What is the nature of tacit knowing experienced by General Practice (GP) Supervisors as they teach GP Registrars in clinical practice?

Author: Hubert Van Doorn

Van Doorn, Hubert, 2021 What is the nature of tacit knowing experienced by General Practice (GP) Supervisors as they teach GP Registrars in clinical practice?, Flinders University, College of Medicine and Public Health

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This research set out to understand the tacit knowing that GP Supervisors experience whilst teaching GP Registrars. Its ontological nature makes it challenging to capture and express in language. To explore it further Hermeneutic Phenomenology was employed, specifically using Van Manen’s and Giles’ approach.

A phenomenological question was asked of nine GP Supervisors to share their experiences with GP Registrars, when they knew what was happening but were not able to fully explain their knowing. The interviews were transcribed and formed into forty-seven crafted stories. These were individually described and interpreted. A novel form of language was developed for the themes, using word couplets with hyphens and containing gerunds. These enabled multiple interpretations to be revealed from the stories. Three ontological themes emerged.

The first theme is ‘re-presenting’. Supervisors teach from who they are and adopt different ways of being themselves in order to help their Registrars learn from encounters with patients. ‘Re-presenting’ means responding to different clinical situations and learning interactions and adopting reconfigured dispositions to wisely guide their Registrars.

‘With-holding‘ is the second theme. It reveals several meanings. Supervisors withhold from offering too much instruction and from taking over Registrars’ consultations. ‘With-holding’ invokes meanings of helping Registrars to grasp important meanings whilst supporting them as they learn.

The third theme is ‘path-marking’. The skilful ways in which Supervisors ‘re-present’ and ‘with-hold’ themselves, enable them to recognise significant encounters where their Registrars need to learn important new ways of becoming a GP. ‘Path-marking’ involves, identifying significant places in their Registrars’ learning pathways and then helping them to transform these encounters into meanings that can be grasped and skills which can be carried into the future.

To conclude, exploring GP Supervisors’ tacit knowing with Hermeneutic Phenomenology uncovered a rich appreciation of what actually happens in the skilful interactions between Supervisors and Registrars. The relational nature of this knowing was not found to be hidden as it was expressed with narrative, crafted stories and ontological themes. But it is not able to be fully extracted from its circumstances. Because of this, its nature can be deemed to be tacit, not in the literal sense of being ineffable, but in the meaning that it is embedded into everyday actions, which can render it to regarded as taken for granted. There is an additional perspective that can also deem this knowing to be tacit. This is because it is enacted through human dispositions which cannot be made into fully explicit propositions of knowledge. If epistemological formulations are demanded, this knowing could be deemed to be ineffable.

What has been learnt from this research is an appreciation that the expertise of Supervisors is constituted by their relationships with their Registrars and is characterised by adaptable dispositions undertaken to wisely guide them. Hermeneutic Phenomenology offers an approach to extend the exploration of this knowing.

Keywords: Clinical education, tacit knowing, general practice supervision

Subject: Health Education thesis

Thesis type: Masters
Completed: 2021
School: College of Medicine and Public Health
Supervisor: Professor Lambert Schuwirth