Knowing and knowing about

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Abstract
Levels of awareness Where then should we position knowing about? It is related to, but not part of, the assessable competencies of Miller's pyramid. It is an awareness of important knowledge that enables an individual to bring the subject into focus at the appropriate time, using tacit knowledge.3 (This is Polyani's concept of our background knowledge which allows us to contextualise and make sense of what we are learning.4) Knowing about is a more advanced form of knowledge than mere “heard of” awareness. To know about something we have to have some understanding of the distinguishing features, as in this example of a diagnostic test in common use in specialist practice. Less visible, perhaps, than the assessable competencies of Miller's pyramid, are the foundation levels of awareness (figure). We have to have heard of something, and indeed know a little about it from a general perspective, before we can begin to know it in detail. Even when we are not going to build advanced knowledge on what we know about, it may still influence our practice. Take the example of a generalist's knowledge and competence approaching a case like that of Mrs Patel after reading this interactive case report. The doctor's vast pool of “heard of” awareness knowledge is little changed, but the “knows about” awareness now includes stress echocardiography. Although the doctor might feel uncomfortable facing an exam question on the topic, practice could be changed at the level of “does,” which for the generalist is about referring patients appropriately for cardiac investigation and treatment and discussing their results. View larger version: In this window In a new window Miller's pyramid of assessable competencies adapted to include levels of awareness Epistemology, or the science of knowledge, is beloved by academics, who talk variously of the contributions of observation, logic, faith, and authority to the ways in which we know something. As a practical contribution to our clinical competence, I hope that case commentary learning continues to develop our “knowing about” as well as the more applied forms of knowledge.