Table 1
The medical habitus
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Through the clinical disposition physicians perceive a person as a patient. To acquire, preserve and develop this disposition, the doctor has to see many patients and acquire experience, because ‘every patient is different’. The disposition manifests itself in specific patterns of reasoning during the presentation of the patient in case discussions, in asking specific kinds of questions and in certain arguments during discussions |
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The scientific disposition means that physicians see medicine as science. Physicians generate and apply scientific knowledge by ‘seeing’ their patients. This disposition reveals itself in book learning and in speaking the scientific medical jargon in the early years of training, and later on in the use of scientific knowledge in patient care, in reading scientific literature, and in visiting research meetings and conferences |
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The professional disposition means that physicians perceive themselves as personally responsible for their patients. Physicians put the interests of the patient first and claim the competence to make clinical decisions on behalf of their own patients. This disposition manifests itself in arguments regarding choices for treatment of patients, in working hard, sometimes in suffering physical deprivation, and in being able and having the courage to decide. The professional disposition is to be considered as the professional conscience of the physician |
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The collegial disposition refers to the inextricable relationship between group membership and individual performance. This disposition gives rise to three forms of collegial manners, mostly in accordance with unwritten rules. Firstly: to give no orders, not to control each other, decision-making by consensus. Secondly: to be collegial: to do each other favours and to be loyal to each other. Thirdly: not to criticize each other openly. Criticism is generally disguised in questions |
Table 2
Workshop ‘case discussions and the hidden curriculum’
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In the workshop we aim at raising the consciousness of the dynamics of case discussions. We discuss the phenomenon of the hidden curriculum, the different characteristic phases of the meeting, the role of power relations and the significance of a competent chair of the meeting. We practise with different interventions for chairs in a simulation of these meetings, as to teach medical specialists for instance: to structure the meeting; to support learning by asking questions; to make considerations aloud (in this way they make their tacit knowledge explicit); to use the different functions of questions; to manage ‘teaching by humiliation’. We stress the fact that all medical specialists need to realize that they function as role models all the time |
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A point of concern that is often mentioned is the time that is available for these meetings, especially in a time where non-paid activities such as mutual and multidisciplinary meetings are under pressure |