Expertise in Transition
Expansive Learning in Medical Work

This book challenges standard notions of expertise. In today's world, truly effective expertise is built on fluid collaboration between practitioners from multiple backgrounds. Such collaborative expertise must also be transformative, must be able to tackle emerging new problems and changes in its organizational framework. Engeström argues that the transition toward collaborative and transformative expertise is based on three pillars: expertise needs to be understood and cultivated as a collective activity; expertise needs to be built on flexible knot-working among diverse practitioners; and expertise needs to be fostered as the expansive learning of models and patterns of activity that are in progress. In this book, Engeström recasts expertise as fluid collaboration on complex tasks that requires envisioning the future and mastering change.

Part I. The Theoretical Landscape: 1. Toward a new framework for understanding expertise; Part II. Expertise as Objected-Oriented Activity: 2. Constructing the object in the work activity of primary care physicians; 3. Objects and contradictions as drivers of expert work; 4. Spatial and temporal expansion of the object; Part III. Expertise as Knotworking: 5. The emergence of knotworking in medicine; 6. Knotworking as expansive decision making; 7. Knotworking as history making; Part IV. Expertise as Expansive Learning: 8. Expansive visibilization of medical work; 9. Expansive learning in a hospital; 10. The horizontal dimension of expansive learning; Part V. Toward Collaborative and Transformative Expertise: 11. From stabilization knowledge to possibility knowledge; 12. Expertise in transition.

Yrjö Engeström is Professor Emeritus of Communication at the University of California, San Diego and Professor Emeritus of Adult Education at the University of Helsinki, Finland, where he is also Director of the Center for Research on Activity, Development, and Learning (CRADLE). In his work, Engeström applies and develops cultural-historical activity theory as a framework for the study of transformations in educational settings, work environments, and communities. He has carried out interventionist research in health care settings for over thirty years. He is known for his theory of expansive learning and for the methodology of formative interventions, including the Change Laboratory method. Engeström's most recent books are From Teams to Knots: Activity-Theoretical Studies of Collaboration and Learning at Work (Cambridge, 2008), Learning by Expanding: An Activity-Theoretical Approach to Developmental Research (Cambridge, Second Edition, 2015), and Studies in Expansive Learning: Learning What Is Not Yet There (Cambridge, 2016).