Dieticians’ Understanding of Coeliac Disease:An Empirical Investigation of Interactional Expertise.
Robert Evans1, and Helen Boyce2
1 Centre for the Study of Knowledge, Expertise and Science (KES), Cardiff School of Social Scienceshttp://www.cardiff.ac.uk/socsi/expertise
2 Health Services Research Unit, Dept. Of Public Health, University of Oxford
Overview
The Imitation Game Key Ideas Software and data
Imitation Games with Coeliacs Hypotheses Aggregate Results Successes, Failures and Interactional
Expertise Conclusions
What next?
Imitation Game
Two Kinds of Expertise
Contributory expertise: enables those who have acquired it to contribute linguistically and practically to the community through the expertise is sustained. The most common usage of the word ‘expert’.
Interactional Expertise: expertise in the language of a specialism in the absence of expertise in its practice. Like contributory expertise, it requires the tacit-knowledge acquired by immersion in a form-of-life (i.e. socialisation). It enables individuals to talk as if they had contributory expertise even though they lack practical or craft skills.
Collins and Evans (2002)
Embodiment and Expertise
http://bmrc.berkeley.edu/courseware/cs298/spring99/w9/slides/sld006.htm
Modern Imitation Game
Female judge setting questions
Female answering naturally
Male pretending to be female
How often do you pluck your eyebrows?
R2‘not very often, when
they need doing’
R1‘once a week’
R2 is female ‘because I expected the man to believe women are more regulated in their beauty regime than they actually are
Coeliac Disease
Coeliac Disease
Autoimmune condition affecting approx 1 per cent of population Intolerance to gluten Usually accompanied by
symptoms but only confirmed by blood test
Leads to damaged intestine and reduced uptake of nutrients
Treatment Life-long gluten-free diet
From 1998
Research Questions
Judge is coeliac Target expertise is
‘living with coeliac disease’
Dieititian has to pretend to have coeliac disease
Prediction: Judge will succeed in identifying dietitian
Reason: disciplining expertise
Outcome = Identify Condition
Judge is coeliac Target expertise is
‘living with coeliac disease’
Dieititian has to pretend to have coeliac disease
Prediction: Judge will NOT succeed in identifying dietitian
Reason: interactional expertise
Outcome = Chance Condition
Imitation Gameswith Dietitians
Sample and data
Coeliac sample recruited Snowball sample via family and friends Facebook and Yahoo groups for people living
with Coeliac disease Dietitian sample recruited by
Direct email to online directory of freelance dietitians
Direct email to NHS depts 119 Imitation Games in total
12 ‘Phase 1’ games 107 ‘Phase 2’ games
Aggregate results and recoding
Key: Coeliac = correct identification of contributory expertDietition = incorrect identificaton / dietitian ‘fools’ judge
Identification Ratio
40
53
26106
13IR = 0.11
Identify Conditions
0.33
0.730.86
0.44
0.68
-0.20
0.00
0.20
0.40
0.60
0.80
1.00
colour blind pitch blind sexuality religion
Topics
Ide
nti
fic
ati
on
Ra
tio
ID Ratio Net Don't Know
Comparisons across topics
Mean IR for ID condition approx 0.6
Mean IR for Chance condition approx zero
Chance Conditions
0.05 0.000.13
-0.01-0.13
-0.20
0.00
0.20
0.40
0.60
0.80
1.00
colour blind pitch blind sexuality religion
Topics
Ide
nti
fic
ati
on
Ra
tio
ID Ratio Net Don't Know
Comparisons between dietitians
Dietitians Knowledge -- success
Dietitians Knowledge
Eating Out All dietitians demonstrated some interactional
expertise e.g. difficulties at social events, need to plan ahead, bring ‘emergency supplies’
Could be common knowledge? Emotional aspects
Only dietitians with higher levels of interactional expertise were explicitly acknowledged as getting this right e.g. stress caused by being seen as ‘fussy eater’
Dietitians Knowledge -- Mistakes
Dietitians’ Knowledge
Dietitians Identified by Mistakes – not careful enough to avoid cross-
contamination, reading labels, not an allergy Limited identification – bringing own food does not
always make you feel part of the crowd, gluten-free baking is not easy!
Wrong discourse – Coeliac disease is not a ‘problem’ Stylistic factors – use of examples often persuasive;
clinical or advisory style often a giveaway Repair work
Some really bad answers ‘excused’ by judges who think dietitian is ‘newly diagnosed’ patient
Conclusions
Overall outcome is chance condition Dietitians have interactional expertise Level of interactional expertise varies
Caveats Need control group of lay persons
Imitation Game as comparative method with different health professionals with different illness or health issues with different training / education
Imitation Game References
Collins, Harry and Robert Evans (2002) ‘The Third Wave of Science Studies: Studies of Expertise and Experience’, Social Studies of Sciences, 32 (2): 235-96.
Collins, Harry and Robert Evans (2007) Rethinking Expertise, Chicago, IL: The University of Chicago Press.
Collins, Harry, Robert Evans, Rodrigo Ribeiro and Martin Hall (2006), ‘Experiments with Interactional Expertise, Studies In History and Philosophy of Science, Volume 37, No. 4 (Dec 2006), pp. 656-674.
Evans, Robert and Harry Collins (forthcoming, 2010) ‘Interactional Expertise and the Imitation Game’ in Michael Gorman (ed) Trading Zones and Interactional Expertise: Creating New Kinds of Collaboration, Chicago, IL: MIT Press