The wolf you feed: Challenging intraprofessional workplace‐based education norms
TL;DR: In this paper, the authors argue that choosing an interprofessional orientation towards workplace learning and guidance may better prepare medical trainees for their future role in health care practice, and suggest three perspectives that might help to deliberately and meaningfully incorporate the interprofessional learning and teaching dynamic within the medical education continuum.
Abstract: CONTEXT The trajectory towards becoming a medical professional is strongly situated within the clinical workplace. Through participatory engagement, medical trainees learn to address complex health care issues through collaboration with the interprofessional health care team. To help explain learning and teaching dynamics within the clinical workplace, many scholars have relied on socio-cultural learning theories. In the field of medical education, this research has largely adopted a limited interpretation of a crucial dimension within socio-cultural learning theory: the expert who guides the trainee into the community is almost exclusively from the same profession. We contend that this narrow interpretation is not necessary. This limited focus is one we choose to maintain-be that choice intentional or implicit. In this cross-cutting edge paper, we argue that choosing an interprofessional orientation towards workplace learning and guidance may better prepare medical trainees for their future role in health care practice. METHODS By applying Communities of Practice and Landscapes of Practice , and supported by empirical examples, we demonstrate how medical trainees are not solely on a trajectory towards the Community of Physician Practice (CoPP) but also on a trajectory towards various Landscapes of Healthcare Practice (LoHCP). We discuss some of the barriers present within health care organisations and professions that have likely inhibited adoption of the broader LoHCP perspective. We suggest three perspectives that might help to deliberately and meaningfully incorporate the interprofessional learning and teaching dynamic within the medical education continuum. CONCLUSION Systematically incorporating Landscapes of Competence, Assessment, and Guidance in workplace-based education-in addition to our current intraprofessional approach-can better prepare medical trainees for their roles within the LoHCP. By advocating and researching this interprofessional perspective, we can embark on a journey towards fully harnessing and empowering the health care team within workplace-based education.
Citations
More filters
TL;DR: In this paper , a multicentre qualitative study was conducted to understand how junior doctors experience interprofessional collaboration (IPC) and what elements shape these experiences considering their transition to clinical practice.
Abstract: The transition from medical student to junior doctor is challenging. Junior doctors need to become part of the physician community of practice (CoP), while dealing with new responsibilities, tasks and expectations. At the same time, they need to learn how to navigate the frontiers and intersections with the other communities of practice that form the Landscape of Practice (LoP). This study aims to understand how junior doctors experience interprofessional collaboration (IPC) and what elements shape these experiences considering their transition to clinical practice.In this multicentre qualitative study, 13 junior doctors individually drew two rich pictures of IPC experiences, one positive and one negative. A rich picture is a visual representation, a drawing of a particular situation intended to capture the complex and non-verbal elements of an experience. We used semi-structured interviews to deepen the understanding of junior doctors' depicted IPC experiences. We analysed both visual materials and interview transcripts iteratively, for which we adopted an inductive constructivist thematic analysis.While transitioning into a doctor, junior doctors become foremost members of the physician CoP and shape their professional identity based on perceived values in their physician community. Interprofessional learning occurs implicitly, without input from the interprofessional team. As a result, junior doctors struggle to bridge the gap between themselves and the interprofessional team, preventing IPC learning from developing into an integrative process. This professional isolation leaves junior doctors wandering the landscape of practice without understanding roles, attitudes and expectations of others.Learning IPC needs to become a collective endeavour and an explicit learning goal, based on multisource feedback to take advantage of the expertise already present in the LoP. Furthermore, junior doctors need a safe environment to embrace and reflect on the emotions aroused by interprofessional interactions, under the guidance of experienced facilitators.
12 citations
TL;DR: In this article, the authors explored how physicians who pursue graduate degrees in medical education navigate their landscape of practice by shifting their engagement from teaching individual learners to translating what they learned in the graduate program to develop educational projects and produce scholarship.
