📖The Dreyfus Model of Clinical Problem-Solving Skills Acquisition: a Critical Perspective

Pena, Adolfo
  • The idea that experts work from intuition, not from reason, should be evaluated carefully.

  • intuition, implicit knowledge does not always work for experts, in which case they fall back to analytical approaches.
  • (The model seems to have been extended to include “master” and “practical wisdom” stages.)

    The only recent change in the model is the addition of two stages (‘master’ and ‘practical wisdom’) (17) to the five originally proposed (2).

  • Dreyfus and Dreyfus define expert level skill almost exclusively in terms of implicit knowledge. (Ignoring explicit knowledge.) → Dreyfus model does not take into account explicit knowledge

    • Dreyfus model does not respect complex and rich interaction between implicit/explicit knowledge domain and has difficulty explaining very complex tasks (not just routines) — e.g., finding solutions to problems
  • Forward/inverse problems: → Forward/reverse problems

    • Direct or forward: given C (causes) → E (effects), find E (effects)
    • Inverse: given effects, find cause

      • inverse problems are also ill-defined: a simple solution might not exist, there may be more than one solution, or a small change in the problem leads to a big change in the solution
  • Dreyfus model has been derived from observations of jet pilots and dancers, who tackle forward problems → Forward/reverse problems

    • (How well does Dreyfus model apply to knowledge work?)
  • Diagnosis that has been formulated in the intuitive way, needs to be worked out in a rational way and then tested by the usual procedures. → Intuitive solutions have to be rationalized

    • “Expert clinicians intentionally avoid any tendency toward automatization as they often lose control of many relevant aspects of a clinical encounter.” → re: Deliberate Practice