Wieringa Sietse, Greenhalgh Trisha
Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK.
Department of Primary Care Health Sciences, New Radcliffe House (2nd floor), Walton Street, Oxford, OX2 6GG, UK.
Implement Sci. 2015 Apr 9;10:45. doi: 10.1186/s13012-015-0229-x.
In 2004, Gabbay and le May showed that clinicians generally base their decisions on mindlines-internalised and collectively reinforced tacit guidelines-rather than consulting written clinical guidelines. We considered how the concept of mindlines has been taken forward since.
We searched databases from 2004 to 2014 for the term 'mindline(s)' and tracked all sources citing Gabbay and le May's 2004 article. We read and re-read papers to gain familiarity and developed an interpretive analysis and taxonomy by drawing on the principles of meta-narrative systematic review.
In our synthesis of 340 papers, distinguished between authors who used mindlines purely in name ('nominal' view) sometimes dismissing them as a harmful phenomenon, and authors who appeared to have understood the term's philosophical foundations. The latter took an 'in-practice' view (studying how mindlines emerge and spread in real-world settings), a 'theoretical and philosophical' view (extending theory) or a 'solution focused' view (exploring how to promote and support mindline development). We found that it is not just clinicians who develop mindlines: so do patients, in face-to-face and (potentially) online communities. Theoretical publications on mindlines have continued to challenge the rationalist assumptions of evidence-based medicine (EBM). Conventional EBM assumes a single, knowable reality and seeks to strip away context to generate universal predictive rules. In contrast, mindlines are predicated on a more fluid, embodied and intersubjective view of knowledge; they accommodate context and acknowledge multiple realities. When considering how knowledge spreads, the concept of mindlines requires us to go beyond the constraining notions of 'dissemination' and 'translation' to study tacit knowledge and the interactive human processes by which such knowledge is created, enacted and shared. Solution-focused publications described mindline-promoting initiatives such as relationship-building, collaborative learning and thought leadership.
The concept of mindlines challenges the naïve rationalist view of knowledge implicit in some EBM publications, but the term appears to have been misunderstood (and prematurely dismissed) by some authors. By further studying mindlines empirically and theoretically, there is potential to expand EBM's conceptual toolkit to produce richer forms of 'evidence-based' knowledge. We outline a suggested research agenda for achieving this goal.
2004年，加贝和勒梅指出，临床医生通常依据思维线路——内化并得到集体强化的隐性指南——来做决策，而非参考书面临床指南。我们思考了自那时起思维线路的概念是如何发展的。
我们在2004年至2014年的数据库中搜索“思维线路”一词，并追踪所有引用加贝和勒梅2004年文章的来源。我们反复阅读论文以熟悉相关内容，并借鉴元叙事系统评价的原则开展解释性分析和分类。
在对340篇论文的综合分析中，我们区分了纯粹从名称上使用思维线路的作者（“名义”观点），他们有时将其视为一种有害现象而不予理会，以及似乎理解该术语哲学基础的作者。后者采取“实践中”观点（研究思维线路在现实环境中如何出现和传播）、“理论与哲学”观点（扩展理论）或“以解决方案为重点”观点（探索如何促进和支持思维线路的发展）。我们发现，不仅临床医生会形成思维线路，患者在面对面以及（可能）在线社区中也会如此。关于思维线路的理论出版物继续挑战循证医学（EBM）的理性主义假设。传统的循证医学假定存在单一的、可知的现实，并试图剥离背景以生成通用的预测规则。相比之下，思维线路基于一种更灵活、具身化且主体间性的知识观；它们考虑背景并承认多种现实。在思考知识如何传播时，思维线路的概念要求我们超越“传播”和“转化”这些受限概念，去研究隐性知识以及此类知识被创造、践行和共享的互动人类过程。以解决方案为重点的出版物描述了促进思维线路的举措，如建立关系、协作学习和思想引领。
思维线路的概念挑战了一些循证医学出版物中隐含的天真理性主义知识观，但该术语似乎被一些作者误解（并过早摒弃）。通过进一步从实证和理论上研究思维线路，有可能扩展循证医学的概念工具包，以产生更丰富形式的“循证”知识。我们概述了实现这一目标的建议研究议程。
