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2018 ; 20
(2
): e34
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How Knowledge Is Constructed and Exchanged in Virtual Communities of Physicians:
Qualitative Study of Mindlines Online
#MMPMID29396385
Wieringa S
; Engebretsen E
; Heggen K
; Greenhalgh T
J Med Internet Res
2018[Feb]; 20
(2
): e34
PMID29396385
show ga
BACKGROUND: As a response to the criticisms evidence-based practice currently
faces, groups of health care researchers and guideline makers have started to
call for the appraisal and inclusion of different kinds of knowledge in guideline
production (other than randomized controlled trials [RCTs]) to better link with
the informal knowledge used in clinical practice. In an ethnographic study,
Gabbay and Le May showed that clinicians in everyday practice situations do not
explicitly or consciously use guidelines. Instead, they use mindlines:
collectively shared, mostly tacit knowledge that is shaped by many sources,
including accumulated personal experiences, education (formal and informal),
guidance, and the narratives about patients that are shared among colleagues. In
this study on informal knowledge, we consider virtual networks of clinicians as
representative of the mindlines in the wider medical community, as holders of
knowledge, as well as catalysts of knowing. OBJECTIVE: The aim of this study was
to explore how informal knowledge and its creation in communities of clinicians
can be characterized as opposed to the more structured knowledge produced in
guideline development. METHODS: This study included a qualitative study of
postings on three large virtual networks for physicians in the United Kingdom,
the Netherlands, and Norway, taking the topic of statins as a case study and
covering more than 1400 posts. Data were analyzed thematically with reference to
theories of collaborative knowledge construction and communities of practice.
RESULTS: The dataset showed very few postings referring to, or seeking to adhere
to, explicit guidance and recommendations. Participants presented many instances
of individual case narratives that highlighted quantitative test results and
clinical examination findings. There was an emphasis on outliers and the
material, regulatory, and practical constraints on knowledge use by clinicians.
Participants conveyed not-so-explicit knowledge as tacit and practical knowledge
and used a prevailing style of pragmatic reasoning focusing on what was likely to
work in a particular case. Throughout the discussions, a collective
conceptualization of statins was generated and reinforced in many contexts
through stories, jokes, and imagery. CONCLUSIONS: Informal knowledge and knowing
in clinical communities entail an inherently collective dynamic practice that
includes explicit and nonexplicit components. It can be characterized as
knowledge-in-context in practice, with a strong focus on casuistry. Validity of
knowledge appears not to be based on criteria of consensus, coherence, or
correspondence but on a more polyphonic understanding of truth. We contend that
our findings give enough ground for further research on how exploring mindlines
of clinicians online could help improve guideline development processes.