Abstract
ObjectivesThe purpose of this study is to explore the habitual constraints and opportunities that affect how experienced clinicians learn new skills and, in particular, how new ways of teaching can influence these. Methods We conducted a case study based on a specialized training program for colonoscopy services in Denmark. Data was obtained from a short-term ethnographic fieldwork and in-depth interviews during this program. Participants were 12 experienced colonoscopists and three expert colonoscopy trainers from Denmark and UK. The analysis of data involved categorization, inductive coding, and theoretical reading inspired by sociological theory. ResultsThe experienced clinicians' responsiveness to training was shaped by an underlying logic of colonoscopy practice that was characterized by tacit skills, routine work, lower status, skepticism and self-protectiveness. In order to overcome these habitual constraints, the trainers applied a pedagogical approach based on four methods: 1) intellectualization: 'academization' of skills and competencies, 2) sensing and scaffolding: hands-on experiences and learning by doing, 3) asymmetry: accentuating the authority and respect of the trainer, and 4) relation-building: building relationship and engagement between trainer and clinician. This multi-dimensional approach to teaching enabled the trainers to affect the clinicians' logic of practice and to create buy-in (so-called illusio). ConclusionsClinical skills include socially constructed behaviors and unconscious competences which affect experienced clinicians' responsiveness to continuing medical education. This study suggests four educational strategies that may help trainers to establish new logics of practice in experienced clinicians and to improve the clinicians' conscious competence.
Highlights
Considering the rapid change in knowledge, procedures, and technologies in the healthcare sector, it seems pivotal for clinicians and other healthcare professionals to be able to change routines and unlearn old habits
Clinicians are under the influence of their own routines and old habits Clinicians are under the influence of cultural logics The power of repetitions Mirroring habits and routines Constraining structural conditions Developing the colonoscopists’ investment and creating illusio
Experienced clinicians’ skepticism and self-protectiveness our study showed that the habitus of the clinicians was characterized by professional pride and deep confidence in one's own abilities
Summary
Considering the rapid change in knowledge, procedures, and technologies in the healthcare sector, it seems pivotal for clinicians and other healthcare professionals to be able to change routines and unlearn old habits. The training of experienced clinicians for the purpose of unlearning old habits, learning new skills, and improving conscious competence may pose a considerable pedagogical challenge to trainers, because they have to overcome incorporated routines and established practices. The craftsmanship of colonoscopy (in short CSPY) is the careful examination of the inner lining of rectum and colon by use of a slim, flexible tube with a small video camera called a colonoscope. This particular craftsmanship is a highly complex skill that takes years to master.[1,2] Expert clinicians get to the cecum more often, use less sedation, cause less discomfort, achieve a better patient experience, and find
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