Abstract
This chapter provides an insight into the value of tacit knowledge and how this contributes directly to the concept of human factors in the context of multi-disciplinary teamwork. In considering the notion of implicit or intuitive knowledge and how this can be taught in practice, the authors draw on the field of creative praxis as a means of harnessing knowledge from other (often under-acknowledged) signature pedagogies of direct relevance to medical practice. The authors focus on the significance of situational awareness and context of medical and healthcare provision as a means of driving debate around the value of affective domain learning and its role in 21st century physician practice. These are bracketed under the category of non-technical skill acquisition, which is linked heavily, in the published literature to date, with holistically positive patient outcomes.
TopImproving Physician Non-Technical Skills (Nts) In Medical And Surgical Practice
For the purposes of this chapter, we examine and situate non-technical skills gained during affective domain learning and consider the notion of the term ‘Human Factors’, which provides an operational definition for the interrelationships between ‘systems’ (i.e. the healthcare infrastructures within which care is delivered) and the human characteristics of those delivering care in everyday healthcare practice. This gives a broad overview for the understanding of structure and agency in medical practice. We use the experience of one of our authors as an emergency obstetrician to evidence our recommendations for the future development of medical education, in relation to Hinshaw’s (2016) previously published work on the subject. We acknowledge that human factors and NTS knowledge and training are required for all members of the maternity team (midwives, anaesthetists, nurses and ancillary healthcare staff) but in this chapter will focus on the relevance to physician training. The critical interaction between team members and their use of non-technical skills in the context of near immediate decision making, hinges on the tacit and intuitively led response that characterizes human reaction in an emergency. A consideration of their relative impact on the health and safety of medical and surgical working environments is crucial if medical and surgical outcomes are to improve in practice by 21st century physicians.
Key Terms in this Chapter
Safety Critical Environment: An environment comprising individuals, equipment, and organizational systems in which safety is of paramount importance and where the consequences of failure or malfunction in one of more elements can result in serious harm, including injury or loss of life and damage to property or the environment.
Obstetrics and Gynecology: An area in medical practice that specializes in the care of women during pregnancy and childbirth (obstetrics) and in the diagnosis and management of health issues relating specifically to women (gynecology).
Signature Pedagogies: A term characterizing the disparate nature of different clinical and academic disciplines and the educational practice that underpins them. For example, the difference between humanities and empirically based science subjects or creative artistic practice.
Human Factors: Refers to the environmental, organizational, and job factors, and human and individual characteristics that influence behavior at work and affect health and safety in the workplace.
Creative Practice: Refers to professional practice (usually in an arts-based discipline) or to processes usually used in professional practice that has the intention of producing work for a purpose beyond the deliberate acquisition of knowledge. In this sense, the term professional practitioner can refer directly to anyone who pursues professional/creative practice beyond the specific context of arts-based disciplines.
Multi-Disciplinary Team: Multidisciplinary care is used to describe the contribution of all members of a healthcare team to ensure the highest standards of shared decision making resulting in the best quality care for individual patients. The MDT varies but can constitute medical and healthcare professionals and administrative and support workers who have the same goal of positively contributing and working together. Each member makes a fundamentally unique contribution to the management of patients in the context of their personal care pathway. This is undertaken in a situational context supporting active communication and dialogue between all parties, regardless of their individual level in the organizational hierarchy.
Tacit Knowledge: In contrast to formal, codified, or explicit knowledge, tacit knowledge is an informal, intuitive, and often socially constructed “gut instinct” that can be inherently difficulty to articulate or verbalize.
Reflexivity: The degree of self-reflection on action that ensures experience can inform subsequent similar events or experiences in the light of knowledge gained. It is a prospective form of ensuring the experiential learning from reflective practice can be positively integrated in the future, regardless of the initial outcome or circumstances of any given scenario.