstraction: a person in the next room, touching you (line 70). The reality of
this death event is, for Kath, frightening: people get scared (line 71). Kath then
skilfully uses narrative linkage, bringing in her personal cultural history to
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further develop her construction of herself as a doctor and her future coping
abilities as she draws on her Aunt’s experience of working with terminally ill
people: it doesn’t seem to be getting any easier for her (lines 79–80). Here, we wit-
ness Kath struggle with her future professional identity as she develops a potent
metaphor of ‘emotional detachment as the summit,’ something to be reached
as an ultimate achievement for a doctor and one which is culturally defined
(lines 80–83). However, in developing this metaphor she begins to question her
own desire to reach that summit: she’s climbing it in her pursuit of a medical
career, yet as a person she is unsure that she truly wishes to adopt that aspect of
the medical professional persona. Thus we can see how Kath contests the dom-
inant discourse of emotional detachment within medicine.
Kath then pauses for a brief moment before she develops her narrative to
question a wider discourse in society that death is a taboo subject thus
broadening her sense-making beyond herself as a future doctor. She draws on
cultural rituals whereby death can be mourned or death can be celebrated (lines
91–92). At this point Kath makes an abrupt temporal shift once again back to
the event, and another aspect of the complicating action, to reveal one further
dimension to her story: there had been a member of the boy’s family present
around the time of his death and Kath had witnessed her distress (lines 93–97).
During this final stage of evaluation, Kath returns to her future role as clini-
cian and the process of breaking bad news. Once again we can see her narrat-
ing her identity as a future clinician seeing death in front of you and you have to
go on and still be strong…’ (lines 98–99) and her identity as she is now and how
she talks about coping I like to believe I’m a fountain (.) I’ll probably overflow and
in what direction?... (lines 105–106). Kath continues by considering what life
will be like as a doctor, although here she is using the pronoun you rather than
we as she did earlier, thus suggesting at this moment she prefers to distance her-
self with this professional identity as a doctor youll encounter death…youre sup-
posed (line 112). Indeed, Kath demonstrates her predicament as she
evocatively draws both on the cultural demands of a clinical professional iden-
tity strong inside and cold and hard against the onslaught of emotions and of her
own personal self unsure of a death world (lines 112–114). Pausing for a few
seconds, Kath’s voice changes tone and pace as she enters into a coda (line
115): bringing herself and the listener back to the here and now, she softly
laughs, apologizing for not getting back with her recording, before continuing
on with a second story that she also found personally emotive.
Discussion
If we now theorize about this narrative, its meaning and its contribution to
Kath’s personal and professional development we are drawn to the following
observations. First, one can see her story oscillating between the literal and the
more elaborate metaphorical, between the diagnostic and the reflective,
between the physical and the metaphysical. Thus, Kath informs us about the
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man’s subarachnoid haemorrhage and his abnormal ECG before reflecting on
his child-like disturbed sleep and describe the events as ‘a mystery unfolding’;
she talks of his broken arm and the need for an x-ray before mulling over the
‘robbery of his youth. She then returns to the implication of the event for her
as a person. At this point her reflections are strictly personal, devoid of any
technical competence in this context. The metaphor she uses here is stark:
climbing, reaching a (probably unachievable) summit. Finally, this incident
invites her to reflect on her own death, visualized as a celebration rather than
a cause for sorrow. Thus, within this narrative, we witness a young girl con-
testing a number of dominant discourses within medicine and society in gen-
eral, in order to reconcile her inner feelings and thoughts evoked by the event
she had just experienced with her future identity as a doctor.
For clinicians, these insights are reminders of the indisputability of their
personal and professional selves, of the elusiveness of ‘professional detach-
ment’ or even ‘scientific objectivity’. They exemplify the two ways of gazing on
the human condition biomedical and narrative that doctors constantly
oscillate between. Finally, they confront us with what Polanyi explained to
clinicians nearly half a century ago: the inseperability of the knower from all
acts of comprehension and the reciprocity, in all acts of knowing, of thinking
and feeling (Polanyi, 1958).
