Research article

Can ill-structured problems reveal beliefs about medical knowledge and knowing? A focus-group approach

Ann Roex¹ , Geraldine Clarebout² , Valerie Dory³ and Jan Degryse⁴

¹Department of General Practice, KULeuven, Kapucijnenvoer 33, Blok J, Bus 7001, 3000 Leuven, Belgium

²Center for Instructional Psychology and Technology, KULeuven, Vesaliusstraat 2, 3000 Leuven, Belgium

³Département de Médecine Générale, Université catholique de Louvain, Avenue Mounier 53 (bte 5360), 1200 Brussels, Belgium

⁴Department of General Practice, KULeuven Kapucijnenvoer 33, Blok J, Bus 7001, 3000 Leuven, Belgium

author email corresponding author email

BMC Medical Education 2009, 9:62doi:10.1186/1472-6920-9-62

Published:	23 September 2009

Abstract

Background

Epistemological beliefs (EB) are an individual's cognitions about knowledge and knowing. In several non-medical domains, EB have been found to contribute to the way individuals reason when faced with ill-structured problems (i.e. problems with no clear-cut, right or wrong solutions). Such problems are very common in medical practice. Determining whether EB are also influential in reasoning processes with regard to medical issues to which there is no straightforward answer, could have implications for medical education. This study focused on 2 research questions: 1. Can ill-structured problems be used to elicit general practice trainees' and trainers' EB? and 2. What are the views of general practice trainees and trainers about knowledge and how do they justify knowing?

Methods

2 focus groups of trainees (n = 18) were convened on 3 occasions during their 1^st year of postgraduate GP training. 2 groups of GP trainers (n = 11) met on one occasion. Based on the methodology of the Reflective Judgement Interview (RJI), participants were asked to comment on 11 ill-structured problems. The sessions were audio taped and transcribed and an adapted version of the RJI scoring rules was used to assess the trainees' reasoning about ill-structured problems.

Results

Participants made a number of statements illustrating their EB and their importance in clinical reasoning. The level of EB varied widely form one meeting to another and depending on the problem addressed. Overall, the EB expressed by trainees did not differ from those of trainers except on a particular ill-structured problem regarding shoulder pain.

Conclusion

The use of focus groups has entailed some difficulties in the interpretation of the results, but a number of preliminary conclusions can be drawn. Ill-structured medical problems can be used to elicit EB. Most trainees and trainers displayed pre-reflective and quasi-reflective EB. The way trainees and doctors view and justify knowledge are likely to be involved in medical reasoning processes.