This chapter provides a survey of the aim and scope of the volume.

A brief overview of Part One. Part One shows that understandings involve people developing brief chains of information, which express various types of relationships among linguistic terms, physical objects, images, and actions. It examines how those process narratives distill information and concepts into a memorable form. Process narratives are a nexus of individual or collaborative interpretation activities, information resources, and culturally shaped patterns of interac- tion. The category, ‘process narrative’, pertains to the processes of interpret- ing human interaction and environmental information resources that result in any type of understanding. Studying process narratives emphasizes the rela- tionships among the various types of interpretation activities and information resources that lead to understandings – during the initial production of the understandings and during their subsequent recall and application. Analysis of the development and use of process narratives exposes the social and indi- vidual interpretation activities that sustain beliefs and ideologies. It clari es aspects of understanding that have been considered in terms of categorical distinctions such as context and content, tacit knowledge, functional xed- ness, and oracular reasoning.

Chapter One examines how interpretation activities applied to interaction and information resources select and link pieces of information in ways that produce recallable units of meaning, process narratives. They may be expressed by a combination of language and gesture related to objects or images. This chapter examines how patients interpret, understand, and recall verbal and visual information related to the symptoms and treatment of uterine fibroid tumors encountered during interventional radiology consultations. The chapter features analysis of video recordings of interaction during two clinical consultations and audio recordings of post-consultation telephone discussions with each patient. During each consultation, a patient and a nurse view and discuss a set of images on a computer screen in order to help the patient understand a medical procedure she is considering. These representative examples of a larger data set show that communication patterns including gestures and pointing affect which pieces of information patients link in the process narratives and understandings they recall days after the consultations. The relationship of process narratives to specific interpretation activities and information resources explains how people develop or fail to develop transferable understandings of new information.

The discussion of classroom data in Chapter Two presents a type of commonplace situation in which the creation of process narratives is complicated by the absence of explanatory information. The chapter details the intricate interpretation activities that organize information as process narratives as high school biology students learn about the genetic inheritance of traits by using a computer simulation of the breeding of generations of rabbits. The classroom interaction displays the interpretive contingencies that students contend with as they create process narratives from newly encountered information. Those contingencies include the concurrent activities of interpreting visual information and developing frames of reference for determining what information is relevant to the activity.

Chapter Three examines how coherent understandings evolve, the endurance of process narratives and frames of reference, and the difficulties of modifying process narratives by continuing analysis of Chapter Two’s genetics learning activities. The biology students’ initial process narratives and their interpretive drift toward a descriptive frame of reference affect the creation of a mistaken understanding of the computer simulation’s pattern of trait inheritance. The students commit to certain process narratives even when the teacher disputes them and a computer simulation provides counterevidence. The data show how the students’ interpretation activities and resulting process narratives produce a belief system that is difficult to change. The cognitive intertwining of process narratives and interpretation activities is why recall of a particular process narrative triggers recall of relevant frames of reference, and particular information resources—all of which combine to constitute an understanding or a belief.

Chapter Four examines the differences between process narratives and mental models. Unlike approaches to memory and understanding that emphasize operations of reasoning within the mind, the process narrative approach accounts for both the material and mental components of understandings. Rather than focusing on the artifacts, such as stories that result from interpretation activities, it emphasizes the enduring linkage of information, interpretation activities, resources in settings, culturally influenced patterns of expression, and frames of reference. In that regard, the clinical and classroom data analysis shows how the creation and expansion of mental models or schemata take place. This chapter examines information constraints in the production of understandings and beliefs, comparing process narratives to Schank and Abelson’s story approach to memory, and reconsidering categories of mental operations, including functional fixedness, oracular reasoning, Rumelhart and Norman’s typology of learning (accretion, tuning, and restructuring), and D’Andrade’s discussion of the role of contentful sense of contingency in solving logic problems.

Examining the creation of process narratives exposes the components of the interpretation activities that produce understandings—both accurate and mistaken understandings. The production of process narratives involves interpretive contingencies, which include the concurrent activities of developing a relevant of frame of reference, interpreting information and interaction, and contending with aspects of local culture and social organization such as time constraints and different degrees of familiarity or expertise with information resources. The activities of forming process narratives become part of the resulting understandings. This contributes to the endurance of understandings as beliefs–even in the presence of additional, contradictory information. The interpretation activities

A brief overview of Part Two. Part Two examines the ways that people often develop placeholders for missing information – referred to here as grey boxes – in order to produce process narratives. The professional cultures of teachers and clinicians feature routine communication patterns that often restrict access to pieces of information needed to create coherent, recallable process narratives. Grey boxes connect the pieces of information that suggest, but do not clearly depict a relationship. They take various forms, such as pointing or gesturing at objects or graphics, using linguistic terms that have vague meanings, or using tables that replace missing scientific information with computations of probable out- comes. Grey boxes reduce the interpretive contingencies of seeking missing information. Part Two explains grey boxes and their relationship to the interpretation activities and information resources of genetics learning activities. Although grey boxes help people to interact and complete tasks in a specific setting, they can hinder the transfer of knowledge between settings, because they are linked to the environment in which they were formed.

