Dieticians’ Understanding of Coeliac Disease: An Empirical Investigation of Interactional Expertise.

1. 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 Sciences http://www.cardiff.ac.uk/socsi/expertise 2 Health Services Research Unit, Dept. Of Public Health, University of Oxford

2. Overview • The Imitation Game • Key Ideas • Software and data • Imitation Games with Coeliacs • Hypotheses • Aggregate Results • Successes, Failures and Interactional Expertise • Conclusions • What next?

3. Imitation Game

4. 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)

5. Embodiment and Expertise http://bmrc.berkeley.edu/courseware/cs298/spring99/w9/slides/sld006.htm

6. Male pretending to be female Female judge setting questions Female answering naturally Modern Imitation Game R1‘once a week’ R2‘not very often, when they need doing’ R2 is female ‘because I expected the man to believe women are more regulated in their beauty regime than they actually are How often do you pluck your eyebrows?

7. Coeliac Disease

8. 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 Coeliac Disease From 1998

9. 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 Research Questions

10. Imitation Gameswith Dietitians

11. 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

12. Aggregate results and recoding Key: Coeliac = correct identification of contributory expert Dietition = incorrect identificaton / dietitian ‘fools’ judge

13. Identification Ratio 40 26 106 53 IR = 0.11 13

14. Comparisons across topics Mean IR for ID condition approx 0.6 Mean IR for Chance condition approx zero

15. Comparisons between dietitians

16. Dietitians Knowledge -- success

17. 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’

18. Dietitians Knowledge -- Mistakes

19. 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

20. 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

21. 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