Practical wisdom in medicine through the eyes of medical students and physicians

Abstract

BackgroundPractical wisdom is considered a multidimensional virtue of enduring relevance to medicine. Though it has received increasing attention in recent years, proposed frameworks for practical wisdom can differ, and little is known about how medical students and physicians describe its dimensions and relevance.MethodsWe used structured interviews, employing open‐ended and closed‐ended questions, to describe how medical students and physicians understand practical wisdom and identify the kinds of clinical situations they believe require practical wisdom. We interviewed 102 participants at two US medical schools in 2021, comprising a voluntary response sample of 40 pre‐clinical medical students and 40 clinical medical students and a purposive sample of 22 nominated physicians. Interviews were conducted by videoconference using a structured interview guide. Open‐ended responses were coded using qualitative content analysis (directed and conventional) and tabulated; closed‐ended responses were tabulated. Quotations provided qualitative illustrations, and frequencies were used for summative results.ResultsParticipants considered practical wisdom clinically meaningful, broadly relevant and multidimensional. Most described it as deliberative, goal‐directed, context‐sensitive, integrated with ethics and marked by integrity and motivation to act. Many described it as experience‐based, person‐centred or problem‐solving. Participants also selected an average of 15.6 (SD = 4.9) additional virtues as being essential for practical wisdom in medicine and described a broad range of clinical situations that require practical wisdom in medicine.ConclusionsParticipants described practical wisdom as a multidimensional capacity that entails deliberation, depends on a constellation of other virtues and is broadly applicable to medicine. Most agreed it is goal‐directed and context‐sensitive and involves ethics, integrity and motivation. Efforts to teach practical wisdom in medical education should clarify its dimensions and highlight its relationship to virtue ethics, professionalism, clinical judgement and the individualised care of patients as persons.

The wisdom of entrustability: A critically conscious approach to practical wisdom

“…Kaldjian and colleagues discuss how trainees and students may not be considered 'wise' under Aristotle's definition because of their lack of experience but highlight how they can effectively engage with the dimensions of practical wisdom. 3 This makes facilitation of practical wisdom in the curriculum not only desirable but also necessary to enable professional development that leads to students 'thriving' as physicians. However, the practical wisdom to accomplish this is currently lacking.…”

“…1,2 In their latest paper, Kaldjian and colleagues consider how to make practical wisdom a 'meaningful and teachable concept in medicine', focusing on clarifying the dimensions of practical wisdom as perceived by physicians and medical students. 3 In doing so, they uncover heterogeneity in how practical wisdom is understood and applied in terms of associated virtues, noting that practical wisdom is 'developed through cultivating other virtues' that mirror the traits empirically associated with professional judgement and good medical practice. 3 However, mindful of the global trend towards inclusivity and decolonisation in health professions education, these findings suggest a need to examine the role of culture in mediating how virtues are conceptualised and a deeper understanding of how they are expressed and experienced by diverse groups of people.…”

“…In their latest paper, Kaldjian and colleagues consider how to make practical wisdom a ‘meaningful and teachable concept in medicine’, focusing on clarifying the dimensions of practical wisdom as perceived by physicians and medical students 3 . In doing so, they uncover heterogeneity in how practical wisdom is understood and applied in terms of associated virtues, noting that practical wisdom is ‘developed through cultivating other virtues’ that mirror the traits empirically associated with professional judgement and good medical practice 3 .…”

“…When applied to practical wisdom frameworks, two inherent tensions are revealed. The first is the modelling of practical wisdom acquisition as a process shaped by virtue narratives from ‘wiser’ clinicians that excludes the perspectives from other groups: when virtuosity is demonstrated through acting for the good of patients, 1–3 how patients, relatives, colleagues and others, perceive and understand the applied virtues becomes a valuable source of reflection to guide the application of future practical wisdom. This becomes even more evident when considering those from non‐Western backgrounds, where the conceptualisation and clustering of virtues may be different, propagating specific and distinct cultural norms that can inform clinical practice.…”

“…The second tension arises when integrating practical wisdom frameworks with the practicalities of competence‐based training, given the agent‐centred locus of the former and the act‐centred focus of the latter. Kaldjian and colleagues discuss how trainees and students may not be considered ‘wise’ under Aristotle's definition because of their lack of experience but highlight how they can effectively engage with the dimensions of practical wisdom 3 . This makes facilitation of practical wisdom in the curriculum not only desirable but also necessary to enable professional development that leads to students ‘thriving’ as physicians.…”