Grey boxes are part of a cognitive ecology of interpretation activities that lead to understandings. They result when interpretation activities confront emergent contingencies, such as ambiguity, absence of information, and lack of coherence among pieces of information. Another case of student-teacher interaction during genetics learning activities provides an example of restrictions on information triggering the creation of a grey box. This example shows how the study of grey boxes and process narratives differs from studies emphasizing mental models by emphasizing the communicative contingencies that affect reasoning and understanding. Difficulties in reasoning do not derive directly from the arbitrariness or specificity of pieces of information, but from the interpretation activities triggered by the linguistic, graphical, or gestural representation of the information. Comparison of the Mendelian genetics learning activities with research on people attempting to solve logic problems elucidates this difference. Both the Mendelian genetics curriculum and the logic problems feature restrictions on information-seeking that lead to similar interpretive contingencies. Those contingencies contribute to an increased load on short-term memory until people grey-box the missing information.

Chapter Seven examines grey boxes in regard to interpretive ambiguity, the effect of a critical mass of interpretive contingencies, forms of expression as resources for understanding, and localized aspects of grey boxes. Expanding on an example introduced earlier, the chapter examines four students and a teacher discussing a learning task featuring the use of a trait inheritance computer simulation. A result of the 10.5-minute discussion is the students’ acceptance of the term, ‘blueprints’, as a placeholder for missing information about the cellular genetic processes. ‘Blueprints’ eliminates the interpretive contingencies related to finding and coherently linking missing information about the biochemical functioning of genes that affects the development of traits. The grey box helps the students develop a useful process narrative. As a consequence of the conventional Mendelian curriculum, students and teachers spend much time and effort constructing a framework to cover the explanatory gap created by the absence of information about cellular biochemical processes. Students’ awareness of contemporary genetic terms and concepts adds contingencies to their interpretation activities. When students repeatedly confront the information gap separating genes and traits during learning activities, they develop grey boxes that alleviate their disbelief or confusion. Grey boxes ease the cognitive load of interpreting and remembering multiple contingencies.

Chapter Eight is a prelude to Part Three’s explanation of discourse frameworks. Grey boxes mobilize resources in settings as components of process narratives. Analysis of interpretation activities related to the creation and use of grey boxes clarifies concepts presented by explanations of reasoning based on mental models and cognitive schemata. For example, the interpretation activities related to producing and applying grey boxes show that ‘context’ is not simply a situational link between material or mental artifacts, but involves interpretations of information resources embedded in and retrievable through grey boxes and process narratives.

A brief overview of Part Three. Part Three examines how the activities of creating process narratives and grey boxes also produce discourse frameworks, which affect the nature and recall of understandings. Discourse frameworks incorporate individual and social interpretation activities, particular material resources in a setting, and the constraints affecting the use of those resources. Discourse frameworks function as components of understandings, because recall of process narratives also involves recall of the interpretation activities that led to them. Examining the relationship of discourse frameworks to process narratives and grey boxes reveals how the interaction that creates and reproduces a professional culture also affects understandings.

Chapter Nine analyzes more interventional radiology consultation data in order to explain the components of discourse frameworks. Topics include the effects of verbal, visual, and gestural information on process narratives, the interrelationship of discourse frameworks and communication patterns, and the relation of discourse frameworks to patients’ understandings of medical information. The data show how patterns of communication related to discussing images contribute to discourse frameworks that provide detailed information to patients. Each patient’s recallable process narratives result from creating a discourse framework, which includes discussion, pointing, gesturing, and head movements related to the images. An example shows how the various components of the discourse framework contributed to a patient developing process narratives related to a potential post-procedure complication, a sloughed necrotic fibroid. The process narratives that the patient recalls during a post-consultation telephone discussion correlate with the moments at the consultation when she completed the nurse’s utterances, voiced comprehension or participation, and turned her head toward images and gestures that related to the nurse’s verbal explanation. Examining the components of the consultation discourse framework explicates how a patient’s agency during a consultation is supported by the presence of information resources that the patient responds to and discusses with the practitioner. The patient shapes the agenda of topics and forms of expression. This contributes to a customized discourse framework that suited the patient’s concerns. The practitioner applies the visual information resources to explanations that address the specific information gaps expressed by the patient. The patient’s understandings of symptoms and treatments of uterine fibroids result from the creation of a discourse framework that both reduces her interpretive contingencies and increases those of the practitioner.

