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Creating and supporting opportunities to learn through work participation

We know that learning is most effective when learners are given opportunities to engage actively in real workplace activity. These opportunities are obviously bounded by competing demands, concerns and priorities, which will include the complexity of the activity, the potential risks involved, the competence and confidence of the learner, the time available and the willingness (and consent) of patients to be involved in training activities.

There will be times when, with adequate preparation and ‘safety-netting’, you will delegate tasks to learners in their entirety. Even students in very early clinical placements can take responsibility for some tasks, such as accompanying patients, helping patients to wash and dress or simple procedures. As you work with learners to enable them to learn more advanced and complex tasks and procedures, you may work with learners in parallel or delegate aspects of work to enhance their learning or to provide participatory opportunities that will increase their confidence and readiness to undertake increasing aspects of work activity. Billett suggests that these pathways of activities (in which learners are increasingly exposed to the knowledge they need to sustain their practice and to tasks of increasing complexity and importance) are ‘inherently pedagogical, as they focus on the continuity of practice through learning’ (2001).

One of the ways in which you can prepare and ‘safety-net’ is by ensuring you start with learning needs analysis. A brief yet really focused conversation with a learner can inform your decision-making about what to delegate and the support strategies you need to put in place. This will usually include finding out what they ‘know’, what they have ‘done’ before that is of relevance, any concerns or anxieties they have about what is proposed and how you can offer back-up support (or rescue) if things don’t go according to plan.

See the Assessing Educational Needs and Setting Learning Objectives modules for further ideas and information.

For example, a surgical trainee might not yet be ready to perform a complete surgical procedure. They may, however, be ready to take the history, perform the examination, obtain consent from the patient, prep the patient and perform one part of the procedure, monitor in recovery and write up the charts. This gives them a sense of taking responsibility for the patient’s management, and time to focus their attention fully on the aspects they are not yet doing, but might do next time.

This is another situation where you can use assessments for learning purposes. By looking at the learner’s profile, you can spot patterns of competence and obvious gaps in either experience or competence. By focusing on these, you can ensure that you guide the learner to the types of experience that are best aligned with their development needs.

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