from higher education to professional practice

272 Pages·2007·0.83 MB·English

by  Alger Klasson

FROM HIGHER EDUCATION

TO PROFESSIONAL PRACTICE
A comparative study of physicians’ and
engineers’ learning and competence use
Staffan Nilsson
Linköping Studies in Behavioural Science No. 120
Linköping University
Department of Behavioural Sciences and learning
Linköping 2007
Distributed by:
LINKÖPING UNIVERSITY
Department of Behavioural Sciences and Learning
SE-581 83 Linköping
Staffan Nilsson
From Higher Education To Professional Practice
A comparative study of physicians’ and engineers’ learning and competence
use
ISBN 978-91-85895-70-0
ISSN 1654-2029
© Staffan Nilsson
Department of Behavioural Sciences and Learning, Linköping University
Omslagsbild: Destiny © Sofia Nilsson, www.sofia-nilsson.com.
Printed by LiU-Tryck, Linköping 2007.
Contents
ACKNOWLEDGMENTS........................................................................................7
CHAPTER 1: INTRODUCTION............................................................................9
1.1AIM OF THE THESIS..........................................................................................12
1.2THEME OF THE STUDY.....................................................................................12
1.3CONTEXT AND SETTING...................................................................................15
1.4SOME CONCEPTS USED IN THE THESIS..............................................................16
1.5OUTLINE OF THE STUDY..................................................................................23
CHAPTER 2: HIGHER EDUCATION AND THE PROFESSIONS - SOME
BASIC ISSUES AND CONCEPTS........................................................................25
2.1PROFESSIONALISATION - FROM CONSENSUS TO CONFLICT...............................26
2.2PROFESSIONAL LEGITIMACY, JURISDICTION, KNOWLEDGE, AND HIGHER
EDUCATION...........................................................................................................28
2.3DIFFERENTIATION AND SPECIALISATION WITHIN THE PROFESSIONS................31
2.4THE EXPANSION OF HIGHER EDUCATION..........................................................34
2.5LEARNING TO PREPARE FOR THE UNKNOWN....................................................36
2.6A GAP BETWEEN HIGHER EDUCATION AND PROFESSIONAL PRACTICE..............39
2.7CONCLUDING COMMENTS AND REFLECTIONS..................................................42
CHAPTER 3: THE FUNCTIONS OF HIGHER EDUCATION........................45
3.1HUMAN CAPITAL THEORY, KNOWLEDGE, AND HIGHER EDUCATION.................45
3.2THE SOCIALISING FUNCTION OF EDUCATION....................................................48
3.3THE SOCIALISING AND QUALIFYING FUNCTION OF EDUCATION........................50
3.4EDUCATION FROM AN INDIVIDUAL PERSPECTIVE.............................................51
3.5AN INSTITUTIONAL PERSPECTIVE ON EDUCATION............................................53
3.6EDUCATION AS A FILTER, SORTING OR SELECTION MECHANISM......................56
3.7CONCLUDING COMMENTS AND REFLECTIONS..................................................60
CHAPTER 4: PROFESSIONAL KNOWLEDGE, COMPETENCE AND
QUALIFICATIONS...............................................................................................63
4.1THEORETICAL AND PRACTICAL KNOWLEDGE..................................................64
4.2REFLECTIVE PRACTICE....................................................................................65
4.3PROFESSIONAL COMPETENCE AND QUALIFICATIONS.......................................69
4.4CONCLUDING REFLECTIONS AND COMMENTS..................................................73
4.5IMPLICATIONS OF THE THEORETICAL FRAMEWORK.........................................74
CHAPTER 5: METHODS.....................................................................................77
5.1A BRIEF DESCRIPTION OF THE RESEARCH PROCESS..........................................77
5.2RESEARCH DESIGN..........................................................................................78
5.3SELECTION OF RESPONDENTS AND DATA COLLECTION....................................79
5.4THE INTERVIEWS.............................................................................................83
5.5ANALYSIS OF THE EMPIRICAL DATA................................................................84
5.6METHODOLOGICAL POSITIONING AND CONSIDERATIONS.................................86
5.7QUALITY OF THE STUDY..................................................................................89
CHAPTER 6: TWO PROFESSIONS IN FOCUS - ENGINEERS AND
PHYSICIANS..........................................................................................................93
6.1DIFFERENT PROFESSIONAL DISTINCTIONS........................................................94
6.2PROFESSIONAL ORGANISATIONS......................................................................97
6.3PHYSICIANS IN SWEDEN................................................................................100
6.4ENGINEERING IN INFORMATION TECHNOLOGY IN SWEDEN............................102
6.5SPECIALISATION IN MEDICINE AND ENGINEERING.........................................105
6.6PREVIOUS RESEARCH ON WHAT ENGINEERS AND PHYSICIANS LEARN DURING
THEIR EDUCATION...............................................................................................106
6.7COMPARATIVE ANALYSIS AND SUMMATION..................................................110
CHAPTER 7: WHAT IS LEARNED IN HIGHER EDUCATION..................113
7.1BACKGROUND - INDIVIDUAL REASONS AND CAREER CHOICES.......................114
7.1.1 The physicians......................................................................................114
7.1.2 The engineers........................................................................................115
7.2SPECIALIST KNOWLEDGE...............................................................................117
7.2.1 The physicians......................................................................................117
7.2.2 The engineers........................................................................................120
7.3GENERALIST COMPETENCE............................................................................123
7.3.1 The physicians......................................................................................124
7.3.2 The engineers........................................................................................126
7.4SOCIO-COMMUNICATIVE COMPETENCE AND INTERACTION WITH OTHERS.....129
7.4.1 The physicians......................................................................................129
7.4.2 The engineers........................................................................................133
7.5COMPARATIVE ANALYSIS AND SUMMATION..................................................136
CHAPTER 8: DEMANDS ENCOUNTERED IN PROFESSIONAL PRACTICE