Chapter Ten examines a discourse framework based on interpretation activities that restrict information and searching for information. Restrictive discourse frameworks can occur in any situation in which an expert provides explanations to individuals or groups who do not have detailed knowledge about the topics being discussed. A new set of classroom data elucidates how communication patterns are constrained by professional culture and organizational arrangements. Diversions and delays in regard to providing information that would answer students’ questions about cellular processes create interpretive contingencies that lead to the students’ creating a discourse framework that supports the use of grey boxes in process narratives. This discourse framework contributes to understandings that rely on grey boxes linked to classroom resources and activities. As a result, understandings that students expressed in a classroom can be difficult to recall later in a setting that lacks the resources of the classroom discourse framework.

Chapter Eleven discusses how discourse frameworks affect cognitive systems that support reasoning and understanding. It examines the relation of discourse frameworks to content and context, diagrams and memory, and tacit knowledge. Analysis of the creation and application of discourse frameworks provides a way of integrating the findings of studies based on mental models and coherence based reasoning, as well as filling their gaps. Examining the creation and use of discourse frameworks shows how cognitive systems impose coherence on decision tasks. The radiology consultation and genetics education data show how the resources in a setting function as external components of memory that reduce the interpretive contingencies of developing understandings.

Chapter Twelve considers the sociocultural variables related to discourse frameworks and the production of understanding. Discourse frameworks can incorporate components reflecting the cultural and social systems affecting participants. The chapter presents examples of commonplace complexities related to the contemporary social and cultural realities of many clinical and educational settings. It describes the diversity of the research participants and settings in the context of earlier chapters’ discussion of their interpretation activities. Topics discussed include: socioeconomic categories, gender and interpretation activities, and recognizing agency by analyzing processes of understanding. Rather than emphasizing behavioral or status differences that precede interaction as determinants of understandings, analysis of discourse frameworks, process narratives, and grey boxes explains the role of interpretation activities in producing and reproducing professional culture and professional authority. The radiology consultation data show how changes to traditional organizational routines and professional culture can occur and benefit all patients’ understandings of medical information relevant to treatment decisions. Removing negative effects of organizational environments and professional cultures on patients’ understandings of their medical conditions and treatment options requires recognizing the components of interpretation activities.

A brief overview of Part Four.Part Four explains how the patterns of expression specific to professional cultures often restrict access to information in ways that affect the quality and recall of understandings. Comparing the genetics and radiology data shows why understanding does not simply result from presenting well-designed explanations. Strategies intended to support comprehension may feature interpretive contingencies that restrict understanding. However, data related to the interventional radiology consultations show how patterns of interaction involving visual resources can replace commonplace restrictive patterns of interaction in medical consultations, and help patients develop recallable understandings of useful medical information.

Chapter Thirteen examines the interactional production of professional culture and its effects on patients’ and students’ understandings. The power of medical practitioners and teachers to expand or restrict understandings stems from their influence on patterns of interaction that produce or resolve interpretive contingencies. The biology classroom and radiology consultation examples show how a particular balance of participants’ interpretive contingencies affects the endurance or change of cultural conventions. During the biology classes, the teachers apply restrictive communication patterns, which functioned as a form of professional persistence overriding students’ digressions. In contrast, the radiology consultation examples show how a practitioner’s adaptations to patients’ responses to visual information produce a balance of interpretive contingencies that favors the patient. Examples show one patient expressing many comments and questions and another patient expressing infrequent and ambiguous comments and questions. In both cases, the patients affect the balance of interpretive contingencies as the nurse adapts her pattern of expression and use of explanatory images for each patient. The resulting expansive pattern of communication supplants the professional culture’s customary restrictive communication patterns. This increases the patients’ authority over the information presented during the consultation. The radiology patients’ recall of the medical information correlated with the changes in the patterns of interaction prompted by the practitioner’s increased interpretive contingencies. The immediate cognitive and interactional work that a practitioner faces in such circumstances overcomes some of the professional culture’s customary communication patterns–particularly the administrative patterns of deemphasizing or ignoring digressive questions.

Considering understanding in terms of the development of process narratives, grey boxes, and discourse frameworks shows that an emphasis on particular interpretive contingencies is part of the production and reproduction of professional culture. Comparing the radiology consultation and genetics learning data shows why understanding does not simply result from providing well-designed linguistic explanations and visual resources. The interrelation of interpretation activities and the information resources of particular environments can lead either to the reproduction of professional cultures that restrict understandings or to changing professional cultures in ways that benefit clients. Identifying the interpretation activities that produce the process narratives, grey boxes, and discourse frameworks explains such outcomes and their effects on understanding. Based on such research, the chapter considers systematic approaches to improving patients and students’ understandings of medical and biological information.

Appendix A describes the research methods.

Documentation