Abstract
BackgroundEpistemological beliefs (EB) are an individual's cognitions about knowledge and knowing. In several non-medical domains, EB have been found to contribute to the way individuals reason when faced with ill-structured problems (i.e. problems with no clear-cut, right or wrong solutions). Such problems are very common in medical practice. Determining whether EB are also influential in reasoning processes with regard to medical issues to which there is no straightforward answer, could have implications for medical education. This study focused on 2 research questions: 1. Can ill-structured problems be used to elicit general practice trainees' and trainers' EB? and 2. What are the views of general practice trainees and trainers about knowledge and how do they justify knowing?Methods2 focus groups of trainees (n = 18) were convened on 3 occasions during their 1st year of postgraduate GP training. 2 groups of GP trainers (n = 11) met on one occasion. Based on the methodology of the Reflective Judgement Interview (RJI), participants were asked to comment on 11 ill-structured problems. The sessions were audio taped and transcribed and an adapted version of the RJI scoring rules was used to assess the trainees' reasoning about ill-structured problems.ResultsParticipants made a number of statements illustrating their EB and their importance in clinical reasoning. The level of EB varied widely form one meeting to another and depending on the problem addressed. Overall, the EB expressed by trainees did not differ from those of trainers except on a particular ill-structured problem regarding shoulder pain.ConclusionThe use of focus groups has entailed some difficulties in the interpretation of the results, but a number of preliminary conclusions can be drawn. Ill-structured medical problems can be used to elicit EB. Most trainees and trainers displayed pre-reflective and quasi-reflective EB. The way trainees and doctors view and justify knowledge are likely to be involved in medical reasoning processes.
Highlights
Epistemological beliefs (EB) are an individual's cognitions about knowledge and knowing
Can ill-structured problems be used to elicit general practice trainees' and trainers' EB?
Can ill-structured problems be used to elicit general practice trainees' and trainers' EB? We used King and Kitchener's framework to analyze the data, and found that it did allow us to code a considerable number of statements made by participants
Summary
Epistemological beliefs (EB) are an individual's cognitions about knowledge and knowing. Questions such as 'How certain is knowledge?', 'Is knowledge definitely right or wrong?', 'How do I justify what I know about something?' play an important role in the way one process and reflect upon (new) information[1] Suppose Doctor A is convinced that all phenomena can be explained by a simple cause-effect relationship. She thinks, for example, that breast cancer is caused by environmental factors, a belief she holds as a result of reading a newspaper article (justification by authorities) and is little inclined to investigate further. What information is she going to consider and why? How does she relate her existing knowledge to the information found on the web? How is she going to justify her final opinion on this matter? .... (example based on [2])
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