Skilled Know-How, Virtuosity, and Expertise in Clinical Practice

Braude, Hillel D.

doi:10.1007/978-94-017-8688-1_68

Cited by 2 publications

(1 citation statement)

References 36 publications

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“…As related research has noted, there is a dialectical relationship between various modes of reasoning and knowledge paradigms (Edwards et al 2004) where "different sources of experience, expression, and knowledge are integrated through reflection-in-interaction" (Øberg et al 2015, p. 250). Practical expertise integrates these into a "gestalt" of different cognitive components (Braude 2017).…”

Section: Functional Textures and Dialectic Scaffoldingmentioning

confidence: 99%

Decision-making in Shiatsu bodywork: complementariness of embodied coupling and conceptual inference

Kimmel

Irran²

2021

Phenom Cogn Sci

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Abstract“4E” cognitive science has demonstrated that embodied coupling offers powerful resources for reasoning. Despite a surge of studies, little empirical attention is paid to discussing the precise scope of these resources and their possible complementariness with traditional knowledge-based inference. We use decision-making in Shiatsu practice – a bodywork method that employs hands-on interaction with a client – to showcase how the two types of cognitive resources can mesh and offer alternative paths to a task: “Local” resources such as embodied presence, empathy, attunement, as well as skilled perception-action coupling are not only central for implementing a successful therapeutic intervention. The immediate coupling with a client also offers basic means of deciding about fitting and meaningful interventions. Yet, when comprehensive intervention strategies are at stake, Shiatsu decision making must be complemented through “non-local” resources, notably inferences rooted in anatomy/physiology knowledge, categories, heuristics, and mental models. To draw out implications for “4E” cognitive science, we argue that “local” embodied coupling and “non-local” conceptual inferences can functionally complement, inform, and scaffold each other in a dialectic process.

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Section: Functional Textures and Dialectic Scaffoldingmentioning

confidence: 99%

Decision-making in Shiatsu bodywork: complementariness of embodied coupling and conceptual inference

Kimmel

Irran²

2021

Phenom Cogn Sci

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‘Deep brain stimulation is no ON/OFF-switch’: an ethnography of clinical expertise in psychiatric practice

et al. 2021

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Despite technological innovations, clinical expertise remains the cornerstone of psychiatry. A clinical expert does not only have general textbook knowledge, but is sensitive to what is demanded for the individual patient in a particular situation. A method that can do justice to the subjective and situation-specific nature of clinical expertise is ethnography. Effective deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) involves an interpretive, evaluative process of optimizing stimulation parameters, which makes it an interesting case to study clinical expertise. The aim of this study is to explore the role of clinical expertise through an ethnography of the particular case of DBS optimization in OCD. In line with the topic of the special issue this article is a part of, we will also use our findings to reflect on ethnography as a method to study complex phenomena like clinical expertise. This ethnography of DBS optimization is based on 18 months of participant observation and nine in-depth interviews with a team of expert clinicians who have been treating over 80 OCD patients since 2005. By repeatedly observing particular situations for an extended period of time, we found that there are recurrent patterns in the ways clinicians interact with patients. These patterns of clinical practice shape the possibilities clinicians have for making sense of DBS-induced changes in patients’ lived experience and behavior. Collective established patterns of clinical practice are dynamic and change under the influence of individual learning experiences in particular situations, opening up new possibilities and challenges. We conclude that patterns of clinical practice and particular situations are mutually constitutive. Ethnography is ideally suited to bring this relation into view thanks to its broad temporal scope and focus on the life-world. Based on our findings, we argue that clinical expertise not only implies skillful engagement with a concrete situation but also with the patterns of clinical practice that shape what is possible in this specific situation. Given this constraining and enabling role of practices, it is important to investigate them in order to find ways to improve diagnostic and therapeutic possibilities.

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Skilled Know-How, Virtuosity, and Expertise in Clinical Practice

Cited by 2 publications

References 36 publications

Decision-making in Shiatsu bodywork: complementariness of embodied coupling and conceptual inference

Decision-making in Shiatsu bodywork: complementariness of embodied coupling and conceptual inference

‘Deep brain stimulation is no ON/OFF-switch’: an ethnography of clinical expertise in psychiatric practice

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