The epistemic roles of clinical expertise: An empirical study of how Swedish healthcare professionals understand proven experience

Abstract

Clinical expertise has since 1891 a Swedish counterpart in proven experience. This study aims to increase our understanding of clinicians’ views of their professional expertise, both as a source or body of knowledge and as a skill or quality. We examine how Swedish healthcare personnel view their expertise as captured by the (legally and culturally relevant) Swedish concept of “proven experience,” through a survey administered to a simple random sample of Swedish physicians and nurses (2018, n = 560). This study is the first empirical attempt to analyse the notion of proven experience as it is understood by Swedish physicians and nurses. Using statistical techniques for data dimensionality reduction (confirmatory factor analysis and multidimensional scaling), the study provides evidence that the proven experience concept is multidimensional and that a model consisting of three dimensions–for brevity referred to as “test/evidence”, “practice”, and “being an experienced/competent person”–describes the survey responses well. In addition, our results cannot corroborate the widely held assumption in evidence-based medicine that an important component of clinical expertise consists of experience of patients’ preferences.

Perceptions of Clinical Experience and Scientific Evidence in Medical Decision Making: A Survey of a Stratified Random Sample of Swedish Health Care Professionals

“…For example, correlation plots show that proven experience is positively correlated with both science and personal experience but that personal experience is largely uncorrelated with science, reinforcing our interpretation (and the intention of the survey design) that by asking about both personal and proven experience in a population in which the latter is a well-known concept, the former would capture the strictly individual aspects of clinical experience. References Persson et al, 10 , 18 Wahlberg and Persson, 19 Wallin et al, 20 and Dewitt et al 21 describe studies focusing on the proven experience data of the survey.…”

“…Refs. [19][20][21]. As proven experience is part of Swedish health care personnels' ideas on evidence, participants were also asked to respond to items on this concept.…”

Certainty and systematicity of practice-derived evidence matter for its relative importance in professional decision-making: Survey results on the role of proven experience in Swedish medicine, nursing, OT, dentistry, and dental hygiene

“…However, a recent study by Dewitt et al. (2021) found that physicians, nurses and OTs primarily understand proven experience in terms of interventions/methods/etc.…”

“…The difference between EBM and VBE is visible also within the integrative role. The integrative aspect is fundamental in EBM for implementation purposes ( Dewitt et al. 2021 ); the clinician needs to understand how to apply the evidence-based knowledge in a concrete case.…”

“… 2 For an empirical analysis of the meaning and use of “proven experience”, see Dewitt et al. (2021) and Persson and Wahlberg (2015) .…”