General Dental Practitioners’ knowledge encounters: how do dentists build their knowledge-in-practice?

Hurst, D

Abstract:: Evidence-based practice suggested that, to deliver good clinical care, clinicians should consult up to date clinical research whilst drawing on their own expertise and experience and the values and aspirations of patients. Despite there being a large interest in generating more robust research evidence and finding ways to disseminate it, there has been relatively little research interest in the moment-to-moment practice it is intended to be incorporated into. John Gabbay and Andrée Le May theorised that the work of good general practitioners was guided by internal, tacit, socially reinforced mindlines. The organisational literature developed concepts of practice as a provisional, ephemeral and socio-material accomplishment. This thesis was inspired by these works to explore the complexity of knowing and interaction when practising as a healthcare professional and, specifically, as a general dental practitioner. It reviews the development of the concept of practice before reporting on three studies: a mixed studies systematic review of how healthcare professionals encounter information and experiences; a mixed methods study of the sources of information and experience GDPs use; and a video-ethnographic study of how knowing in practice arises in clinical encounters in general dental practice. Together, these studies show how knowing in practice arises as GDPs, patients, nurses and things interact in time and space; how the GDPs’ performances in these practices are generated from their embodied and in-the-moment knowing; and how diverse the sources of knowing are that healthcare professionals interact with in developing their ostensive and performative knowing. The thesis discusses the implications of taking a more practice-orientated approach to how we think about quality improvement in general dental practice and professional learning generally.

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APA Style

Hurst, D. (2019). General Dental Practitioners’ knowledge encounters: how do dentists build their knowledge-in-practice? [PhD thesis]. University of Oxford.

MLA Style

Hurst, D. General Dental Practitioners’ Knowledge Encounters: How Do Dentists Build Their Knowledge-in-Practice? University of Oxford, 2019.

Chicago Style

Hurst, D. 2019. “General Dental Practitioners’ Knowledge Encounters: How Do Dentists Build Their Knowledge-in-Practice?” PhD thesis, University of Oxford.
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Authors

+ Hurst, D More by this author

Division:: MSD
Department:: School of Medicine and Dentistry, Queen Mary University of London, UK
Role:: Author

Contributors

+ Greenhalgh, T

Department:: Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
Role:: Supervisor

+ Mickan, S

Department:: Bond University, Australia
Role:: Supervisor

+ Richards, D

Department:: School of Dentistry, University of Dundee, UK
Role:: Supervisor

+ Le May, A

Department:: University of Southampton, UK
Role:: Examiner

+ Mahtani, K

Department:: Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
Role:: Examiner

DOI:: 10.5287/ora-gakvnkk1e
Type of award:: DPhil
Level of award:: Doctoral
Awarding institution:: University of Oxford

Language:: English
Keywords:: Qualitative

Video ethnography

Practice knowledge

Systematic review

Faceted classification

Interviews

knowing in practice

Observation

Bliss Bibliographic Classification

General Dental Practice

Mixed methods

Dentistry
Subjects:: Evidence-Based Dentistry

Quality improvement

Knowledge in practice

General Dental Practice

Healthcare
UUID:: uuid:43abd440-fbf8-47ea-b6ea-e3bbe19fa443
Deposit date:: 2019-09-07

