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

Background From an ecological perspective, we have demonstrated two distinc t logics of practice in anaesthesia. One reflected attitudes characteristic of traditional medical thinking, while the other an insight into the uncer tainty of actual situations. Objective We explored interactions between anaesthetists and patients, i.e. anaesthetist's habit of action. By tools we mean information, drugs, and c oncepts. Methods For studying the expert anaesthetists' habits of action in clinical circumstances, wide-ranging material was necessary including video recordi ngs, documented observations and interviews. For each anaesthesia, characte ristic cycles between perceived information and regulative actions were con structed. Together with meanings of distinct actions, they constituted the material for analysis of the criteria for evaluation. Results Besides differentiating the two habits of action, the criteria migh t provide a perspective for assessing trainees' performances. The 'reactive ' habit of action was qualified by conservative and monological ways of usi ng tools and reluctance to construct subjective evaluations. A failure to r ecognise the semantic aspect of information contributed to the absence of l earning. The 'interpretative' habit of action, however, was qualified by cr eative and interactive use of tools. Ongoing sense-making and anticipation were achieved through cumulative learning based on a dialogical and reflect ive way of constructing subjective interpretations. Conclusion Professional behaviour was defined through selectivity, interpre tation, and judgement. To argue for a professional artistry view is to argu e for how we should use our conceptual and material tools in striving for e xcellence.