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Helping learners to ‘talk’ their way into workplace learning

One of the challenges of learning in the workplace is that much of the complexity of practice goes unseen. Many aspects of professional practice take place in the minds of practitioners, who engage in an internal dialogue based around one or more of the following: taking a patient’s history or listening to their narrative, making a diagnosis, exploring alternative diagnoses, clinical reasoning, management or treatment planning and exploring prognosis. A key challenge for the clinical teacher is to find ways to make this thinking accessible to the learner and to find ways to access the learner’s ‘thinking’ as a way of ensuring they are ‘on track’.

Some of the ways in which you can do this include the following:

‘Thinking aloud’ – providing a narrative as we teach a skill or procedure is commonplace in clinical teaching. Providing a narrative along the lines of ‘What I am considering with this patient because…’ or ‘What I am struggling with here is…’ or ‘I am weighing up the options of X versus Y because…’ are equally powerful.

Purposeful observation – by priming a learner to observe purposefully, we are making explicit the ways in which we look at patients or situations. For example, rather than asking a learner to just observe a meeting with a distressed patient or relatives, you might ask them to note aspects of their verbal or non-verbal behaviour that indicate distress. Alternatively, you might ask them to note down specific strategies you use to calm the patient and relatives and to address their fears or anxieties.

‘Talk the talk’ – many clinical teachers have ‘set ways’ they like learners to present ‘cases’ or patients. These also vary between different professions and often reflect the ways in which the professional body of knowledge or the practitioners organise their thoughts about patients, as a way of ensuring a systematic approach to providing care. By being clear with learners that this talking prompts a way of thinking, you are labelling it as a teaching strategy rather than a personal ‘quirk’. These ways of talking about patients are often the ways in which particular ‘cultural practices’ are made evident. For example, the way a patient is presented in osteopathy is different from medicine, which is different from psychology, etc. By being explicit about this, learners again gain insight into the ways in which the profession is practised in that context and how their profession differs from others (thus helping them acquire professional identity).

Use case-based discussion – this is another example of the ways in which workplace assessment can be a powerful workplace learning tool. Case-based discussion is designed to explore the thinking behind practice, for example to consider why the learner made a particular diagnostic or treatment/management decision. It provides an opportunity for the learner to make their thinking explicit and to develop their ideas. Clinical teachers can make the most of these opportunities by changing the types of question that check out the knowledge base (e.g. why would you prescribe X and not Y for this patient?) to those that require the learner to provide a rationale for decisions made or not made. For example, ‘You have suggested that this patient needs to be admitted, can you tell me more about the factors that you took into account… how might you justify sending this same patient home… who else in the team did you involve/could you involve in that decision-making process?’, etc.

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