On learning in the clinical environment

Abstract

IntroductionThe clinical environment has been increasingly acknowledged as an important setting for learning within healthcare professional education. In particular, researchers have highlighted the need to advance the knowledge on the social nature of learning in the workplace setting. The aim of the thesis was to explore workplace learning among undergraduate medical and nursing students.MethodThe thesis adopted a socio-cultural perspective on learning and employed a qualitative approach embedded in an interpretative tradition of inquiry. Four consecutive studies were included in the thesis, the first one designed according to qualitative description whereas the other three had an ethnographic approach. Data were collected through individual interviews and field observations. Content analysis and thematic analysis were employed.ResultsFor the medical students, workplace learning entailed access to a variety of activities in the role of a marginal member of the healthcare team. Medical students demonstrated an adaptive approach to workplace learning. For the nursing students, workplace learning involved being entrusted to hold responsibility for patient care and the need to negotiate their basic values with those of the workplaces. Nursing students showed a hesitant approach to workplace learning.DiscussionWorkplace learning was built upon varying theoretical perspectives of learning in the medical and nursing contexts respectively. The main message in the thesis argued for an upgrading of students as a powerful and active stakeholder in workplace learning, so as not to view students as passive consumers of clinical education.

You say it, we say it, but how do we use it? Communities of practice: A critical analysis

“…22,24,25 It has also been highlighted that organisations such as universities and workplaces operate within formal structures and that CoP fails to recognise the power of such structures. 12,23,25,26 Further criticism targets the focus on how a CoP builds newcomers' identity, where it is argued that newcomers also bring previous skills and beliefs. 27 Thus, although some undoubtedly view CoP as useful and appropriate in medical education, the literature also presents some concerns.…”

“…Criticism has been levelled against the increasingly homogeneous and instrumentalist use of CoP to encapsulate ‘knowing in action’, whereas others have argued that many interpretations of CoP may be inconsistent, or even at odds with each other, or that CoP has become a generic concept that represents how organisations are organised . It has also been highlighted that organisations such as universities and workplaces operate within formal structures and that CoP fails to recognise the power of such structures . Further criticism targets the focus on how a CoP builds newcomers’ identity, where it is argued that newcomers also bring previous skills and beliefs .…”

Integration in the light of curriculum design

“…This gives students the opportunity to perform authentic activities in a real-life context [10], [11]. By gradually phasing out supervision and giving them more responsibility, they are progressively being prepared for their future work as doctors.…”

Finding your feet: student participation during initiation of international clinical placements: Student participation during initiation

“…Consequently, it is widely assumed that international placements can foster students' development into professionals that are 'fit for practice': who are open to ongoing developments, able to deal with change in their respective disciplines and ready to face future healthcare challenges. According to the concept of 'legitimate peripheral participation' [1,2], students undergo a process of realignment with their social learning environment when entering practice [3]. Research on workplace learning suggests that this realignment, in addition to being highly influenced by context [4], is a result of students' engagement in novel activities [5] and support provided by the supervisor or local healthcare team [6,7].…”

“…Students face opportunities and challenges when starting a new clinical placement [3,8]: they step out of their familiar educational framework and into a different frame of professional practice. This transition into the workplace can be stressful, even if it is not in a foreign country, as students may struggle to understand their role and responsibilities in the clinical setting.…”