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