As always, I thoroughly appreciated your exposition on the week’s discussion topic. I was following your smooth flow of logic until the last paragraph when you cited Knight and Mattick (2006). Their insistence that “knowledge … being more contextual, contingent and fluid” (p. 1065, emphasis added) is predicated on the uncomfortable reality that medics do not always know the exact nature of a patient’s condition. Trainee doctors themselves experience “the difficulty of accepting clinician uncertainty” (ibid.). I emphasised “contingent” because the contingencies seem to be less concerned with the epistemologic subtleties of different ways of knowing potentialities and much more to do with baser dichotomies of not actually knowing fundamental information. If there was clear knowledge of how to treat particular cases, there would be no issue. This leads to the criticism of the Knight and Mattick article that much of what they are arguing for is not personal epistemology in terms of more sophisticated ways of knowing, but that trainee medics need to learn to deal with how to overcome their not knowing.
Certain truths remain certain even when applied by an expert. Whether or not experts are able to locate speedily why they performed an action (Schön’s reflection-in-action, 1992), can say later (reflection-on-action), or can’t say at all (Dreyfus’s claim, 2005), their action will be correct most of the time. Is there an argument that epistemological develop is the synchronous accumulation of information with more sophisticated retrieval techniques for accessing more appropriate action from within more complex situations? As Atherton (2013) remarked, “I’m all for students being supported and being given the benefit of the doubt, as long as my doctor/dentist/airline pilot/plumber didn’t learn that way!”
Atherton J S (2013) Doceo; Against supporting students [On-line: UK] retrieved 9 August 2015 from http://www.doceo.co.uk/heterodoxy/supporting.htm
Dreyfus, H. L., Dreyfus, S. E., & Dreyfus, S. E. (2005). Expertise in Real World Contexts. Organization Studies, 26(5), 779–792. http://doi.org/10.1177/0170840605053102
Knight, L. V., & Mattick, K. (2006). “When I first came here , I thought medicine was black and white: Making sense of medical students” ways of knowing. Social Science and Medicine, 63, 1084–1096. http://doi.org/10.1016/j.socscimed.2006.01.017
Schön, D. A. (1992). The crisis of professional knowledge and the pursuit of an epistemology of practice. Journal of Interprofessional Care, 6(1), 49–63. http://doi.org/10.3109/13561829209049595