Abstract: INTRODUCTION Despite its widespread application in medical education, belonging to a single community of practice does not reflect the overall experience of physician-educators. Knowing how physician-educators find their way among different communities of practice (ie their landscape of practice) has implications for professional development but the limited description in the literature. In this longitudinal qualitative research, we explored how physicians who pursue graduate degrees in medical education navigate their landscape of practice. METHODS 11/29 physicians in one cohort of a masters in medical education programme were interviewed annually from 2016 (programme start) to 2020 (2 years post-graduation). We iteratively collected and analysed data, creating inductive codes and categorising coded data by mode of identification (engagement, imagination, alignment) and time. We organised narratives into time-ordered data matrices so that final analysis wove together mode, time and participant. RESULTS All participants consistently spoke of navigating their landscape of practice, which included the community created in the graduate programme; but that single community 'doesn't define the journey itself'. They shifted engagement from teaching individual learners to translating what they learned in the graduate programme to develop educational projects and produce scholarship. They shifted the imagination from relying on internal and external assessments to experience-inspired versions of their future self. And they shifted alignment from belonging to the graduate programme's community of practice, then belonging to different communities in their landscape of practice and ultimately focussing on communities that mattered most to them. DISCUSSION Physicians in a graduate programme in medical education navigated their dynamic landscape of practice by shifting how they engaged in medical education, as well as what they imagined and who they aligned with as physician-educators. Our work offers novel insights into how knowledgeability emerges through time as overlapping modes of identification.
5 citations
4 citations
TL;DR: The authors explored sociocultural factors in dietetics education influencing the transition into the profession from the perspective of dietetics students and educators, and found that sociOCultural factors are powerful influences on the student-professional transition.
4 citations
TL;DR: In this article, the authors discuss the value of narrative analysis as a set of analytic approaches that offer several lenses that can support health professions education (HPE) scholars' research.
Abstract: CONTEXT Health professions education (HPE) has increasingly turned to qualitative methodology to address a number of the field's difficult research problems. While several different methodologies have been widely accepted and used in HPE research (e.g., Grounded Theory), others remain largely unknown. In this methodology paper, we discuss the value of narrative analysis (NA) as a set of analytic approaches that offer several lenses that can support HPE scholars' research. METHODS After briefly discussing the 'narrative turn' in research, we highlight five NA lenses: holistic, situated, linguistic, agentive and sequential. We explore what each lens can offer HPE scholars-highlighting certain aspects of the data-and how each lens is limited-obscuring other aspects. To support these observations, we offer an example of each lens from contemporary HPE scholarship. The manuscript also describes methods that can be employed in NA research and offers two different typologies of NA methods that can be used to access these lenses. CONCLUSIONS We conclude with a discussion of how different analytic methods can be used to harness each of the lenses. We urge the deliberate selection and use of NA methods and point to the inherent partiality of any NA approach. Reflecting on our position as narrative scholars, we acknowledge how our own lenses illuminate some areas and conceal others as we tell the story of NA. In conclusion, we invite other researchers to benefit from the potential NA promises.
3 citations
References
More filters
TL;DR: In this article, two such metaphors are identified: the acquisition metaphor and the participation metaphor, and their entailments are discussed and evaluated, and the question of theoretical unification of research on learning is addressed, wherein the purpose is to show how too great a devotion to one particular metaphor can lead to theoretical distortions and to undesirable practices.
Abstract: This article is a sequel to the conversation on learning initiated by the editors of Educational Researcher in volume 25, number 4. The author’s first aim is to elicit the metaphors for learning that guide our work as learners, teachers, and researchers. Two such metaphors are identified: the acquisition metaphor and the participation metaphor. Subsequently, their entailments are discussed and evaluated. Although some of the implications are deemed desirable and others are regarded as harmful, the article neither speaks against a particular metaphor nor tries to make a case for the other. Rather, these interpretations and applications of the metaphors undergo critical evaluation. In the end, the question of theoretical unification of the research on learning is addressed, wherein the purpose is to show how too great a devotion to one particular metaphor can lead to theoretical distortions and to undesirable practices.
