På väg mot yrkeskompetens: Spår av tyst kunskap och lärande under det kiropraktiska praktikåret

Abstract in English

This dissertation consists of two parts, which are reported on separately, with a combined results discussion.

Part I

The first part consists of empirical studies reported in five scientific articles together with a theoretical and methodological framework. The aim of this work was to explore which aspects are most important regarding supervision of newly graduated chiropractors in Sweden and England. The aim was also to investigate expectations of new patients when consulting a chiropractor, and in a prospective study, assess whether these expectations are related to patient satisfaction or not. Data was collected with questionnaires containing open and closed questions. They were examined using descriptive statistics, interferential statistics, and content analysis.

The main results were that participants agreed that the most important aspect of the clinical activities was to have regular meetings between the chiropractor and the graduate and to explain the patient's problems to them. The most important characteristic to become a good supervisor was that the supervisor is willing to spend time and listen to the graduate throughout the postgraduate training period. It was emphasized that it is the human aspect and the personal relationship between the supervisor and the graduate are important during the graduate's 1-year postgraduate education at the chiropractic clinic.

There are conflicting views as to whether expectations play a role in patient satisfaction. A questionnaire was designed that could be used to identify expectations of patients and their treating chiropractors. Although chiropractors and patients have some common goals in relation to the therapeutic encounter, there is also a mismatch in certain areas. A higher proportion of patients had lesser expectations of the chiropractic treatment when compared to their treating chiropractors. The patients had stronger expectations of being given advice and exercises than the chiropractors. There was also a tendency for the patients to expect to get better faster than the chiropractors expected them to. It is possible that these differences in expectations between the groups influence the treatment and the outcome of the treatment negatively. In the prospective study it was revealed that patients who had their expectations fulfilled were more satisfied compared with those who did not. It therefore seems important for the practitioner to be aware of patients´ expectations and to consider them in his or her treatment plan. This emphasizes the importance of good communication between the chiropractor and their patients in order to increase patient satisfaction.

Part II

After the completion of my articles I realised that there were more to be said. In my results and interpretation of them I saw signs of something more. These signs pointed to the fact that professional learning takes place in the interaction between people and in reflection over our practical professional actions. This insight led me into the notion that we know more than we can tell and to theories of tacit knowledge, which subsequently made me expand my aim. The new aim centred on a definition of tacit chiropractic knowledge and to which extent this knowledge can be articulated. My interpretation of the results from part I together with new theories made me aware of the importance for graduates to reflect on and articulate their practical actions in examining and treating patients in a supervisory context. It also became clear that there is a parallel process between the supervisor, the graduate and his or her patients, in which the graduate takes over the supervisors attitudes and imposes them on his or her patients, which is important for the supervisor to be aware of and influences the graduates learning process. Furthermore, it is probably important for the supervisor to have certain personality traits in order to be a good supervisor. These include a humanistic perspective, empathy and the realisation that the graduate goes through different stages in his or her learning process. The results point towards the necessity to broaden competence for chiropractic supervisors through further education which will generate higher status for the chiropractic profession, better postgraduate education for new chiropractors and, as a consequence, better service for patients.