PMID: 9162849Jan 4, 1997Paper

Physicians as connoisseurs and teachers in practical clinical education: good example engenders good following

Nederlands tijdschrift voor geneeskunde
J H Stegeman

Abstract

There is theoretical knowledge (of facts) and there is knowledge that might be described as 'synthetizing ability resulting from experience': the clinical eye, pattern recognition, intuition, art. Experienced GPs, for instance, in formulating hypotheses, make much use of contextual information and patients characteristics such as occupation, social connections, housing situation and consumption of tobacco and alcohol. Owing to their great experience with patients, they know how to handle such contextual information more effectively than recently graduated MDs. They are, however, unable to state explicitly how they do this. There are always mental steps that stubbornly refuse to submit to logical step-by-step reconstruction. How can this practical knowledge be taught? The master-apprentice situation serves this purpose well: the student not only practises on his or her own, but also sees an experienced doctor at work and can exchange ideas with him or her about the how and why of medical activities. Uncertainty plays a major part: doubt is not a sign of incompetence, but constitutes the essence of clinical action.

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