3,660 citations
TL;DR: In this paper, a review of the literature reveals four potential learning mechanisms that can take place at boundaries: identification, coordination, reflection, and transformation, and these mechanisms show various ways in which sociocultural differences and resulting discontinuities in action and interaction can come to function as resources for development of intersecting identities and practices.
Abstract: Diversity and mobility in education and work present a paramount challenge that needs better conceptualization in educational theory. This challenge has been addressed by educational scholars with the notion of boundaries, particularly by the concepts of boundary crossing and boundary objects. Although studies on boundary crossing and boundary objects emphasize that boundaries carry learning potential, it is not explicated in what way they do so. By reviewing this literature, this article offers an understanding of boundaries as dialogical phenomena. The review of the literature reveals four potential learning mechanisms that can take place at boundaries: identification, coordination, reflection, and transformation. These mechanisms show various ways in which sociocultural differences and resulting discontinuities in action and interaction can come to function as resources for development of intersecting identities and practices.
1,541 citations
TL;DR: Insight into the educational, systemic and personal factors which contribute to the culture of the professions can help guide the development of innovative educational methodologies to improve interprofessional collaborative practice.
Abstract: Each health care profession has a different culture which includes values, beliefs, attitudes, customs and behaviours. Professional cultures evolved as the different professions developed, reflecting historic factors, as well as social class and gender issues. Educational experiences and the socialization process that occur during the training of each health professional reinforce the common values, problem-solving approaches and language/jargon of each profession. Increasing specialization has lead to even further immersion of the learners into the knowledge and culture of their own professional group. These professional cultures contribute to the challenges of effective interprofessional teamwork. Insight into the educational, systemic and personal factors which contribute to the culture of the professions can help guide the development of innovative educational methodologies to improve interprofessional collaborative practice.
1,247 citations
TL;DR: In this article, the authors critically explore the communities of practice approach to managing knowledge and its use among management academics and practitioners in recent years, and identify the limits of the approach in the field of knowledge management.
Abstract: The purpose of this paper is to critically explore the communities of practice approach to managing knowledge and its use among management academics and practitioners in recent years. In so doing, the aim is to identify the limits of the approach in the field of knowledge management. The paper begins with a brief description of the communities of practice approach. This is followed by a review of critiques of the approach evident in the management literature. A number of further challenges are then elaborated. The limits of communities of practice are subsequently discussed and brief conclusions drawn
771 citations
TL;DR: This large‐scale, interdisciplinary review of literature addressing supervision is the first from a medical education perspective to focus on clinical supervision in postgraduate and undergraduate medical education.
Abstract: Context
Clinical supervision has a vital role in postgraduate and, to some extent, undergraduate medical education. However it is probably the least investigated, discussed and developed aspect of clinical education. This large-scale, interdisciplinary review of literature addressing supervision is the first from a medical education perspective.
Purpose
To review the literature on effective supervision in practice settings in order to identify what is known about effective supervision.
Content
The empirical basis of the literature is discussed and the literature reviewed to identify understandings and definitions of supervision and its purpose; theoretical models of supervision; availability, structure and content of supervision; effective supervision; skills and qualities of effective supervisors; and supervisor training and its effectiveness.
Conclusions
The evidence only partially answers our original questions and suggests others. The supervision relationship is probably the single most important factor for the effectiveness of supervision, more important than the supervisory methods used. Feedback is essential and must be clear. It is important that the trainee has some control over and input into the supervisory process. Finding sufficient time for supervision can be a problem. Trainee behaviours and attitudes towards supervision require more investigation; some behaviours are detrimental both to patient care and learning. Current supervisory practice in medicine has very little empirical or theoretical basis. This review demonstrates the need for more structured and methodologically sound programmes of research into supervision in practice settings so that detailed models of effective supervision can be developed and thereby inform practice.
746 citations