12 Most of these studies concentrate on trainees and residents training to be competent and independent clinicians. Teaching and learning the skills of CSPY is a growing research field which include a broad range of studies such as measurement of competency in CSPY, 1, 7, 8 simulation training versus hands-on or bedside training in CSPY, 9, 10, 11 and trainees' view on teaching in clinical endoscopy. Furthermore, we believe it to be important to investigate the pedagogical approach and teaching methods of experienced trainers who try to change old habits of experienced clinicians, as this will help us to optimize the training of future trainers. We believe it important to explore habitual constraints in response to opportunities - in short, the so-called habitus - of the experienced clinician as this will help us understand why some clinicians might instinctively dig in their heels when faced with new teachings and when they train their colleagues. In this article, we explored the habitual constraints and opportunities that affect how experienced clinicians learn new skills and, in particular, how new ways of teaching CSPY can influence these. Old habits die hard, and it is unclear how the ingrained habits of experienced clinicians can be overcome and improved. But when new techniques arise and old habits need change, it challenges and perhaps even threatens the intuitive expertise and unconscious competent craftsmanship of the experienced clinician. 6 Tacit knowledge allows the clinician to act quickly and deal with difficult situations.
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It has been argued that tacit knowledge and intuitive expertise are the most desirable forms of knowledge in a craftsmanship such as surgery. But how does unconscious competence influence experienced clinicians' learning? the clinician may perform it without conscious thought, 5 because the competency has become a tacit routine and an ingrained habit. 3, 4 However, when a clinician masters CSPY, he or she often becomes unconsciously competent when performing the procedure, i.e. 1, 2 Expert clinicians get to the cecum more often, use less sedation, cause less discomfort, achieve a better patient experience, and find more polyps. This particular craftsmanship is a highly complex skill that takes years to master. The craftsmanship of colonoscopy (in short CSPY) is the careful examination of the inner lining of rectum and colon by use of a slim, flexible tube with a small video camera called a colonoscope. Surgery and the techniques of examining and treating the inner structures of the body is a craftsmanship.
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This study provides in-depth insights in the interconnection between the habitus - the socially constructed behaviors and traditions - among experienced colonoscopists and the pedagogical investments among expert trainers in their endeavor to change old habits in the colonoscopists. Exploring the habitus of the experienced clinicians may help trainers to understand why some clinicians might instinctively dig in their heels when faced with new teachings. However, the training of experienced clinicians for the purpose of unlearning old habits, learning new skills, and improving conscious competence may pose a considerable pedagogical challenge to trainers, because they have to overcome incorporated routines and established practices. Considering the rapid change in knowledge, procedures, and technologies in the healthcare sector, it seems pivotal for clinicians and other healthcare professionals to be able to change routines and unlearn old habits.