Conclusion
The solicited audio diary methodology is a powerful tool for researchers inter-
ested in narrative enquiry. It opens up new insights into the way in which we
make sense of the world of telling our stories to another and to ourselves. One
interesting question regarding the narratives found within our solicited audio
diary data is to what extent they typify narratives (Burke, 1945; Labov, 1972;
Labov and Waletzky, 1967) and to what extent they can be described as con-
versational narratives (Ochs and Capps, 2001). While it is possible to see from
Kath’s narrative that this method of data collection gives participants the
opportunity to tell their stories in a classically structured way, with the key ele-
ments of summary, orientation, complicating action, evaluation and coda
(Labov and Waletzky, 1967), aspects of these narratives reveal an element of
conversational mindfulness. Indeed, when recording a diary entry the narra-
tor has the opportunity and space for editing and repairing their narrative
structure. So we see Kath’s narrative contains embedded additions to the com-
plicated action within her evaluation talk. This recursive aspect of these nar-
ratives is interesting for a number of different reasons including the insights it
provides regarding the process of sense-making and narrative identity forma-
tion in action. For example, Kath describes and evaluates the events sur-
rounding the man’s death, what happened and what it means to her as a
medical student and a doctor of tomorrow, she returns to the scene to provide
more information about the complicating action three times: the first time was
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to give us details of the actions of the medical team and of herself at the very
moment that the ECG started to beep, the second time she returned once more
to this key moment in time to further embellish on what was happening to the
man himself and the medical team’s actions, later she returns to the compli-
cating action but moves on from this moment, bringing a new protagonist to
the scene, the grieving relative. These key moments that Kath returns to, fur-
ther enhance our own understanding of the event, whilst at the same time
enables Kath to establish a clearer understanding of the meaning as she makes
sense of these events.
Additionally, data collected using the solicited audio diary method contains
further dimensions of conversational narrative (Ochs and Capps, 2001). So,
although there is a single active teller in the narratives collected using solicited
audio diaries it is clear from the data that the stories are directed at a known
individual. While there is essentially no turn-taking, it is interesting to see how
these solitary narrators take both sides in a conversation: taking on the role of
the other, asking questions and then providing an answer. As participants in
the study narrate their stories they are mindful of who the researcher is and
what she stands for. At times it seems that they treat the researcher as a co-
narrator, addressing their comments in order to answer anticipated questions
from the other. For example, Kath included an explanation of why she was pre-
sent in the accident and emergency ward of a hospital without consent. As
such, there remains the feeling of a co-narrator actively influencing the con-
struction of these narratives.
On the dimension of tellability (Ochs and Capps, 2001) the longitudinal
audio diary method enables a broad spectrum of forms from the highly tellable
events with profound consequences (such as Kath’s narrative) to relatively
uneventful ordinary’ events with low tellability (such as Anwar’s brief diary
entry on his SSU). Therefore the longitudinal nature of the study, in addition
to the audio diary method, enables participants to leave a variety of tellable
stories that give the narrative analyst a deeper understanding of identity in
formation and practice. Ochs and Capps (2001) also point out that narratives
may differ on the dimension of linearity whereby ‘highly linear narratives link
events within a plot structure with a beginning that builds to a middle, then
resolves into an ending’ (p. 83). While some solicited diary entries are more-or-
less linearly structured, others are nonlinear (like Kath’s narrative). Such non-
linearity reflects the spontaneous and recursive nature of sense-making in
practice. Capturing this process gives a deep and unique insight into identity
formation: this discursive think-aloud process is an unintended, yet profound
insight into an individuals’ sense-making activity. Indeed, we can see from
Kath’s narrative how she shifted from narrating one event to another, to this
process of pondering and wondering about her own expectations of what
death was and how the events she had experienced had affected her. In doing
so, a noticeable shift in the framing of her talk was apparent: it took on a more
pensive and questioning tone. Similarly, stories solicited via the audio diary
100
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Monrouxe: Solicited audio diaries in longitudinal narrative research 101
method invariably have a moral stance. This is typically uncertain and fluid as
individuals narrate their developing personal and professional identities.
We have also seen how the solicited audio diary method captures talk that is
highly conversational in nature from the perspective of micro analysis. Thus,
we notice reported talk and thoughts, paralinguistic aspects such as the use of
tone and pitch, the use of humour and even laughter are all apparent. While
it is beyond the scope of this article, further research into understanding just
how these compare to examples found in talk-in-interaction would be advan-
tageous. Questions such as whether they perform the same function in narra-
tion when the audience is not physically present would be of importance here
for the narrative analyst.