Related item:: . Knowing in general dental practice: Anticipation, constraint, and collective bricolage. Journal of Evaluation in Clinical Practice, 1-9
Description:: RATIONALE, AIMS, AND OBJECTIVES: Much of the literature concerned with health care practice tends to focus on a decision-making model in which knowledge sits within the minds and bodies of health care workers. Practice theories de-centre knowledge from human actors, instead situating knowing in the interactions between all human and non-human actors. The purpose of this study was to explore how practice arises in the moment-to-moment interactions between general dental practitioners (GDPs), patients, nurses, and things. METHOD: Eight GDPs in two dental practices, their respective nurses, 23 patients, and material things were video-recorded as they interacted within clinical encounters. Videos were analysed using a performative approach. Several analytic methods were used: coding of interactions in-video; pencil drawings with transcripts; and dynamic transcription. These were used pragmatically and in combination. Detailed reflective notes were recorded at all stages of the analysis, and, as new insights developed, theory was sought to help inform these. RESULTS: We theorized that knowing in dental practice arises as actors translate embodied knowing through sayings and doings that anticipate but cannot predict responses, that knowing is constrained by the interactions of the practice but that the interactions at the same time are a collective bricolage-using the actors' respective embodied knowing to generate and solve problems together. CONCLUSION: Practices are ongoing ecological accomplishments to which people and things skilfully contribute through translation of their respective embodied knowing of multiple practices. Based on this, we argue that practices are more likely to improve if people and things embody practices of improvement.
Related item:: Disseminating research evidence: what matters to general dental practitioners?
Description:: Background In the era of evidence-based practice, pressure is placed upon clinicians to stay updated and inform their practice. This appears to be challenging, in the light of the sheer volume of the existing research evidence and the reported gap between knowledge and clinical practice. Therefore, the need to develop more effective dissemination methods is evident if knowledge translation is to be promoted. Aim To explore how dentists perceive different existing and potential means of receiving and communicating research evidence. Methods This was a qualitative study conducted through one-to-one artefact-stimulated semi-structured interviews conducted among general dental practitioners working in three European countries. Nine GDPs were recruited through purposive sampling. Results Four themes emerged as qualities essential for an artefact. First, a pleasant-to-use artefact; being multiplatform, more visual, interactive and inclusive of a social component. Second, a usable form of evidence; being brief/timely, easy to remember, convenient to use and easily found. Third, a relevant content; being contextualised and practical/procedural. Fourth, robustness of the evidence; having a trustworthy source. Conclusion The findings of the study suggested that research dissemination requires artefacts that are pleasant to use, while conveying a usable form of evidence, which is perceived both as relevant and trustworthy.
Related item:: Describing knowledge encounters in healthcare: a mixed studies systematic review and development of a classification.
Description:: BACKGROUND: Implementation science seeks to promote the uptake of research and other evidence-based findings into practice, but for healthcare professionals, this is complex as practice draws on, in addition to scientific principles, rules of thumb and a store of practical wisdom acquired from a range of informational and experiential sources. The aims of this review were to identify sources of information and professional experiences encountered by healthcare workers and from this to build a classification system, for use in future observational studies, that describes influences on how healthcare professionals acquire and use information in their clinical practice. METHODS: This was a mixed studies systematic review of observational studies. DATA SOURCES: OVID MEDLINE and Embase and Google Scholar were searched using terms around information, knowledge or evidence and sharing, searching and utilisation combined with terms relating to healthcare groups. ELIGIBILITY: Studies were eligible if one of the intentions was to identify information or experiential encounters by healthcare workers. DATA EXTRACTION: Data was extracted by one author after piloting with another. STUDY APPRAISAL: Studies were assessed using the Mixed Methods Appraisal Tool (MMAT). PRIMARY OUTCOME: The primary outcome extracted was the information source or professional experience encounter. ANALYSIS: Similar encounters were grouped together as single constructs. Our synthesis involved a mixed approach using the top-down logic of the Bliss Bibliographic Classification System (BC2) to generate classification categories and a bottom-up approach to develop descriptive codes (or "facets") for each category, from the data. The generic terms of BC2 were customised by an iterative process of thematic content analysis. Facets were developed by using available theory and keeping in mind the pragmatic end use of the classification. RESULTS: Eighty studies were included from which 178 discreet knowledge encounters were extracted. Six classification categories were developed: what information or experience was encountered; how was the information or experience encountered; what was the mode of encounter; from whom did the information originate or with whom was the experience; how many participants were there; and where did the encounter take place. For each of these categories, relevant descriptive facets were identified. CONCLUSIONS: We have sought to identify and classify all knowledge encounters, and we have developed a faceted description of key categories which will support richer descriptions and interrogations of knowledge encounters in healthcare research.
Related item:: Practice, complexity and evidence-based practice. British Dental Journal.
Description:: In this opinion piece, I explore practice and complexity, the latter a term often used in relation to the field of special care dentistry. As research is usually concerned with generating new knowledge of some sort, I explore how knowledge is viewed from a practice perspective, as shared, transitory and situated in interactions, rather than being a thing possessed. This leads into a discussion of how the word complexity has been viewed in complexity science, contrasting it with the linear models generated in the evidence-based practice realm from research and research-informed guidelines. Finally, I address the inherent paradox of attempting to align linear models generated from research with the complexity of practice. I suggest that to evaluate and improve practices we should use narrative and exploratory methods that allow its complexity to be made sense of, made transparent and made available for interpretation.

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