Professional socialization in a surgical specialty: Acquiring medical judgment

Contingency in everyday surgical work

“…Various writers have explored these forms of knowledge, notably Ryle (1945) and Polyani (1961) who distinguish between ‘knowing that’ and ‘knowing how’. These ideas have been applied to medical practice by Jamous and Peloille (1970), Knafl and Burkett (1975), Atkinson et al . (1977) and Nyiri and Smith (1988) in their discussions of clinical judgement or ‘indeterminacy’ as the tacit, private component of medical practice, and ‘technicality’ as its technical component.…”

What Do We Mean by Professional Development?

“…Because so much professional decision-making takes place in conditions of ambiguity, part of this initial training involves getting the new practitioner to develop a personal stance which narrows down the alternatives available, so that decisions can be made in a relatively straightforward manner. Knafl & Burkett (1975) (Knafl CBurkett, 1975, p. 401) Although developing such a philosophy to underpin rapid decision-making about normal cases is a key part of professional development and practice (Paechter, 1992;Eraut, 1994), Schon (1983) suggests that there is a further aspect to professional thought: 'reflection-in-action'. This has three salient features (Eraut, 1994): 1. the reflection is in some measure conscious; 2. reflection-in-action has a critical function, questioning the assumptional nature of knowing-in-action; and 3. reflection gives rise to on-the-spot experiment in order to solve the problem experienced in the situation.…”

“…It inducts the initiate into the professional role, indicating the behaviours and attitudes (including ethical ones ) that are to be expected of a member of this particular profession. It deals with knowledge, both by imparting that which underlies and underpins practice (medical knowledge, knowledge of the law, nursing procedures) and by giving those in initial professional training opportunities to experience and develop their competence by the use of knowledge-in-action (Knafl & Burkett, 1975;Elliot, 1991). It develops the capacity and inclination for reflection-on-action, and a willingness to carry this out collaboratively with colleagues.…”

Deviance among professionals: The case of unnecessary surgery

“…Exploratory observational studies of both the medical socialization of surgical residents (Knafl and Burkett, 1975) and the decision making of ear, nose, and throat specialists (Bloor, 1976) confirm this. When outcomes for "conservative" as opposed to "radical" operating propensities were compared, radical doctors removed 14% more normal appendixes but had 10% fewer nonoperative cases with subsequent recurrent symptoms than did their conservative counterparts (Donabedian, 1976).…”