Oxford Internet Institute (OII)

Reconfiguring Expertise: AI, Relational Practice, and Clinical Learning in the Emergency Department

The Oxford Digital Ethnography seminar featured Professor Maya Brun’s ethnographic investigation of how artificial‑intelligence tools are reconfiguring professional expertise in Danish emergency departments. By focusing on a fracture‑detection algorithm and a sepsis‑risk scoring system, Brun illustrates the varied ways AI enters clinical practice, from tightly regulated imaging tools to broader decision‑support platforms. Her fieldwork reveals that clinicians continue to exercise primary judgment, with liability and final decisions remaining with doctors despite algorithmic suggestions. The study highlights a paradox: while AI promises to automate routine tasks, it simultaneously reduces demand for junior specialists yet amplifies the need for senior experts who can interpret, validate, and troubleshoot algorithmic outputs. Brun draws on anthropological concepts of relational expertise, citing Dreyfus’s skill‑acquisition model and the actor‑network perspective to argue that expertise emerges through everyday interactions rather than residing as a static, digitizable asset. Concrete examples—radiograph markup, early‑warning scores, and generative‑AI tools in education—show how different AI forms follow distinct implementation pathways and cultural negotiations. The findings suggest hospitals must redesign training, governance, and inter‑professional workflows to accommodate AI as a collaborative partner rather than a replacement. Recognizing expertise as relational can mitigate the illusion of fully automated decision‑making and ensure patient safety while leveraging AI’s efficiency gains.