Practice-based criteria for assessing anaesthetists' habits of action: outline for a reflexive turn in practice

From an ecological perspective, we have demonstrated two distinct logics of practice in anaesthesia. One reflected attitudes characteristic of traditional medical thinking, while the other an insight into the uncertainty of actual situations.

We explored interactions between anaesthetists and patients, i.e. anaesthetist's habit of action. By tools we mean information, drugs, and concepts.

For studying the expert anaesthetists' habits of action in clinical circumstances, wide-ranging material was necessary including video recordings, documented observations and interviews. For each anaesthesia, characteristic cycles between perceived information and regulative actions were constructed. Together with meanings of distinct actions, they constituted the material for analysis of the criteria for evaluation.

Besides differentiating the two habits of action, the criteria might provide a perspective for assessing trainees' performances. The 'reactive' habit of action was qualified by conservative and monological ways of using tools and reluctance to construct subjective evaluations. A failure to recognise the semantic aspect of information contributed to the absence of learning. The 'interpretative' habit of action, however, was qualified by creative and interactive use of tools. Ongoing sense-making and anticipation were achieved through cumulative learning based on a dialogical and reflective way of constructing subjective interpretations.

Professional behaviour was defined through selectivity, interpretation, and judgement. To argue for a professional artistry view is to argue for how we should use our conceptual and material tools in striving for excellence.