title: Professional approaches in clinical judgements among senior and junior doctors: implications for medical education.
abstract: BACKGROUND
  Clinical experience has traditionally been highly valued in medical education and clinical healthcare. On account of its multi-faceted nature, clinical experience is mostly difficult to articulate, and is mainly expressed in clinical situations as professional approaches. Due to retirement, hospitals in Scandinavia will soon face a substantial decrease in the number of senior specialist doctors, and it has been discussed whether healthcare will suffer an immense loss of experienced-based knowledge when this senior group leaves the organization. Both senior specialists and junior colleagues are often involved in clinical education, but the way in which these two groups vary in professional approaches and contributions to clinical education has not been so well described. Cognitive psychology has contributed to the understanding of how experience may influence professional approaches, but such studies have not included the effect of differences in position and responsibilities that junior and senior doctors hold in clinical healthcare. In the light of the discussion above, it is essential to describe the professional approaches of senior doctors in relation to those of their junior colleagues. This study therefore aims to describe and compare the professional approaches of junior and senior doctors when making clinical judgements.
  
  
  METHODS
  Critical incident technique was used in interviews with nine senior doctors and nine junior doctors in internal medicine. The interviews were subjected to qualitative content analysis.
  
  
  RESULTS
  Senior and junior doctors expressed a variety of professional approaches in clinical judgement as follows: use of theoretical knowledge, use of prior experience of cases and courses of events, use of ethical and moral values, meeting and communicating with the patient, focusing on available information, relying on their own ability, getting support and guidance from others and being directed by the organization.
  
  
  CONCLUSIONS
  The most prominent varieties of professional approaches were seen in use of knowledge and work-related experience. Senior doctors know how the organization has worked in the past and have acquired techniques with respect to long-term decisions and their consequences. Junior doctors, on the other hand, have developed techniques and expertise for making decisions based on a restricted amount of information, in relation to patients' wellbeing as well as organizational opportunities and constraints. This study contributes to medical education by elucidating the variation in professional approaches among junior and senior doctors, which can be used as a basis for discussion about clinical judgement, in both pre-clinical and clinical education. Further research is required to explain how these professional approaches are expressed and used in clinical education.
authors.affiliation: University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Box 457, SE-405 30 Göteborg, Sweden. maria.skyvell-nilsson@fhs.gu.se
authors.forename: Maria Skyvell
authors.initials: MS
authors.lastname: Nilsson
authors.forename: Ewa
authors.initials: E
authors.lastname: Pilhammar
mesh_terms: D000368:Aged; D002983:Clinical Competence; D003142:Communication; D004501:Education, Medical; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007600:Judgment / Q000941:ethics; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D010817:Physician-Patient Relations; D013548:Sweden