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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 -

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A comparative study of physicians' and engineers' learning and competence use. ISBN 978-91-85895-70-0 .. Alexander de Courcy for editing the language in my thesis. I would also like to thank base of professional education, professional practice, and the context in which the professionals are
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