Diagnostics using next generation sequencing (NGS) requires high-quality interdisciplinary collaboration. In order to gain insight into this crucial collaborative process, we made video recordings of a new multidisciplinary team at work in the clinical genetics department of the University Medical Centre Groningen. Conversation Analysis was used to investigate the ways in which the team members deal with the disciplinary boundaries between them. We found that the team established different 'participation frames' in which to discuss recurring topics. Patients were discussed only by the medical doctors, whereas results of genetic tests were discussed by doctors, molecular biologists and genetic laboratory technicians. Information technology (IT) aspects were discussed by biologists, genetics analysts and bio-informaticians, but not doctors. We then interviewed team members who said they believed that the division of labour embodied in these participation frames contributes to achieving their team's goals.
This paper examines how expertise is treated as a separable domain of epistemics by looking at simulated intensive care shift-handovers between resident physicians. In these handovers, medical information about a patient is transferred from an outgoing physician (OP) to an incoming physician (IP). These handovers contain different interactional activities, such as discussing the patient identifiers, giving a clinical impression, and discussing tasks and focus points. We found that with respect to (factual) knowledge about the patient, the OPs display an orientation to a knowledge imbalance, but with respect to (clinical) procedures, reasoning, and activities, they display an orientation to a knowledge balance. We use ‘expertise’ to refer to this latter type of knowledge. ‘Expertise’ differs from, and adds to, how knowledge is often treated in epistemics in that it is concerned with professional competence or ‘knowing how’. In terms of epistemics, the participants in the handovers orient to a steep epistemic or knowledge gradient when it concerns the patient, while simultaneously displaying an orientation to a horizontal expertise gradient.
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