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      Knowing in general dental practice: Anticipation, constraint, and collective bricolage

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          Abstract

          Rationale, aims, and objectives

          Much of the literature concerned with health care practice tends to focus on a decision‐making model in which knowledge sits within the minds and bodies of health care workers. Practice theories de‐centre knowledge from human actors, instead situating knowing in the interactions between all human and non‐human actors. The purpose of this study was to explore how practice arises in the moment‐to‐moment interactions between general dental practitioners (GDPs), patients, nurses, and things.

          Method

          Eight GDPs in two dental practices, their respective nurses, 23 patients, and material things were video‐recorded as they interacted within clinical encounters. Videos were analysed using a performative approach. Several analytic methods were used: coding of interactions in‐video; pencil drawings with transcripts; and dynamic transcription. These were used pragmatically and in combination. Detailed reflective notes were recorded at all stages of the analysis, and, as new insights developed, theory was sought to help inform these.

          Results

          We theorized that knowing in dental practice arises as actors translate embodied knowing through sayings and doings that anticipate but cannot predict responses, that knowing is constrained by the interactions of the practice but that the interactions at the same time are a collective bricolage—using the actors' respective embodied knowing to generate and solve problems together.

          Conclusion

          Practices are ongoing ecological accomplishments to which people and things skilfully contribute through translation of their respective embodied knowing of multiple practices. Based on this, we argue that practices are more likely to improve if people and things embody practices of improvement.

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          Most cited references28

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          Knowing in Practice: Enacting a Collective Capability in Distributed Organizing

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            Action and embodiment within situated human interaction

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              Principles of educational outreach ('academic detailing') to improve clinical decision making.

              With the efficacy and costs of medications rising rapidly, it is increasingly important to ensure that drugs be prescribed as rationally as possible. Yet, physicians' choices of drugs frequently fall short of the ideal of precise and cost-effective decision making. Evidence indicates that such decisions can be improved in a variety of ways. A number of theories and principles of communication and behavior changes can be found that underlie the success of pharmaceutical manufacturers in influencing prescribing practices. Based on this behavioral science and several field trials, it is possible to define the theory and practice of methods to improve physicians' clinical decision making to enhance the quality and cost-effectiveness of care. Some of the most important techniques of such "academic detailing" include (1) conducting interviews to investigate baseline knowledge and motivations for current prescribing patterns, (2) focusing programs on specific categories of physicians as well as on their opinion leaders, (3) defining clear educational and behavioral objectives, (4) establishing credibility through a respected organizational identity, referencing authoritative and unbiased sources of information, and presenting both sides of controversial issues, (5) stimulating active physician participation in educational interactions, (6) using concise graphic educational materials, (7) highlighting and repeating the essential messages, and (8) providing positive reinforcement of improved practices in follow-up visits. Used by the nonprofit sector, the above techniques have been shown to reduce inappropriate prescribing as well as unnecessary health care expenditures.
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                Author and article information

                Contributors
                Role: Senior Clinical Lecturer, BSc. BDS. MSc. DPhil studentr.d.hurst@qmul.ac.uk
                Role: Professor of Primary Care Health Sciences
                Journal
                J Eval Clin Pract
                J Eval Clin Pract
                10.1111/(ISSN)1365-2753
                JEP
                Journal of Evaluation in Clinical Practice
                John Wiley and Sons Inc. (Hoboken )
                1356-1294
                1365-2753
                18 October 2018
                December 2019
                : 25
                : 6 ( doiID: 10.1111/jep.v25.6 )
                : 921-929
                Affiliations
                [ 1 ] Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Dental Hospital Turner Street London E1 2AD UK
                [ 2 ] Nuffield Department of Primary Care Health Sciences University of Oxford Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road Oxford OX2 6GG UK
                Author notes
                [*] [* ] Correspondence

                Dr Dominic Hurst, Senior Clinical Lecturer; BSc. BDS. MSc. DPhil student; Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Dental Hospital, Turner Street, London E1 2AD, UK.

                Email: r.d.hurst@ 123456qmul.ac.uk

                Author information
                http://orcid.org/0000-0002-4319-7486
                http://orcid.org/0000-0003-2369-8088
                Article
                JEP13051 JECP-2018-0298.R1
                10.1111/jep.13051
                6899494
                30334329
                b8bca198-8c2c-4b5d-9d6b-cc60a852baf8
                © 2018 The Authors Journal of Evaluation in Clinical Practice Published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 03 July 2018
                : 12 August 2018
                : 24 September 2018
                Page count
                Figures: 6, Tables: 0, Pages: 9, Words: 5642
                Funding
                Funded by: National Institute for Health Research (NIHR) Oxford Biomedical Research Centre
                Award ID: BRC‐1215‐20008
                Categories
                Original Paper
                Original Paper
                Custom metadata
                2.0
                December 2019
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.2 mode:remove_FC converted:05.12.2019

                Medicine
                general dental practice,knowledge,practice epistemology,practice theory,sociomateriality,video

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