チイキ ニホンゴ キョウシツ ニオケル ガクシュウシャ ノ ニーズ ニ モトズイタ ジュギョウ ジッセン

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. </p