Enacted Phronesis (Practical Wisdom) in Medical Practitioners: An Empirical Mixed Methods Study

Abstract

AbstractBackgroundPhronesis (Practical Wisdom) is a useful way of conceptualising professional knowledge in the field of Medicine. Phronesis is one of five intellectual virtues described by Aristotle. Two of these intellectual virtues are well embedded in Medical Education; scientific knowledge (episteme) and technical skill (techne). The remaining two intellectual virtues are philosophical wisdom (sophia) and intellectual insight (nous). A critical interpretive literature review identified a lack of empirical work on the characteristics of phronemoi (wisdom exemplars). This paper is based on mixed-method PhD research which sought to determine the constituents of enacted phronesis in a population of family medicine practitioners in the UK. The work is positioned in a constructivist paradigm.MethodsA validated wisdom questionnaire (Ardelt 3D wisdom scale) was administered to 211 General Practitioners (GPs) at five training events. Outlier scoring doctors were invited to participate in biographic narrative interviews. 18 doctors were interviewed, 16 of which met Ardelt’s criterion for high levels of wisdom. Individual transcripts were analysed using the Wengraf biographic narrative interpretive method (BNIM), this looked at the lived life and told story of the exemplar and resulted in the generation of vignette statements which have been used for teaching. All transcripts were analysed using corpus linguistic frequency analysis, this enabled a conceptual framework to be produced which facilitated comparison of narratives and reflected the expressed thought-processes of the exemplars.Results34 constituents of enacted phronesis were identified in 5 key areas: their personal qualities, contexts, mental habits, knowledge-of-self and relational aspects. The 34 constituents inform practical action through wise deliberation. Comfort in dealing with uncertainty differentiated the wisdom exemplars from lower scoring participants.ConclusionsThis work has made explicit what is ordinarily tacit in relation to the process of phronesis. It has the potential to impact undergraduate medical education, continuing professional development and educational policy. The work also relates the concept of phronesis to flourishing (eudaimonia), and demonstrates that wiser doctors are happier doctors.