The ethical dimension for the researcher employing this methodology also
needs to be taken into account when considering its use. As we have seen, the
solicited audio diary method encourages both prototypical narratives and
small stories. Each of these narrative forms brings with it an ethical dimen-
sion. Small stories bring the researcher closer to the everyday life of the par-
ticipant and with it a feeling of knowing someone that other methods do not.
Prototypical narratives can be difficult to hear and may comprise highly event-
ful stories that are deeply significant in the lives of the participants.
Accordingly, the researcher should expect the unexpected: while we may
solicit the telling of stories using the audio diary method, we can never know
which stories will be told and how the narrators will tell them, until the
moment of listening. Sometimes the emotional or the ethical tone of the nar-
rative entails that the researcher consider further action following the receipt
of a diary entry. At all times, however, the world into which the solicited audio
diary method brings us is brimming with a multitude of ways in which to
understand how our participants make sense of their world and the manner in
which they narrate their developing identities.
A C K N O W L E D G E M E N T S
I would like to thank all of the medical students who participate, and who have
participated, in this research for giving their time and sharing their stories. I
would also like to thank Brett Smith (Qualitative Research Unit, University of
Exeter, UK), Kieran Sweeney (Peninsula College of Medicine and Dentistry,
Universities of Exeter and Plymouth, UK) and Charlotte Rees (Faculty of
Medicine, The University of Sydney, Australia) for their helpful comments on
earlier drafts of this work. Finally, I extend my thanks to three anonymous
reviewers who provided comprehensive and insightful comments to improve
the article.
N O T E S
1. All names have been changed to preserve anonymity. The notation for these
excerpts is as follows:
SMALL CAPITALS = spoken loudly; Underlined = emphasized;
<words in sharp brackets>=spoken faster than typical speech for individual;
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Qualitative Research 9(1)
Dash- at- end- = running on speech; [words in square brackets] = further
information or substitute words; (words in single brackets) = probably word spoken;
(…) = inaudible speech; (1.5) = pause to nearest half second;... = omitted speech.
2. The AMK (Applied Medical Knowledge) is the main form of assessment at the
School and is in the form of 125 multiple choice responses to a clinical scenario.
R E F E R E N C E S
Antaki, C. and Widdicombe, S. (1998) Identities in Talk. London: Sage.
Atkinson, J.M. and Heritage, J. (1984) Structure of Social Action. Cambridge: Cambridge
University Press.
Atkinson, P. (2005) ‘Qualitative Research Unity and Diversity [25 paragraphs]’,
Forum Qualitative Sozialforschung / Forum: Qualitative Social Research 6(3), article 26,
URL: http://www.qualitativeresearch.net/fqs-texte/3-05/05-3-26-e.htm
Atkinson, P., Coffey, A., and Delamont, S. (2003) Key Themes in Qualitative Research.
Oxford: AltaMira Press.
Atkinson, P. and Silverman, D. (1997) ‘Kundera’s Immortality: The Interview Society
and the Invention of the Self ’, Qualitative Inquiry 3: 304–25.
Bamberg, M. (2006) ‘Stories: Big or Small: Why Do We Care?’, Narrative Inquiry 16:
139–47.
Burke, K. (1945) A Grammar of Motives. Berkeley and Los Angeles, CA: University of
California Press.
Button, G. and Casey, N. (1984) ‘Generating Topic: The Use of Topic Initial Elicitors’, in
J.M. Atkinson and J. Heritage (eds), Structures of Social Action, pp. 167–90. New York:
Cambridge University Press.
Crawford, M. (2003) ‘Gender and Humor in Social Context’, Journal of Pragmatics
35(9): 1413–30.
Cutting, J. (2000) Analysing the Language of Discourse Communities. Amsterdam:
Elsevier.
Diaute, C. and Lightfoot, C. (2004) Narrative Analysis: Studying the Development of
Individuals in Society. Thousand Oaks, CA: Sage.
Dyer and Keller-Cohen (2000) The discursive construction of professional self through
narratives of personal experience. Discourse Studies 2(3): 283–304.
