Expertise as a domain of epistemics in intensive care shift-handovers

Abstract

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.

Expertise as a domain in interaction

“…In those contexts where there is no training or overhearing audience or work is carried out among professionals, the ways in which expertise is exuded are often subtle or subliminal, and they may remain seen but unnoticed. Among peers working in routine tasks, the dispositional excellence is not separately displayed but just an inherent aspect of the execution of the activity, nor is its reception marked (Bassetti, 2021; Harms, Koole, Stukker and Tulleken, 2021). In these cases, the excellence or know-how is inbuilt in the performance and its efficiency, and they pose a challenge for the analyst.…”

Expertise in interaction – Introduction

“…In some environments, propositional and procedural knowledge are clearly distinguishable with differing distributions. Harms et al (this issue) explore intensive care handovers in which medical information about a patient is transferred from an outgoing physician (OP) to an incoming physician (IP). In these handovers, they point out participants’ orientations to a striking disparity between on the one hand knowledge about the patient, and on the other hand, a parallel orientation to a shared knowledge with respect to (clinical) procedures, reasoning and practices.…”