knowledge project

Recruiting: dentists who will share their knowledge encounters

As part of my DPhil research at Oxford I am hoping to recruit general dental practitioners from the UK who would be willing to record their knowledge encounters for a week and be interviewed for between 30 minutes and one hour about one or more of the encounters.

You can see what is involved in recording knowledge encounters here by working through a few simulations.

And as this is an educational activity for those participating everyone who takes part in recording their encounters and the interview afterwards is awarded 2 hours of verifiable CPD.

Below is a 3 minute video introducing the study. I hope you’ll feel motivated to join the endeavour and get in touch via the form below.

Ethics and an ethnographic dimension to my DPhil

Ethics: Great news!CUREC banner image for screen

The web form and interview study was given ethics clearance by the Medical Sciences Interdivisional Research Ethics Committee this week.

The ethics code is MS-IDREC-C1-2015-088.

Ethnography addition

Another development is that I will add an ethnographic component to my DPhil project, which is very exciting. Ethnography is an approach to studying people in their natural setting through observation, interviews and other methods such as documentary analysis.

I have been inspired by ethnographies conducted in healthcare such as that by John Gabbay and Andre Le May that led to their concept of Mindlines and Annemarie Mol’s fascinating ethnography of atherosclerosis that resulted in a book called The Body Multiple.

..”ethnography offers a holistic way of exploring the relationship between the different kinds of evidence that underpin clinical practice”

The purpose of the ethnographic component of the thesis is to research how dentists, their teams, patients and third parties such as salespeople interact with, create and use knowledge in their natural setting.

It is well suited to my enquiry into the knowledge that dentists use in practice. Jan Savage argues that “ethnography is particularly valuable because of the attention it gives to context and its synthesis of findings from different methods. Moreover, ethnography offers a holistic way of exploring the relationship between the different kinds of evidence that underpin clinical practice.”

My intention is to conduct the ethnographies in two different-sized practices in London. One practice owner has already offered her practice as case study, for which I am very grateful.

Evidence Live 2015: Knowledge encounters poster

Evidence Live is the gathering in Oxford of folk interested in promoting and developing evidence-based healthcare. This year it takes place on April 13th-14th.Evidence Live 15

I will present a poster of my systematic review looking into the sources of information and experiential knowledge that healthcare workers use in practice. It was from this review that I developed the concept of “knowledge encounters” and the multifaceted classification of these that I am using in this mixed methods study.

I’ve uploaded a pdf of the poster, which you can see below.

A mixed studies systematic review of knowledge encounters

Web form usability testing

The web form that I have developed for this project is based on some theoretical work I did as part of a systematic review.

In brief, the research project will ask dentists to record as many of the times when they learn something new from information or an experience over three 7-day periods. I call these occasions “knowledge encounters” and I’ll ask some dentists to take part in 30 minute interviews to gain a deeper understanding of what the encounters meant to them.

The web form is designed to help dentists record the encounters and categorise them in 30-60 seconds.

I have used the form with some dentists but would like to recruit 5-10 willing participants to try it out and feedback on the experience.

Knowledge encounters on computer and phone

What would be involved?

  1. When you get in touch, I will assign you a personalised web form for a training exercise (see below) and for testing the form over a day or two.
  2. Before recording encounters with new information or experience, I would like participants to work through 5 simulated knowledge encounters online. These shouldn’t take more than a minute each to do.
  3. After that, I will ask you to use the web form either on your phone, tablet or computer to record the encounters you had over the course of a day – or more if you’re willing 🙂
  4. Finally, I will ask for your feedback via another web form. This is about usability testing – so I am looking to identify problems with using the web form.

I can’t offer much in return at this stage other than the pleasure of helping progress the science of evidence-based practice, but if you go on to take part in the study itself I will feedback your patterns of knowledge encounters.

You can find out more about the project here and get in touch via the contact form there too.

Thanks,

Dominic

Dominic Hurst

Storifying academic discussion about knowledge encounters

A couple of weeks ago Trish Greenhalgh (@trishgreenhalgh) publicised the blog I’d written about knowledge encounters and I had a twitter exchange with Anita Kothari (@anitarena) in Ontario about them. She went on to use the blog post in her grad class. Here is a storify presentation of the exchange.

What is a “knowledge encounter”?

I was recently challenged by my supervisor to explain why I use the term “knowledge encounter” in my work. The story of how I arrived at it was actually one of frustration perhaps 12-18 months ago as I searched for terms in the literature that would best describe the experiences clinicians have of discovering new knowledge. Here is a draft of my explanation that will in due course find its way into my thesis. It may also help those who participate in the study to understand what it is I am trying to get them to capture.

Encounter

The word encounter is used throughout this thesis as a means to describe the occasions when clinicians happen upon or discover new information or experience something new or in a new way. The intention is to reflect the way in which mindlines [1] appear to be formed, with experiences and information often happened upon in non-linear and unexpected ways, in various contexts, as well as through so-called “knowledge transfer” attempts.

The more familiar terms in the literature around knowledge transfer, translation, exchange and sharing were not sufficient to allow description of the totality of the experiences clinicians were reported to have in coming across new information and experiences [unpublished systematic review]. Elements of these may surface in some of the occasions when clinicians come across new information e.g. as a part of a “knowledge translation” project they may read some guidelines; they may happen across information or an experience as someone shares it with them; they may indeed exchange information or experiences with a colleague. But none of these terms alone were able to incorporate the multitude of ways in which clinicians come across new information and experiences that were identified in the systematic review. Encounter was a word that kept surfacing in my mind to describe what I was seeing.

