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Making workplace learning opportunities explicit

While the workplace is a great place to learn, the primary focus is on working, and opportunities to learn may go unrecognised. Learners have their own priorities and can’t always see how working in the clinical environment is a valuable part of their learning. Whilst we endeavour to design curricula and programmes that align clinical and ‘textbook’ learning, learners are very strategic and might be reluctant to attend a clinic, ward round or theatre list, preferring to study in the library for a forthcoming examination. Others might be reluctant to come into clinic or visit a patient’s home more than once, because they have ‘seen it already’. In both these situations it may well be that the learner's reluctance is because they can’t ‘see’ the learning opportunities that are part and parcel of the experience and nobody has made them explicit. There are a number of ways in which you can help learners recognise the learning value of everyday working activity.

Label the learning opportunity e.g. ‘We have a theatre list this afternoon and we need to consent patients this morning. It would be a great opportunity for you to learn more about how to explain procedures and gaining patient consent.’

Establish prior experience and negotiate a learning goal e.g. ‘So, you have experience of consenting patients for routine procedures, so why don’t we work together this morning to consent patients about to undergo more complex procedures, with the aim being that you will do two without my needing to intervene by the end of the morning?’

Prime them for learning through observing e.g. ‘In ante-natal clinic this morning we are likely to see patients who are booked in for a home birth or who will raise the question of this. While you observe I want you to notice the reasons given for requesting home delivery and consider the ways in which they might influence your decision-making if it was your decision to make.’

Use assessment for learning purposes e.g. workplace assessment tools provide repeated opportunities to identify the possibility for development that can be addressed through workplace-based activity. For example, directly observing procedural skills and observing a brief clinical examination provides you with first-hand information about learner strengths and weaknesses. Use this as a means of identifying ways to enhance performance, be it through more opportunities to do something, purposeful observation of peers doing something or shadowing members of the team who are particularly skilled in something of relevance. ‘One of the aspects you found difficult this morning was taking the history from a slightly confused patient. Why don’t you find out if you can sit in on the next memory clinic and watch how the team do their initial consultations with patients?’ or ‘I noticed you were struggling with inserting that catheter, why don’t you work with the staff nurse tomorrow and practice under her supervision?’

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