................................................................................................................................141
8.1THE PHYSICIANS............................................................................................141
8.1.1 The encounter with the workplace........................................................142
8.1.2 Becoming a leader................................................................................145
8.1.3 Reprioritising and re-evaluating knowledge.........................................149
8.1.4 Insight into their own knowledge and limitations.................................151
8.1.5 Practical ‘know-how’...........................................................................152
8.1.6 Experience, variation and routine.........................................................155
8.2THE ENGINEERS.............................................................................................158
8.2.1 The encounter with the workplace........................................................158
8.2.2 Initiatives and innovation.....................................................................161
8.2.3 Transferability of knowledge and competence use...............................163
8.2.4 Education as a formal credential...........................................................167
8.2.5 The gap between theory and practice...................................................169
8.3COMPARATIVE ANALYSIS AND SUMMATION..................................................172
CHAPTER 9: LEARNING AND PROFESSIONAL DEVELOPMENT.........177
9.1LEARNING AT WORK......................................................................................177
9.1.1 The physicians......................................................................................178
9.1.2 The engineers........................................................................................181
9.2WHAT IS LEARNED IN THE WORKPLACE.........................................................187
9.2.1 The physicians......................................................................................187
9.2.2 The engineers........................................................................................189
9.3THE SPECIALISATION.....................................................................................191
9.3.1 The physicians......................................................................................191
9.3.2 The engineers........................................................................................194
9.4THE PROFESSIONAL IDENTITY........................................................................196
9.4.1 The physicians......................................................................................197
9.4.2 The engineers........................................................................................203
9.5COMPARATIVE ANALYSIS AND SUMMATION..................................................205
CHAPTER 10: DISCUSSION..............................................................................209
10.1MAIN RESULTS............................................................................................210
10.2THE ORGANISATIONAL CONTEXT.................................................................217
10.3THEORY AND PRACTICE...............................................................................219
10.3.1 The physicians....................................................................................219
10.3.2 The engineers......................................................................................221
10.4SPECIALISATION AND DIFFERENTIATION.....................................................222
10.5PROFESSIONAL KNOWLEDGE, LEGITIMACY AND JURISDICTION....................226
10.6EDUCATION FOR COMPETENCE, QUALIFICATIONS OR CREDENTIALS– THE USE
OR EXCHANGE VALUE OF EDUCATION.................................................................228
10.7PRACTICAL IMPLICATIONS AND SUGGESTIONS FOR FURTHER RESEARCH.....232
10.8CONCLUDING COMMENTS AND REFLECTIONS..............................................234
REFERENCES......................................................................................................237
APPENDIX A: INTERVIEW GUIDE 1
APPENDIX B: INTERVIEW GUIDE 2
Acknowledgments
Something that is not at all self-evident is when it is time to stop writing. It
seems as though a text is not something that is ever finished or complete.
However, there comes a time when it seems appropriate to just stop writing,
and as I start writing these words I realise that this is apparently that time.
The construction of a thesis is an individual project and responsibility for all
that is written in the text, shortcomings and inconsistencies as well as
everything that is lacking is solely my own. Nevertheless, it is also a
collective effort and without assistance, support and encouragement from
others I would not be writing these words.
The thesis has been written within the framework of a more extensive
research project called Higher Education, Work and Lifelong Learning and I
would like to thank the Swedish Governmental Agency for Innovation
Systems (VINNOVA) for financing the project. Furthermore, I would like to
thank the people who have been involved in the project for their support in
the practical aspects of data collection and development of my ideas and my
colleagues at Linköping University, the Department of Behavioural Sciences
and Learning, the unit for Studies of Learning in Working Life and
Educational Settings (PiAU), the unit for Adult, Popular and Higher
Education (VUFo) and the graduate school of Adult Learning, as well as of
course all the respondents who have taken their time to participate in the
study. I would like to acknowledge Madeleine Abrant Dahlgren, Sofia
Evertsson, and Andreas Gill for their valuable insightful comments, tips, and
suggestions when reading the text at the final stages of my work, as well as
Alexander de Courcy for editing the language in my thesis. I would also like
to thank Lennart Svensson for the very thorough reading of the text and
astute comments at the final seminar. Especially I would like to express my
gratitude to my constant discussion partner Rose-Marie Axelsson. I would
like to express my gratitude to my supervisors, Per-Erik Ellström for the
constructive comments, and for pushing, supporting and helping through this
undertaking and, Kjell Rubenson for helping me to feel at home and find my
way around the campus at the University of British Columbia, as well as
reading and commenting on the text at different stages.
Most importantly this work would never have been possible without the
support and encouragement of my family and friends. I would like to thank
my mother, Anne, and my sisters, Susanna and Sofia. Finally, I dedicate all
the work I have put into this text to Anna and Stina and Arvid.
Staffan Nilsson, Linköping, September 2007.

