29 March 2021

We can know more than we can tell


An irrepressible habit of mine is to seek out any new bookstore within my vicinity and in 2012, during a visit to Perth for a conference, I ventured into Boffins bookshop and found a book on tacit knowledge by Professor Harry Collins from Cardiff in Wales1. On the opening page of the introduction Michael Polanyi’s quote ‘we can know more than we can tell’2 immediately captured me. I must have said something to myself like, yes ! that’s right ! I do and can know more than I can easily explain.

Further ideas followed reading Collins book and then onto several of Polanyi’s. What became both clearer to me and also confusing, was that often my experiences as a GP and a Supervisor, seemed tacit in nature. These were when I knew that I had ways of knowing what was going on, and also what needed to be done, but couldn’t readily share these with clear explanations.

Four years later, in 2016 I was very fortunate to be able to begin a new phase in my life and began to work as a medical educator with NTGPE. I was grateful to enrol in the graduate certificate of clinical education with the Prideax Centre at Flinders University with the generous support of NTGPE.

I have recently read that a life story combines intention with accident3. The intention to walk into Boffins bookstore, the accidental finding of Harry Collins book and Polanyi’s now famous aphorism, then led to my second intention. Yes, I need to research this phenomenon.

So from there, I moved onto enrolling in the masters degree undertaken by research in 2017, again supported by NTGPE.

Now, after another four years I have just had my research thesis conferred. It is called, What is the nature of tacit knowing experienced by GP Supervisors as they teach GP Registrars in clinical practice? Like all scholastic work the thesis is written in academic language and is quite philosophical. However, the storyline is quite straightforward. I asked nine other GP Supervisors if they had experiences like mine. Their stories, combined with descriptions and then interpretations formed the data. This was then further interpreted and thematised. The research approach I used was Hermeneutic Phenomenology.

So, what did I find? The three themes in the findings are ‘re-presenting’, ‘with-holding’ and ‘path-marking’. These word couplets contain a gerund and also a hyphen. The use of this dynamic form of language promotes multiple meaning to arise that show the extraordinary flexibility and adaptability of how Supervisors support their Registrars. The nature of this is not tacit in the sense that it is inexpressible. The accounts from the supervisors shows revealed rich descriptions and understandings from their lived experience.

The tacit nature is more in the sense it is expressed in enacted expertise, rather than epistemological explanations. The word that captures this is, dispositional in contrast to being definitional and propositional. Its more about who we are, how we engage with our Registrar colleagues and the myriad ways of being clinical educators. Its essential nature is relational.

Another term that emerged from the pre-readings which comes close to capturing its nature is phronesis. It is a word offered over two thousand years ago by Aristotle in his work to define a form of knowing that invokes practical wisdom leading to virtuous judgement and action. It was a pleasant surprise to stumble across this finding, which resonated with the tacit nature of the knowing shared in the supervisors stories.

The additional sense of why this can be deemed to be tacit is that it is often taken for granted and hitherto not fully understood, appreciated, and valued. I hope this research might challenge this situation.

In order to achieve this work I have had extraordinary support from my three academic supervisors, Professor Lambert Schuwirth, Emeritus Professor David Giles and Associate Professor Julie Ash. Additionally all the staff at the Prideaux Centre especially Fiona Smith helped.

NTGPE offered not only direct sponsorship but so many of my NT friends and colleagues have been part of the journey. The practical support, encouragement and innumerable conversations and ideas I was able to share during the course of the research is woven into the thesis. For this, and to all of you who helped me, I am so grateful.

Hubert van Doorn was NTGPE’s Lead Medical Educator, Supervisor and Practice Accreditation from 2017–2019.

1Collins, H 2010 Tacit and Explicit Knowledge. The University of Chicago Press. p.1.

2Polanyi, M 1966 The Tacit Dimension. The University of Chicago Press. p.4.

3Cavarero, A 2000 Relating Narratives, Story telling and Selfhood. Routledge (English trans. Kotman) p.1.