Encounter is defined as “An unexpected or casual meeting with someone or something” in the Oxford Dictionaries [2]. The Random House Dictionary (accessed via Dictionary.com) the word is defined as “To come upon or meet with, especially unexpectedly” [3]. Merriam-Webster defines an encounter as “a usually brief experience with another person” or “an occasion when you deal with or experience something” [4]. Although these suggest that the encounter is an unexpected event the second definition does not suggest that it is always unexpected. And although it may usually be brief it isn’t always. Furthermore an encounter may be with a person or something allowing for that thing to be a journal article, a procedure or internal thought process.

The word encounter also has numerous synonyms or related words that help to clarify what I intend in using the word. Gathered from Roget’s print and online thesauri [5, 6] these include:

  • discover
  • meet
  • meeting
  • experience
  • find
  • detect
  • bump into (happen upon)
  • come upon
  • stumble (happen upon)
  • detect
  • feel
  • find
  • talk (discussion)
  • turn up (be discovered)

Encounter is of course commonly used in the context of a medical encounter [7-9], which is often a planned event even if the actual content of the event is perhaps uncertain. Thus encounter seems appropriate as a way to describe the many ways in which clinicians come across, happen upon, or plan to discover new information or experiences. This is, I believe, in keeping with the type of learning that Gabbay and Le May suggest is taking place as clinicians form their mindlines.

“Knowledge” versus “information or experience” encounter

But why “knowledge” rather than “information or experience” encounters?

Quoting Bell, Tsoukas and Vladimouri give the following distinction between information and knowledge:

“Information is a context-based arrangement of items whereby relations between them are shown (e.g. the subject index of a book). And knowledge is the judgement of the significance of events and items, which comes from a particular context and/or theory (e.g. the construction of a thematic index by a reader of a book).” [10]

I recognise that clinicians will encounter information or their own experiences by this definition. But within the encounter they will make a judgement of the significance of the information or experience and therein turn the encounter into one of knowledge. Thus “knowledge” does not refer to the object of the encounter but to what happens to the object within the encounter.

I would therefore define a knowledge encounter as: an expected or unexpected circumstance in which an individual comes across new information, or experiences something new, and in doing so makes a judgement (consciously or not) about the significance of that information or experience.

References

  1. Gabbay J, Le May Ae. Practice-based evidence for healthcare : clinical mindlines. Abingdon: Routledge; 2011.
  2. Oxford Dictionaries. Encounter. 2015. http://www.oxforddictionaries.com/definition/english/encounter. Accessed 07/02/2015 2015.
  3. Random House Inc. Encounter. 2015. http://dictionary.reference.com/browse/encounter. Accessed 07/02/2015 2015.
  4. Merriam-Webster. Encounter. 2015. http://www.learnersdictionary.com/definition/encounter. Accessed 07/02/2015 2015.
  5. Roget PM, Kirkpatrick EM, Roget PMRstoEw, phrases. Roget’s thesaurus. New ed. / prepared by Betty Kirkpatrick. ed. London: Penguin; 1998.
  6. Thesaurus.com Roget’s 21st Century Thesaurus. Encounter. 2009. http://www.thesaurus.com/browse/encounter/1.
  7. Greene MG, Adelman RD, Charon R, Friedmann E. Concordance between physicians and their older and younger patients in the primary care medical encounter. The Gerontologist. 1989;29(6):808-13.
  8. Moumjid N, Gafni A, Bremond A, Carrere M-O. Shared decision making in the medical encounter: are we all talking about the same thing? Medical Decision Making. 2007.
  9. Lazare A. Shame and humiliation in the medical encounter. Archives of Internal Medicine. 1987;147(9):1653-8.
  10. Tsoukas H, Vladimirou E. What is organizational knowledge? Journal of management studies. 2001;38(7):973-93.

From theory to practice…

The knowledge encounters research project I have been working on as part of my doctorate at Oxford is now moving into the primary research phase.

A mixed studies systematic review of the knowledge sources used by healthcare workers is in its final draft and will soon be submitted for publication. It feels like it’s been a long time coming.

I did the review so that I could design a way to capture the ways in which dentists in primary care might find knowledge in their day to day lives. Some really interesting ethnographic work with general medical practitioners suggested that most of the time good clinicians don’t seek out formal knowledge products like evidence-based guidelines. Instead they garner their knowledge from discussions with colleagues, from sales reps, from the local consultant or from their experiences with patients.

This probably explains why implementation scientists who try to push research evidence into practice have struggled to change practice.

The review I have done has allowed me to extract from 76 studies over 170 different ways in which healthcare workers access knowledge. From this I have then created what is called a faceted categorisation of what I have termed knowledge encounters.

Faceted categorisations recognise that there are several ways in which a particular “thing” can be categorised. This appealed because many of the knowledge sources reported were quite multidimensional. Below is a wordle that shows what some of them were.

Sources wordle

The 6 categories I developed were based on a previous classification called BC2. The intention was always to use this to help dentists classify their knowledge encounters in a richer way than just saying who or what the knowledge source was.

The categories are shown below.

I have now taken these categories and put them into a web form that I am piloting with dentists who will record as many of their daily encounters with knowledge as possible.

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