title: Old habits die hard: a case study on how new ways of teaching colonoscopy affect the habitus of experienced clinicians.
abstract: OBJECTIVE
  The purpose of this study is to explore the habitual constraints and opportunities that affect how experienced clinicians learn new skills and, in particular, how new ways of teaching can influence these.
  
  
  METHODS
  We conducted a case study based on a specialized training program for colonoscopy services in Denmark. Data was obtained from a short-term ethnographic fieldwork and in-depth interviews during this program. Participants were 12 experienced colonoscopists and three expert colonoscopy trainers from Denmark and UK. The analysis of data involved categorization, inductive coding, and theoretical reading inspired by sociological theory.
  
  
  RESULTS
  The experienced clinicians' responsiveness to training was shaped by an underlying logic of colonoscopy practice that was characterized by tacit skills, routine work, lower status, skepticism and self-protectiveness. In order to overcome these habitual constraints, the trainers applied a pedagogical approach based on four methods: 1) intellectualization: 'academization' of skills and competencies, 2) sensing and scaffolding: hands-on experiences and learning by doing, 3) asymmetry: accentuating the authority and respect of the trainer, and 4) relation-building: building relationship and engagement between trainer and clinician. This multi-dimensional approach to teaching enabled the trainers to affect the clinicians' logic of practice and to create buy-in (so-called illusio).
  
  
  CONCLUSIONS
  Clinical skills include socially constructed behaviors and unconscious competences which affect experienced clinicians' responsiveness to continuing medical education. This study suggests four educational strategies that may help trainers to establish new logics of practice in experienced clinicians and to improve the clinicians' conscious competence.
authors.affiliation: Centre for Health Sciences Education, Aarhus University, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Lund
authors.affiliation: Department of Public Health Programmes, Regional Hospital of Randers, Denmark.
authors.forename: Berit
authors.initials: B
authors.lastname: Andersen
authors.affiliation: Centre for Health Sciences Education, Aarhus University, Denmark.
authors.forename: Mette K
authors.initials: MK
authors.lastname: Christensen
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003113:Colonoscopy / Q000193:education*; D015179:Colorectal Neoplasms / Q000175:diagnosis; D003718:Denmark / Q000453:epidemiology; D004502:Education, Medical, Continuing / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D004521:Educational Measurement; D005260:Female; D006184:Habits; D006801:Humans; D062069:Inventions; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D013663:Teaching / Q000639:trends*
keywords: conscious and unconscious competence; continuing medical education; denmark; habitus; logic of practice; surgery