Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway.
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Scand J Prim Health Care. 2021 Dec;39(4):515-518. doi: 10.1080/02813432.2021.2004831. Epub 2021 Nov 16.
General practitioners (GPs) often find that linear, deductive knowledge does not provide a sufficient map for clinical management. But experience, accompanied by enduring familiarity with individual patients, may offer unique complementary skills to interpret a patient's symptoms and navigate skilfully through diagnosis, treatment, follow-up and prevention.In this article, we draw attention to the nature of this tacit knowing that is executed by many GPs every day. We argue that the nonlinear, unpredictable complexity of this domain nurtures a particular logic of clinical knowing. This kind of knowledge is not intuition and can to some extent be intersubjectively accessible. We substantiate and discuss how and why general practice research can contribute to knowledge development by transforming reflection-in-action to reflection-on-action.We briefly present some concepts for reflection-on-action of clinical knowing in general practice. The VUCA model (volatility, uncertainty, complexity, ambiguity) embraces dynamic and confusing situations in which agile work (adaptive, flexible and responsive behaviour and cognitive creativity) is assumed to be an appropriate response. Using such perspectives, we may sharpen our gaze and apply reflexivity and analytic elaboration to interpret unique incidents and experiences and appreciate the complexity of general practice. In this way, exploratory research can fertilize general practice and offer innovation to the entire domain of clinical knowledge.
全科医生常常发现，线性的、演绎式的知识并不能为临床管理提供充分的指导。但是，经验——伴随着对个体患者持久的熟悉——可能为解释患者的症状和熟练地进行诊断、治疗、随访和预防提供独特的补充技能。在本文中，我们提请注意许多全科医生每天都在运用的这种隐性知识的本质。我们认为，该领域的非线性、不可预测的复杂性孕育了一种特殊的临床知识逻辑。这种知识不是直觉，在一定程度上可以被主体间获得。我们证实并讨论了一般实践研究如何以及为何能够通过将行动中的反思转化为行动后的反思来促进知识的发展。我们简要介绍了一些在一般实践中对临床知识进行行动后反思的概念。VUCA 模型（易变性、不确定性、复杂性、模糊性）包含动态和混乱的情况，在这种情况下，敏捷工作（适应性、灵活性和响应性的行为和认知创造力）被认为是一种适当的反应。使用这种观点，我们可以更敏锐地观察，并运用反思性和分析性阐述来解释独特的事件和经验，欣赏一般实践的复杂性。通过这种方式，探索性研究可以使一般实践得到深化，并为整个临床知识领域带来创新。
