Access, boundaries and their effects: legitimate participation in anaesthesia

Abstract

The distribution of work, knowledge and responsibilities in the delivery of anaesthesia has attained particular significance recently as attempts to meet the demands of the European Working Times Directive intensify existing pressures to reorganise anaesthetic services. Using Lave and Wenger's (1991) notions of 'legitimate peripheral participation' in 'communities of practice ' (and Wenger 1998) to analyse ethnographic data of anaesthetic practice we illustrate how work and knowledge are currently configured, and when knowledge may legitimately be taken as the basis for action. The ability to initiate action, to prescribe healthcare interventions, we suggest, is a critical element in the organisation of anaesthetic practices and therefore central to any attempts to reshape the delivery of anaesthetic services. Keywords: anaesthesia, boundaries, communities of practice, ethnographyThe 'crisis' in anaesthesia Pilnick and Hindmarsh (1999) argue that anaesthetic practice is accomplished by anaesthetic teams in collaboration with the patient and emphasise the necessity to understand how anaesthetic work is created in interactions. This interaction becomes increasingly salient when service reconfiguration and redistribution of work within the anaesthetic team is being considered.In the UK medically-qualified anaesthetists currently provide general and regional anaesthesia for operative procedures, they practice in high dependency and intensive care, provide obstetric epidural services, and acute and chronic pain management services. The 'New Deal for Junior Doctors' restricted the amount of time junior doctors spend training and working in

Communities of clinical practice: the social organization of clinical learning

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Professional legitimacy claims in the multidisciplinary workplace: the case of heart failure care

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Embedding instruction in practice: contingency and collaboration during surgical training

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