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ObjectivesThe main aim of this study was to demonstrate how ordered network analysis of video-recorded interactions combined with verbal response mode (VRM) coding (eg, edification, disclosure, reflection and interpretation) can uncover specific communication patterns that contribute to the development of shared understanding between physicians and nurses. The major hypothesis was that dyads that reached shared understanding would exhibit different sequential relationships between VRM codes compared with dyads that did not reach shared understanding. DesignObservational study design with the secondary analysis of video-recorded interactions. SettingThe study was conducted on two oncology units at a large Midwestern academic health care system in the USA. ParticipantsA total of 33 unique physician–nurse dyadic interactions were included in the analysis. Participants were the physicians and nurses involved in these interactions during patient care rounds. Primary and secondary outcome measuresThe primary outcome measure was the development of shared understanding between physicians and nurses, as determined by prior qualitative analysis. Secondary measures included the frequencies, orders and co-occurrences of VRM codes in the interactions. ResultsA Mann-Whitney U test showed that dyads that reached shared understanding (N=6) were statistically significantly different (U=148, p=0.00, r=0.93) from dyads that did not reach shared understanding (N=25) in terms of the sequential relationships between edification and disclosure, edification and advisement, as well as edification and questioning. Dyads that reached shared understanding engaged in more edification followed by disclosure, suggesting the importance of this communication pattern for reaching shared understanding. ConclusionsThis novel methodology demonstrates a robust approach to inform interventions that enhance physician–nurse communication. Further research could explore applying this approach in other healthcare settings and contexts. 

Numerous computer-based collaborative learning environments have been developed to support collaborative problem-solving. Yet, understanding the complexity and dynamic nature of the collaboration process remains a challenge. This is particularly true in open-ended immersive learning environments, where students navigate both physical and virtual spaces, pursuing diverse paths to solve problems. In response, we aimed to unpack these complex collaborative learning processes by investigating 16 groups of college students (n = 77) who utilized an immersive astronomy simulation in their introductory astronomy course. Our specific focus is on joint attention as a multi-level indicator to index collaboration. To examine the interplay between joint attention and other multimodal traces (conceptual discussions and gestures) in students’ interactions with peers and the simulation, we employed a multi-granular approach. This approach encompasses macro-level correlations, meso-level network trends, and micro-level qualitative insights from vignettes to capture nuances at different levels. Distinct multimodal engagement patterns emerged between low- and high-achieving groups, evolving over time across a series of tasks. Our findings contribute to the understanding of the notion of timely joint attention and emphasize the importance of individual exploration during the early stages of collaborative problem-solving, demonstrating its contribution to productive knowledge coconstruction. This research overall provides valuable insights into the complexities of collaboration dynamics within and beyond digital space. The empirical evidence we present in our study lays a strong foundation for developing instructional designs aimed at fostering productive collaboration in immersive learning environments.