Exploring and describing professional knowing in a cohort of specialist physicians:  A qualitative study of metacognition and affect in clinical decision making

Year: 2012

Author: Dunphy, Stacey, Cantwell, Robert, Holbrook, Allyson, Bourke, Sid

Type of paper: Abstract refereed


This presentation reports the initial findings of a study of the "professional knowing" of a cohort of specialist physicians, in the context of two questions: (1) are there specific patterns of knowing across a cohort of specialist Obstetricians which can provide a foundation for understanding expert medical practice and complex clinical decision making; and (2) are such patterns of professional knowing predictive of expert practice behaviours as evidenced in health outcomes for mother and baby?

The study is part of a broader investigation of physician decision-making (see Dunphy, B., et al. 2010a, 2010b). Reports on the broader study by Dunphy, B., Dunphy, S., Cantwell, R., & Bourke, S., (2009, 2010a, 2010b) have demonstrated associations between underlying non-clinical metacognitive dispositions in clinical decision making of specialist physicians and the quality of decision making and patient outcomes. However, this has not been extended to an investigation of the relationships between the attributes of professional thinking and the more distal notion of professional knowing, as we explore the attitudes and approaches towards intellectually complex professional challenges experienced by these Obstetricians, and the potential role of metacognitive dispositions and socio-cultural professional contexts in expert practice.

This paper is based on analysis of as yet unreported semi-structured interviews of the specialist physicians conducted as part of the broader study.  The paper will provide preliminary findings of the direct qualitative content analysis approach (Hsieh, & Shannon, 2005) used to analyse the text. Processes underlying the development of coding categories are described and linked to existing theory and research on professional thinking (Carper, 1978;  Paley et al. 2007), metacognitive theory (Cantwell, 2004; Cantwell, Scevak, Bourke & Holbrook, 2012), complex clinical decision making (Eva, 2002;  Dunphy et al., 2010a; 2010b; Cantwell & Cholowski, 2009)  and medical ethics (Nama, V., & Wilcock, F. 2011; Beauchamp, T., & Childress., 2001) and medical expertise (Dunphy et al. 2009; Dreyfus & Dreyfus, 1986; 1966) to determine initial categories and to guide the discussion of findings. 

The paper has significance for our understandings of both clinical decision-making in physicians and for metacognitive theory in relation to professional education and practice.