From Higher Education To Professional Practice
Chapter 1: Introduction
Higher education is an important foundation for the allocation of people to
different positions in society and a prerequisite for many professions.
Institutionalised knowledge is generally considered central to the legitimacy
of the professions. This thesis is concerned with some of the implications of
the relationship between professional practice, knowledge and higher
education; more specifically, what constitutes professional knowledge, and
how the relationship between professional education and practice is
understood by a group of physicians and engineers, respectively. Both
physicians and engineers undergo a long professional education before they
enter the world of work, but what is it that happens during this education,
what is learned and what happens in the encounter with professional
practice? What is the meaning of higher education in relation to professional
practice? Do the professionals learn anything substantial or does their
education rather constitute a symbolic ritual? Does their education have a use
or exchange value? Does higher education promote generalist or specialist
competence? Our understanding of how the knowledge presented in
professional educational programs is meaningful in professional practice is
incomplete. There is a need for comprehensive reflection on the
interrelationship between the learners or the professionals, the knowledge
base of professional education, professional practice, and the context in
which the professionals are active (Daley 2001, see also Eraut 1994). The
focus of this study is on the relationship between the professions,
professional practice, knowledge, and higher education.
Classic theories about the professions are often concerned with the
structure, historical development, and prerequisites for the development,
organisation, and upholding of the professions. In this context knowledge and
the relationship to higher education is generally considered central. Control
of knowledge within a field of practice as well as claims of authority and
jurisdiction through monopolising the knowledge as well as the work within
the delimited territory of the professionals are some of the main
characteristics of the professions according to professional theory. The
professionals’ authority and legitimacy is based on institutionalised scientific,
academic knowledge, the expertise of the professionals and the
institutionalised belief that they are the only actors competent to perform
certain services in a specific field of practice. A central aspect of the modern
professions is the delimitation of a territory in which they have a monopoly
on exploring, planning, performing services, and controlling the members’
- 9 -
Chapter 1: Introduction
education and other formal qualifications. The delimitation of a territory and
certain competence in turn strengthens the professionals’ authority. The
legitimacy of the professions is also dependent on public acceptance
associated with ethics, morals, and trust (see e.g. Macdonald 1995, Castro
1992). However, the professionals’ legitimacy and their claims of expertise
have been questioned by the logic of the market where calls for formal
knowledge and expertise have become subordinate to demonstrable results
(see e.g. Alvesson 2006, Knight & Yorke 2004, Harvey 2001, Barnett
2000a).
However, there is still a close relationship between higher education,
professional knowledge, and work. The professionals supposedly acquire
scientific or academic knowledge in higher education, which then constitutes
the basis for the professionals’ claims of expertise and central to the
legitimacy of the professionals and the public’s acceptance and trust in the
professionals’ expertise (see e.g. Macdonald 1995, Sarfatti Larson 1977).
Thus, higher education is assumed to provide credentials and to increase the
professionals’ formal competence. However, less interest has been paid to the
relationship between professional education and professional practice, as well
as to the substance of professional knowledge. It seems less clear whether
and how actual competence is appropriated through higher education and
how this competence is related to the professionals’ work and the demands
encountered or the qualifications required in professional practice, i.e. the
competence-in-use. What professional knowledge consists of, how it is
appropriated, and the relationship between the professional knowledge
assumed to be appropriated through professional education, and professional
practice are seldom of central concern in professional research. The focus
should be shifted from the structure of occupations to the work that the
profession actually does (Abbott 1998, Freidson 1970b). There is a lack of
research on the content of professional development and work; that is what
the professionals know, how this is learned, and what they do (see e.g. Parkin
1979). In research on the professions it is generally assumed that the
professionals are socialised and trained through professional education and
that education increases the human capital of the graduates. However, in
previous research on the functions of higher education, it has been suggested
that education may primarily increase the formal credentials of the graduates
(rather than their actual competence) and thereby mainly has a sorting and
allocating function (see e.g. Collins 1979, Meyer 1977, Arrow 1973).
Professional practice is characterised by increased complexity,
unpredictability, and the rapid emergence of new knowledge and technology
(see e.g. Barnett 2004, 2000a, Schön 1983), which has also lead to increased
specialisation and differentiation within the professions (Hellberg 2002,
- 10 -