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Fostering 'horizontal' learning

Health professions learners move rapidly from one workplace to another and are expected to somehow identify and absorb the nuanced differences between one setting or team and another, and adapt their own behaviour to fit accordingly. For example, all doctors routinely take a history from their patients – but consider the differences between those taken in acute hospital settings from those in general practice. And all health professionals establish professional relationships with patients – again think about the differences in relationship between osteopaths, psychologists or GPs in individualised (sometimes private practice, often long-term) clinic situations from those in an Emergency Department or day theatre.

How do you help newcomers ‘see’ such differences and find ways of working with you, your team and your patients, that are appropriate and congruent? One way is to provide clear ‘joining’ instructions that outline preferred styles of dress, ways of addressing colleagues and patients (even what we call the people for whom we care is different in different contexts and professional groups – patients, clients, service users, etc.), format for writing in notes or constructing letters, for example. Another is to invite newcomers to actively seek and articulate differences between observed practice in your workplace and those experienced elsewhere, and to discuss these where it would appear to be helpful. This is another situation where purposeful observation can be very powerful.

Another important aspect of horizontal learning is around helping learners to draw on their formal learning (gained in the classroom) to understand what they see in practice. One of the ways we can do this really effectively is through questioning, rather than telling. You might start with some Socratic questions, designed to explore what they know already, in order to make sense of what they see. For example, when they meet a patient who is receiving different treatment from other similar patients, you might start by asking them to identify observed signs and symptoms and read the notes, then explore why this is the treatment plan and their role in carrying this out. This might lead to another set of unanswered questions, which you might address through some heuristic-type questions, designed to help the learner identify the ways in which they might develop their understanding. ‘Where might you go to find out more about this condition? What are the possible side effects of the treatment and what can we put in place to support the patient and their family?’

For more ideas, see the Small Group Teaching module.

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