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Entered 20/05/03

AUSTRALIAN STUDY OF MODEL KNOWLEDGE WORKERS IN HEALTHCARE.
Wyatt, L. A. (2002) Paramedic Practice - Knowledge Invested in Action
Master of Education Thesis, University of Melbourne.

In practice, how do we acquire high levels of
professional judgment we call expertise ?

Do we simply put it down to the elusive concept of 'experience' ? What are the mental processes that presumably go on ?

Does time on the job, in the pool, on the tennis court, naturally generate expertise ? Many would say that the amount of activity in a discipline rarely guarantees the generation of expertise. Some people with far less years in a given practice have seemed to excel in their thinking and practice. There must be something more.

This study on Australian knowledge workers,paramedics, in complex, often non-routine, work provides key discoveries into the mental processes of knowledge worker competence.

Paramedics in Action Wyatt examined in detail the practices of three (3) advanced paramedics. Through observation and interviews the researcher was able to determine how and why when facing unique clinical problems professional judgments seem to be made. Participants were from Mobile Intensive Care (MICA) stations from the Metropolitan Ambulance Service in Melbourne, Australia. Although a relatively small sample size, new principles into expertise formation have been tentatively proposed from such a rare study.

STUDY RESULTS

"I am all for the aspect that a lot of this job is really experienced-based. I don't necessarily think people who stay in the job a long
time become better at it as such, but certainly they are able to
draw from experience and that is the big thing." - Advanced Paramedic.

The researcher found the following factors amongst the paramedics.

Clear direct correlations with quality and quantity of experiences to form expertise in a field.
Experience in isolation does not seem to be enough.
Experience with active reflection is a critical combination
"I find my interaction with the patient I learn from, the interaction my partner has with the patient, and also when my partner is working in the patient care role, absorbing all that, absorbing information from the relatives, so there is a great deal of knowledge gained from all that."
Observation of and interaction with peers.
"I think you can base it on experience and you learn from all the previous people that you work with - yes, I think the experience of doing and experience you glean from others can be of vast assistance."
Having a strong general knowledge base from formal training (explicit 'first principles' knowledge base/ heuristics)
All participants expressed the inability to adequately capture the nature of the knowledge gained, highlighting again the tacit nature of expert judgments and the difficulty in making these processes explicit.
Context is crucial. Participants struggled to make transition from ambulance paramedic to intensive care paramedic. Knowledge acquired in certain contexts may not be applicable in other contexts.

All of the following four characteristic themes involved in the development of tacit knowledge and the ability to make judgments in practice.were common among the participants.

CHARACTERISTICS ASTUTE KNOWLEDGE WORKER
	1.	Experience WITHIN a particular community of practice.
	2.	Learning in a specific context, discovering mental models and general rules (heuristics).
	3.	Active reflection on practice.
	4.	Capacity to face uncertainty with confidence in both multiple approaches and multiple outcomes and the preparedness to 'try.'

They have had the capacity to generate INSIGHT from their experiences rather than when at a novice stage in their occupation. Distinctly :
a. Managing multiple inputs concurrently
b. Capacity to 'follow a hunch' or back your judgment when faced with uncertainty.

There seems to be a mental phenomenon of steady reliance on different inputs : In a clinical situation, participants rely BOTH on tried and trusted rules and guidelines (established heuristics) but also the capacity to play a hunch and trust your judgment….managing diverse inputs.

'Paramedics are not only relying on existing knowledge, both explicit and tacit, but they are generating new knowledge and understanding as they confront unique situations in the workplace.' - Researcher

The researcher then concludes with proposed methods to capitalise this treasure of tacit knowledge generation, arguably KM's premier added-value business objective.

Context-sensitive simulation and scenario facilities. Enables the adequate capture of the richness and complexity of the workplace context. Transfers speedily new knowledge to peers.
Continual reinforcement of heuristics.
Clinical educators optimising learning environment of operations staff particularly novice staff.
Institutionalise emerging heuristics from advanced staff.

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