Using theories of professional knowledge and reflective practice to influence educational change

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  • Medical Teacher, Vol. 20, No. 1, 1998

    Using theories of professional

    knowledge and re ective practice

    to in uence educational change


    Faculty of Health Care and Social Work Studies, University of Salford, UK

    SUMMARY Theories of professional knowledge and re ective

    practice were used in the development of a new postgraduate

    programme. Central to the curriculum design was the acknowl-

    edgement that a wealth of knowledge creation takes place

    outside the academic setting. The existing experience of practi-

    tioners is an important source of knowledge, and the ability to

    re ect on and share experience is a powerful form of learning.

    These concepts were integrated into the curriculum, and the

    paper gives a number of examples to demonstrate how the

    programme works in practice.


    The purpose of this paper is to describe how the expanding

    and changing role of radiographers in uenced the develop-

    ment of a new postgraduate curriculum. In order to under-

    stand the types of knowledge which are necessary to under-

    take new professional roles, the concept of professional

    knowledge is explored. It is argued that professional

    knowledge should be interpreted with the broadest poss-

    ible meaning, and the context in which knowledge is

    acquired should be viewed as a signi cant factor. Because

    of the value which practitioners place upon the importance

    of their practical experience, the advantages of re ecting

    on and learning from existing experience are contrasted

    with the acquisition of knowledge which has no useful

    professional purpose. It will be maintained that the use of

    re ective practice both assists in the integration of theory

    with practice and enables practitioners to improve their

    skills of clinical reasoning.

    There has been a revolution in radiography practice in

    the last ve years. Central to the aspects driving this

    transformation have been technological advances, socio-

    economic factors and the impact of government policy on

    hospital care. First, technological advances have created

    expert practitioners and have resulted in changes in the

    structure of the workforce especially in the breaking of

    traditional boundaries between professions, as in the adop-

    tion by nurse practitioners and radiographers of tasks pre-

    viously performed by doctors (Chapman, 1993; Loughran,

    1994). Second, the in uence of socioeconomic factors has

    placed greater emphasis on the consumer: for example,

    meeting the expectations of patients/clients for better treat-

    ment and for their inclusion in the decision making about

    the treatment they receive. This emphasis has placed

    greater demands on radiographers whose practice places

    them at the critical interface between the consumer and

    their diagnosis and treatment. Third, the impact of govern-

    ment policy on the health service will radically change the

    context for the delivery of health and social care, with a

    shift in the proportion of work currently undertaken in

    hospitals to primary and community settings. Coupled

    with the change in medical practice, which is shifting the

    balance between curative and preventive medicine, this

    policy raises questions as to the appropriateness of hospi-

    tals as the major places in which radiographers will work

    (Department of Health, 1989a, 1989b, 1992; Williams and

    Berry, 1997).

    Central to all of these changes is the importance of

    effective interpersonal communication. There is an in-

    creasing requirement for radiographers work to involve

    more challenging interactions with patients. Examples of

    these include the discussion of procedures, their risks,

    bene ts and alternatives and the need to assess and cater

    for a wide range of individuals. The result is the develop-

    ment of a climate in which open-ended transactions are

    created of the kind which characterize a professional client

    relationship (Barnett, 1994). This shift in emphasis of the

    role of the radiographer has created the need for a prac-

    titioner who takes a holistic approach to patient care, and

    who balances technological expertise with skill in com-

    munication (Castle, 1988; Caseldine, 1994). But how do

    radiographers acquire this new knowledge? For the ma-

    jority, a large amount of learning will occur in the work-

    place and in general it has been accepted that practical

    experience is at the centre of professional learning (Bines &

    Watson, 1992). Moreover, it is argued that, without this

    focus, it is unlikely that the skills required for competent

    practice will be achieved (Palmer et al., 1994). However,

    the knowledge underpinning practice is elusive, and for

    descriptive purposes is often characterized in several differ-

    ent ways (Oakeshott, 1962; Ryle, 1949; Polanyi, 1967).

    Correspondence: Faculty of Health Care and Social Work Studies, Department

    of Radiography, Allerton Building, University of Salford, Salford, M6 6PU.

    0142-159X/98/010028-07 1998 Carfax Publishing Ltd28



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  • Using theories of professional knowledge and re ective practice

    Therefore, the following part of this paper aims to describe

    professional knowledge, and will argue that such knowl-

    edge is a composite from which it is dif cult to isolate its

    separate parts. This argument will be developed to show

    how learning from experience can be associated with a high

    level of cognitive content so that the knowledge acquired in

    practice can be legitimately incorporated into higher edu-


    Professional knowledge

    It has been stated that the nature of professional knowl-

    edge is complex and dif cult to isolate (James, 1993).

    However, for the purpose of description, several authors

    have attempted to tease out its essential meaning into

    several explicit strands. Oakeshott (1962), following Aris-

    totle, makes a clear distinction between `technical knowl-

    edge and `practical knowledge. Technical knowledge is

    understood by reference to the sciences, for example bi-

    ology and physics, and is capable of being assembled into

    a published form. By contrast, practical knowledge is ex-

    pressed only in practice and learned only through experi-

    ence with practice (Eraut, 1985). The tendency to separate

    theoretical from practical knowledge has been followed by

    Ryle (1949) who used the terms `knowing that and `know-

    ing how to describe the distinction. Moreover, Polanyi

    (1967) observed that much of our knowledge is implicit or

    `tacit and cannot always be revealed. However, the separ-

    ation of knowledge into two categories neatly side-steps the

    complexity of its derivation. Eraut (1994), asserts that the

    whole eld of professional knowledge is lacking in trans-

    parency owing to a neglect in conceptualizing the different

    types of knowledge. In an attempt to provide guidance,

    Eraut uses the terms `propositional, personal and process

    to characterize and de ne professional knowledge. Accord-

    ing to Eraut (1994), propositional knowledge comprises

    the disciplined-based theories and concepts which are de-

    rived from bodies of systematic knowledge, and is the

    traditional means by which higher education constructs its

    syllabi. Aligned to these theories are practical principles

    which stem from the applied sphere of professional activity

    with speci c examples of tried and tested cases. The ma-

    jority of this knowledge is in a publicly available, codi ed

    form, although it is argued that personal knowledge is

    in ltrated by propositions, and that publicly available

    knowledge is open to personal interpretation (Grif ths &

    Tann, 1992).

    In contrast with the systematized knowledge which is in

    a published form, personal knowledge is individually ac-

    quired by experience. Eraut (1994) citing Schutz (1967),

    maintains that individuals construct schemes of experience

    which are a composite of our contact with the external

    world and our own personal inner thoughts and feelings.

    Many experiences are simply lived through unless the `act

    of attention halts the process and confers a meaning on

    the experience, the depth of which depends upon the

    purpose of the attention. Much of this knowledge will be

    taken for granted and not subjected to further analysis.

    However, should attention be focused deeply upon experi-

    ence then it can be comprehended in a meaningful way.

    Schutz (1967) argues that:

    the re ective glance will penetrate more or less

    deeply into lived experience depending on its

    point of view. (p. 105)

    For purposes of description, both personal and proposi-

    tional knowledge are easy to separate, but during pro-

    fessional practice, the two strands are inextricably inter-

    twined. Nevertheless, these two forms of knowledge are

    not adequate when explaining the nature of professional

    work: a third dimension is required to complete the pic-

    ture. This is because the majority of professional activity is

    concerned with