Practice knowledge and practice models

Knowledge in critical thinking (table 27.1) becomes practice knowledge when applied in a clinical context. Billet (2009), summarizing two decades of research into expert performance, described three kinds of knowledge: domain-specific conceptual knowledge (concepts, facts, propositions); domain-specific procedural knowledge (knowing how to undertake strategic procedures); and dispositional knowledge (values and attitudes). Practice knowledge helps define professions and sets their boundaries. It is the basis of the professional curriculum—the formal (stated and endorsed) curriculum, the informal curriculum (unscripted interpersonal components, e.g., role modeling), and the hidden curriculum (influences of organizational structure and culture) (Hafferty 1998)—and it cultivates students' professional identities in preparation for practice life. Professional values and assumptions consciously or unconsciously guide the way health practitioners practise. Each profession is grounded in one or more practice models, such as the illness and wellness models; biopsychosocial model; metaphysical model; and practitioner-centered, patient-centered, and patient-empowered models (Trede and Higgs 2008). Clinical reasoning in a specific profession involves commitment to the practice models by which the profession identifies itself. By the time of graduation, many students will have assimilated the values of the profession and modified their own worldviews accordingly. For example, medical students' faith in complementary medicine was found to have declined during their medical education (Einarson, Lawrimore, Brand, Gallo, Rotatone, and Koren 2000; Furnham and McGill 2003). First year students typically displayed an openness to complementary medicine that had largely disappeared by the end of their training.

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