Smith A, Goodwin D, Mort M, Pope C
Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster LA1 4RP, UK.
Br J Anaesth. 2003 Sep;91(3):319-28. doi: 10.1093/bja/aeg180.
Expert professional practice in any field is known to rely on both explicit (formal) and tacit (personal) forms of knowledge. Current anaesthetic training programmes appear to favour explicit knowledge and measurable competencies. We aimed to describe and explore the way different types of knowledge are learned and used in anaesthetic practice.
Qualitative approach using non-participant observation of, and semi-structured interviews with, anaesthetic staff in two English hospitals.
The development of expertise in anaesthesia rests on the ability to reconcile and interpret many sources of knowledge--clinical, social, electronic, and experiential--and formal theoretical learning. Experts have mastered technical skills but are also able to understand the dynamic and uncertain condition of the anaesthetized patient and respond to changes in it. This expertise is acquired by working with colleagues, and, importantly, by working independently, to develop personal routines. Routines mark the successful incorporation of new knowledge but also function as a defence against the inherent uncertainty of anaesthetic practice. The habits seen in experts' routines are preferred ways of working chosen from a larger repertoire of techniques which can also be mobilized as changing circumstances demand.
Opportunities for developing expertise are linked to the independent development of personal routines. Evidence-based approaches to professional practice may obscure the role played by the interpretation of knowledge. We suggest that the restriction of apprenticeship-style training threatens the acquisition of anaesthetic expertise as defined in this paper.
众所周知，任何领域的专家专业实践都依赖于显性（形式化）和隐性（个人化）两种知识形式。当前的麻醉培训项目似乎更倾向于显性知识和可衡量的能力。我们旨在描述和探索不同类型的知识在麻醉实践中是如何学习和运用的。
采用定性研究方法，对英国两家医院的麻醉工作人员进行非参与式观察和半结构化访谈。
麻醉专业技能的发展取决于整合和解读多种知识来源的能力——临床、社会、电子和经验知识——以及正规的理论学习。专家们掌握了技术技能，但也能够理解麻醉患者的动态和不确定状况并做出相应反应。这种专业技能是通过与同事合作，更重要的是通过独立工作来形成个人常规而获得的。常规标志着新知识的成功融入，但同时也起到抵御麻醉实践中固有不确定性的作用。专家常规中所体现的习惯是从更多技术方法中选择出来的优选工作方式，这些技术方法也可根据不断变化的情况加以运用。
发展专业技能的机会与个人常规的独立形成相关。基于证据的专业实践方法可能会掩盖知识解读所起的作用。我们认为学徒式培训的受限威胁到本文所定义的麻醉专业技能习得。
