Reflection has been proclaimed as a means to help physicians deal with medicine’s inherent complexity and remedy many of the shortcomings of medical education. Yet, there is little agreement on the nature of reflection nor on how it should be taught and practiced. Emerging neuroscientific concepts suggest that human thought processes are largely nonconscious, in part inaccessible to introspection. Our knowledge of the world is fraught with uncertainty, ignorance and indeterminacy, and influenced by emotion, biases and illusions, including the illusion (...) of not having illusions. Neuroscience also documents that lifelong learning processes may hone nonconscious cognition to high levels of sophistication, allowing rapid and precise perceptions, judgments and actions in complex situations. We argue that knowledge of mechanisms underlying human thought may be useful in designing educational programs to foster desired attributes such as curiosity, critical self-awareness and intuitive acumen in medical professionals. The juxtaposition of neuroscientific insights with ideas from Kant on reflective judgement, van Manen on tact, and Aristotle on phronésis, supports a concept of reflection that manifests as wise practice. We suggest that reflection in medical education should be an imperative for educators seeking to guide learners to manage the complexity and “messiness” of medical practice, and a role-modelling mode of medical practice characterized by self-correcting behaviors that culminate in good and right professional actions. An example illustrates reflective practice in the teaching and learning of physicianship. (shrink)

In science and environmental studies, there is a general concern for the democratization of the expert-lay interplay. However, the democratization of expertise does not necessarily lead to more sustainable decisions. If citizens do not take the sustainable choice, what should experts and decision makers do? Should the expert-lay interplay be dissolved? In thinking about how to shape the expert-lay interplay in a better way in agro-biodiversity conservation, I take the case of the MST (Movimento Sem Terra/Landless People’s Movement), possibly the (...) largest rural movement in Latin America. The MST is in a process of turning towards environmentalism. It has adopted agroecology, a democratically oriented knowledge field. However, not all of the farmers were willing to adopt new environmentalist ideas and practices. Through ethnographic research, I analyze how expertise was recognized and redistributed within the MST, attending particularly to the role of MST coordinators and technicians. I explore how participation was framed and put into action. The adoption of agroecology brought to the MST a new and more inclusive map of expertise, but it also influenced new social distinctions within the communities. In part, farmers’ knowledge was labeled as ignorance. This may close down possibilities for dialogue as well as for sustainability. The paper suggests that experts’ power for discriminating among lay knowledges should come together with a responsibility for opening spaces for dialogue and action. One way of doing so could be by adding “interactional reflexivity” to experts’ expertise. (shrink)