11 GDPs kindly contributed their time and thoughts to help with my first study about knowledge encounters. My supervisor, Trish Greenhalgh, and I identified a number of recurring themes from the interviews that helped to demonstrate how complex knowledge-in-practice is. We have submitted an article describing these for publication to the Qualitative Health Research Journal and await reviewer comments.
Whereas the first study used participant records of knowledge encounters followed by interviews, the next study will seek to confirm or develop our findings by observing dentists as they practise and using these observations to stimulate reflection in interviews. We want to be able to characterize further what knowledge-in-practice is for GDPs in the moment of practising.
A couple of weeks ago I received ethics approval to begin the study and so am now hoping to recruit up to 10 GDPs with 5+ years of clinical experience working within 3 hours travel from London to take part. Dentists can be working in NHS, private or mixed practices.
Dentists will choose a clinical session when they are happy to be video and audio recorded as they see their patients. Consent will be sought from patients and any member of staff who might be in the recordings (e.g. a nurse) prior to the clinical session. In this way, only patients and staff who are willing to be recorded will be.
On the chosen day I will set up a video camera and digital audio recorder in the clinic and when patients who have consented arrive I will press record and leave the clinic. The intention is to record everything that goes on and then, at a convenient time with the dentist watching the video, explore what knowledge means in the moment of practising as they interact with patients, staff and information (e.g. letters from specialists or consultants).
To reiterate, the intention is to explore the ways in which dentists’ knowledge develops in the moment of practising – not to make any judgement about how GDPs practise clinically.
All documentation relevant to the study, including the protocol, participant information sheets and ethics approval letter, are available in the Project Documents section.
Please do get in touch using the form below if you’d like to know more. Even if you live some way from London, where I am based, I am happy to travel some distance to record a willing participant!
All the best,
I am very grateful to all the GDPs, nurses, practice managers and patients who have contributed to my DPhil research. Over the past three years of fieldwork dozens of people have been willing to give up their time, “expose” themselves to interviews and videos and offered insights to improve the design of the research. Here are some examples:
- Testing and feeding back on a data gathering tool (Study 2 of the DPhil)
- Recording knowledge encounters and being interviewed about these (Study 2)
- Providing feedback on a study protocol and participation information leaflets (Study 3)
- Being filmed in clinical encounters between dentists and patients (Study 3)
- Being interviewed about those clinical encounters (Study 3)
There has been no financial reward for anyone and yet all these people have willingly given their time to help further my DPhil. I am very grateful and hope that my thesis will do justice to the efforts of all involved.
I am now writing up the thesis with the plan of submitting this summer. Wish me luck.
I am pleased to write that my article describing how I derived my classification of knowledge encounters has just been published in Implementation Science. This work was used to design the knowledge encounters tool used in the studies described on this website.
I am very grateful to the GDPs who helped me test the usability of the classification.
All the best,
It’s been a while since I last posted. After the great response to my requests to participate in recording knowledge encounters I had a lot of really good data to analyze. And it’s taken some time to work through.
Key themes that have arisen from the work are the role of routines as repositories of knowledge, the way dentists constantly innovate as they practice (and so generate new personal knowledge) and the role of case-based reasoning in advancing their understandings.
The implications for me are that if research evidence is to find its way into the complexity of practice we need to firstly recognize that knowledge in practice is something much greater than just research knowledge and then to work out ways of helping integrate research evidence alongside all the other knowledge dentists build.
My next and final phase of research is going to video and audio record dentists, patients and staff for a whole clinical session at a time. Building on the ideas developed from the previous research, the idea is to observe the roles of routine, innovation and case-based reasoning as dentists build knowledge in practice. As it involves NHS patients this is now going through NHS ethics approval but I hope to begin recording the clinical sessions from March 2017 onwards.
If you are a GDP working in NHS, mixed or private practice in the London area, I would welcome the opportunity to record one of your clinical sessions and to interview you for no more than an hour soon after. Here is the participant information sheet Participant information sheet I have submitted for ethics approval. Although the ethics committee may make some suggestions for changes this shouldn’t change it too much.
