Expertise in nursing practice : caring, clinical judgment - Springer ...

Chapter 1 The Relationship of Theory and Practice in the Acquisition of Skill 7
might turn out that skill acquisitionmoves in just theopposite direction—
from abstract principles to particular cases.
We previously mentioned the belief—all too prevalent in our highly
rationalistic, scientific Western culture—that the role ofexperience is
merely to refine theory. We reject the view that, presumably unconsciously,
subtle theory produces skilledperformance notbecause wecan
prove that it is wrong but, in part, because no plausible arguments have
been offered (beyond the assertion that noother explanation exists) that
it is right. As we shall see later, this assertion isbeing called into question
asunderstanding slowly emerges about how the brain’s neuronal
activity accompanied by synaptic modifications during learning can produce
improvedperformance based on experience—aprocess that cannot
adequately be explained asthe acquisition of theoretical knowledge.
Furthermore, it certainly doesnotlookreasonable to say that the application
of principles and rules of thumb produce skilled human coping,
giventhe effortlessness and speed with which skilled drivers,for example,
cope with changing situations or with which skilled carpenters, say,carry
out their activities. Even highly skilled chess players, coping with what
appear to be difficult situations requiring planning, reasoning, and careful
assessment of various trade-offs,can play chess at the rateof1second
or less per move and still produce games of very high quality. As well,
they can do this even if they are required simultaneously to do simple
computational tasks that seem to leave little, if any, room for theoretical
thinking about chess.
Add to this the fact that computer scientists have been striving unsuccessfully
for more than 30 years to produce artificial intelligence by
programming vast numbers of facts, various principles of logical inference,
and rules of thumb into computers. Even though computers can
store far more facts than any human can remember and can apply inferential
rules thousands of times more rapidly and with more accuracy
than can human beings, programs optimistically called expert systems
consistently fail to perform at the level of human experts in areas such
as nursing, in which people learn with experience to make rapid, effective
decisions. Through these intense efforts toward artificial intelligence,
the hypothesis that intelligence consists of nothing more than
rules and principles has been put to an empirical test and has been found
wanting.
Itseems to us that it is more plausible to believe that sufficient experience,
accompaniedbyno theoretical knowledge, could produce skilled
coping behavior. After all, animals cope skillfully with their environments