Fortunet (2004) The use of ‘we’ in university lectures: reference and function. English
for Specific Purposes 23: 45–66.
Georgakopoulou, A. (2007) Small Stories, Interaction and Identities. Amsterdam: John
Benjamins Publishing Company.
Gergen, K.J. and Gergen, M.M. (1986) ‘Narrative Form and the Construction of
Psychological Science’, in T.R. Sarbin (ed.), Narrative Psychology: The Storied Nature of
Human Conduct. New York: Praeger.
Goffman, E. (1967) Interaction Ritual. New York: Anchor Books.
Goffman, E. (1981) Forms of Talk. Philadelphia, PA: University of Pennsylvania Press.
Hay, J. (2000) ‘Functions of Humor in the Conversations of Men and Women’, Journal
of Pragmatics 32(6): 709–42.
Hislop, J., Arber, S., Meadows, R. and Venn, S. (2005) ‘Narratives of the Night: The Use
of Audio Diaries in Researching Sleep’, Sociological Research Online 10(4), URL:
http://www.socresonline.org.uk/10–4/hislop.html
Holstein, J. and Gubrium, J. (2000) The Self We Live By. New York: Oxford University
Press.
102
at Cardiff University on November 9, 2012qrj.sagepub.comDownloaded from
Monrouxe: Solicited audio diaries in longitudinal narrative research 103
Holt, E. and Clift, R. (2007) Reporting Talk: Reported Speech in Interaction. Cambridge:
Cambridge University Press.
Jefferson, G. (1978) ‘Sequential Aspects of Storytelling in Conversation’, in
J. Schenkein (ed.), Studies in the Organisation of Conversational Interaction,
pp. 294–338. New York: Academic Press.
Knight, L.V. and Mattick, K. (2006) ‘“When I First Came Here, I Thought Medicine was
Black and White”: Making Sense of Medical Students’ Ways of Knowing’, Social
Science & Medicine 63(4): 1084–96.
Labov, W. (1972) Language in the Inner City: Studies in the Black English Vernacular.
Oxford: Blackwell.
Labov, W. and Waletzky, J. (1967) ‘Narrative Analysis’, Journal of Narrative and Life
History 7: 1–38.
Martin, R.A. (2004) ‘Sense of Humour and Physical Health: Theoretical Issues, Recent
Findings and Future Directions’, Humor 17: 1–19.
McAdams, D. (1993) The Stories We Live By. New York: The Guildford Press.
Mead, G.H. (1934) Mind, Self and Society. Chicago, IL: Chicago University Press.
Milligan, C., Bingley, A. and Gatrell, T. (2005) ‘Digging Deep: Using Diary Techniques to
Explore the Place of Health and Well-Being Amongst Older People’, Social Science &
Medicine 61: 1882–92.
Mishler, E.G. (1984) The Discourse of Medicine. Dialectics of Medical Interviews. Norwood,
NJ: Ablex.
Ochs, E. and Capps, L. (2001) Living Narrative: Creating Lives in Everyday Storytelling.
Cambridge, MA: Harvard University Press.
Polanyi, M. (1958) Personal Knowledge. Chicago, IL: University of Chicago Press.
Ricoeur, P. (1992) Oneself as Another. Chicago, IL: University of Chicago Press.
Riessman, C. (1990) Divorce Talk: Women and Men Make Sense of Personal Relationships.
New Brunswick, NJ: Rutgers University Press.
Saraglou, V. and Anciaux, L. (2004) ‘Liking Sick Humor: Coping Styles and Religion as
Predictors’, Humor 17: 257–77.
Sarbin, T.R. (1986) Narrative Psychology: The Storied Nature of Human Conduct. New
York: Praeger.
Sinclair, S. (1997) Making Doctors: An Institutional Apprenticeship. Oxford: Berg.
LYNN V. MONROUXE is Director of Medical Education Research at the School of
Medicine, Cardiff University, Wales. Her current research interests include professional
identity formation, narrative enquiry, epistemological talk and doctor-student-patient
interaction. Address: Division of Medical Education, Room 158, Upper Ground Floor, B-
C link corridor, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN,
Wales, UK. [email: knightlv@cardiff.ac.uk]
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