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Web Paper

Tacit knowledge and visual expertise in medical diagnostic reasoning: Implications for medical education

Pages e184-e188 | Published online: 03 Jul 2009
 

Abstract

Background: Much education—especially at the university level—has been criticized for having primarily dealt with explicit knowledge, i.e. those aspects of mental activities, which are verbal and conscious. Furthermore, research in medical diagnostic reasoning has been criticized for having focused on the specialty of intern medicine, while specialties with other skills, i.e. perceptive skills within pathology and radiology, have been ignored.

Aims: To show that the concept of tacit knowledge is important in medical education—at all levels and in medical diagnostic reasoning.

Methods: Describing how tacit knowledge according to Michael Polany, is experienced and expressed in day-to-day life, it is shown that there is a tacit dimension to all knowledge. Reviewing recent literature on medical diagnostic reasoning, it is shown that tacit knowledge is recognized in connection with concepts such as “non-analytical reasoning” and “dual process of reasoning.”

Conclusion: It is important that educators are trained in how explicit and implicit knowledge is attained and that tacit knowledge is included in educational programmes of all medical specialties.

Notes

Notes

1. The duration of post-graduate medical training in Denmark has for several reasons often lasted 8–10 years. In 2003, a reform by the National Board of Health accelerated higher specialist training (Danish ministry of Health Citation2000): formal post-graduate training programmes have been accelerated and must define learning objectives and assessment methods based on the CanMEDS framework (CanMEDS Citation2000). Requirements of post-graduate education of today include an 18-month internship (in 2008 it is further reduced to 12 months), a 1-year introductory training in a specialty and a further 4–5-year specialty training as a resident.

2. “Epistemic knowledge.” Wackerhausen (Citation1996) bases this concept on Aristotle's concept, where episteme is the true, universal and definitive scientific knowledge, techne is the skills and crafts, which are connected to the making of things and phronesis is connected to ethically correct actions among human beings. According to Aristotle, all three kinds of knowledge are to be considered as a whole and are equally important in understanding the nature of man and his society.

Additional information

Notes on contributors

Peter Johan Heiberg Engel

PETER ENGEL is a consultant pathologist at Roskilde Sygehus. He is also a post-graduate lecturer in Pathology at the University of Copenhagen, with special interests in medical diagnostic reasoning, visual expertise and tacit knowledge. This manuscript is based on a speech “Tacit Knowledge in the Hidden Specialty (of Pathology)” presented at the Center of Educational Development in Health Sciences, University of Copenhagen, June 14, 2006.

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