Please do get in touch if you might be interested using the form below or the email address on the information sheet.
The knowledge encounters project continues with many colleagues kindly contributing their time to recording those events when they come across something new in their professional lives, which may or may not impact on their practice.
Whilst the knowledge encounters themselves reveal much about the ways in which dentists are actually learning, the interviews around these encounters are helping me to get a picture of what is going on in more detail.
The data so far suggests that the majority of encounters occur in the workplace and that dentists learn 2/5 of the time from fellow practitioners. The dentists recording these encounters on the whole intend in some way to use the new knowledge they have encountered even if it is only conceptually.
If you might be interested in contributing to this project by recording your own encounters for a week and reflecting on these in a 30-60 minute interview please do get in touch.
All the best,
It has been a real pleasure talking to the participants before they take part and very warming to hear their enthusiasm for the project as they come to understand in greater depth what I am up to.
As a recap, the knowledge encounters project I am running seeks to improve our understanding of where dentists get their knowledge from and how this knowledge is integrated (or not) with existing knowledge.
As evidenced by the breadth of knowledge encounters dentists have recorded so far, clinicians build knowledge from diverse sources.
I thought I’d pop out a few more interim results here as more data has come in from dentists recording their encounters.
As you can see below, experiential knowledge and codified knowledge (e.g. published articles, research, educational books) are encountered about a quarter of the time, and codified knowledge in a personalised form (e.g. a colleague or educator talking about codified knowledge) almost a fifth of the time. (There is a full description of what these terms mean here).
Perhaps not surprisingly the largest group of people who share knowledge with the dentists in this study are fellow colleagues 42% of the time. Interestingly, patients, employers, salespeople and researchers each share knowledge 10% of the time. The detail of the encounters with patients that emerges from the qualitative data collected is fascinating, with quite detailed knowledge being passed on to GDPs, particularly from specialists and hospital consultants.
Much of the knowledge encounters seem to take place when dentists are alone or with one other person, usually a colleague or patient. A large proportion of the group encounters involve online discussion forums.
Once again, I’d like to thank all my colleagues who have taken part so far and those who have enrolled and will soon begin collecting data.
If you think you would like to contribute please do get in touch.
All the Best,
It is clear from the data recorded by participants, and the narrative interview that follows it, that the process of recording knowledge encounters encourages dentists to reflect on what they are doing, ask further questions and seek answers to knowledge gaps.
It is therefore clear that this is a planned learning activity for most participants as they use the web form tool to collect and reflect on the experiences and knowledge that they come across over the course of a week. The narrative interviews have thrown up further deeper consideration of how dentists learn and therefore how they might further their development of the knowledge they have encountered.
The GDC defines CPD in the following way:
CPD for dental professionals is defined as: lectures, seminars, courses, individual study and other activities, that can be included in your CPD record if it can be reasonably expected to advance your professional development as a dentist or dental care professional and is relevant to your practice or intended practice.
Participants use about an hour to do the web form training and, over a week, record their own knowledge encounters. They also spend up to an hour describing, reflecting and analysing their encounters for up to one hour during a narrative interview. Therefore, I think this will adequately fulfil the GDC’s requirements and enable participants to claim 2 hours of verifiable CPD once the interview is completed.
The learning outcomes for this exercise are therefore:
- Participants will learn how to use a web-based tool to record and reflect on clinical knowledge encounters they have over the period of 1 week
- They will reflect on what they intend to do with the new knowledge or experience in terms of using it conceptually, politically, instrumentally or not at all
- Through a 1 hour narrative interview they will be encouraged to reflect on and analyse their encounters in greater depth
A requirement of the GDC is that all verifiable CPD providers encourage feedback as a quality assurance step and therefore participants will be asked to provide this using a brief web form.
So now there’s even more reason to join in.
Have a great weekend.