Article Professional knowledge, midwifery and the role of the external examiner Mike Walker and Judith Sibson Following the move of midwifery education into institutions of higher education (IHE), professional sources have voiced some concern over the apparent 'cultural conflict' between IHE and the midwives. In order to investigate this, a 1-day conference was convened for midwife teachers and external examiners in the south of England, during which data were collected from recorded discussions and interviews. The findings confirm the existence of conflict which polarized around two issues: first, the centrality of practice for midwives and the perceived undermining of that practice by the academically orientated IHE; and second, the somewhat ambiguous role of the external examiner. These findings are explained in terms of recent work on professionalization which suggests that professional knowledge can be legitimized where the emphasis is placed on the indeterminate elements of the work and where knowledge originates from abstractions and conceptualizations derived from working practice. Such a knowledge base would be rather more resistant to undermining by the deductive, rationalist approach employed by IHE academics. It is suggested that external examiners are best placed to represent practice based knowledge to IHE examiners. Mike Walker CEd, BSc,MA, Lecturer in Education, Brunel University College, St. Margaret's Road, Twickenham, Middx TWl 1PT,UK Judith Sibson RM, MTD, MEd, (formerly) Course Director (Midwifery), Kingston and St George's NHS College of Nursing and Midwifery, Blackshaw Road, Tooting, London SWl 7 OQT,UK (Requests for offprints to MW) Manuscript accepted: 16 April 1996 Introduction Over many years, there has been a continuing debate on the nature of the professions. However, there is one professional trait upon which most commentators would agree and that is that professionals possess a body of knowledge. That is, perhaps, where the consensus ends as the precise nature of this knowledge is still at issue. Occupations will always acquire know-how in relation to their day-to-day tasks. The professions, on the other hand, have traditionally claimed that their knowledge is derived from a prolonged and rigorous training. Midwifery has been no exception in making such claims. Indeed, Siddiqui (1994) has argued that attempts by midwives to demonstrate their professional status have led to an 'overemphasis on the scientific rigour of knowledge at the expense of relevance' and that this has led to a 'failure to account for the many indeterminate areas of practice' (Siddiqui 1994 p 419). The notion of indeterminate practice derives from Jamous & Peloille (1970), who claimed that all occupations could be characterized by the ratio of their technicality to their indeterminacy. Technicality refers to those aspects of work where rules and procedures can be made explicit, where techniques can be analyzed and explained. By contrast, indeterminacy refers to aspects of work which have evolved through practice, which are tacit and unique and which cannot easily be formulated into rules or recipes. Their argument is that aspiring professions will emphasize the indeterminate elements of their work. This is because the knowledge inherent in the technicality aspects of work can be described precisely, and is therefore accessible to, and may be acquired by others. The acquisition of indeterminate knowledge, however, requires 'a lengthy period of induction in the mysteries and arcane knowledge of the occupation' (Atkinson 1981). This indeterminate knowledge is less accessible and therefore promotes the autonomy of the profession. The idea that midwives should emphasize those 20 Nurse Education Today (1998) 18, 20-24 © 1998 Harcourt Brace & Co. Ltd