This paper examines how expertise is treated as a separable domain of epistemics by looking at simulated intensive care shift-handovers between resident physicians. In these handovers, medical information about a patient is transferred from an outgoing physician (OP) to an incoming physician (IP). These handovers contain different interactional activities, such as discussing the patient identifiers, giving a clinical impression, and discussing tasks and focus points. We found that with respect to (factual) knowledge about the patient, the OPs display an orientation to a knowledge imbalance, but with respect to (clinical) procedures, reasoning, and activities, they display an orientation to a knowledge balance. We use ‘expertise’ to refer to this latter type of knowledge. ‘Expertise’ differs from, and adds to, how knowledge is often treated in epistemics in that it is concerned with professional competence or ‘knowing how’. In terms of epistemics, the participants in the handovers orient to a steep epistemic or knowledge gradient when it concerns the patient, while simultaneously displaying an orientation to a horizontal expertise gradient.

本文通过观察住院医师之间模拟的重症监护轮班交接，研究如何将专业知识视为可分离的认知领域。在这些移交中，有关患者的医疗信息从即将离任的医生 (OP) 传输到新任医生 (IP)。这些交接包含不同的交互活动，例如讨论患者标识符、给出临床印象以及讨论任务和重点。我们发现，就患者的（事实）知识而言，OP 显示出知识不平衡的方向，但就（临床）程序、推理和活动而言，它们显示出知识平衡的方向。我们使用“专业知识”来指代后一种类型的知识。“专业知识”不同于并补充，知识在认识论中通常如何处理，因为它与专业能力或“知道如何”有关。在认知方面，当涉及患者时，交接中的参与者倾向于陡峭的认知或知识梯度，同时显示出对水平专业知识梯度的定向。