Some Key Concepts and their Implication
Socio-cultural theorists like Wenger (1997), Lave and Wenger (2003), Billett (2002) and those who have argued for greater attention to these models of learning (such as Bleakley, 2002 and 2005; and Swanwick, 2005) identify some key ideas and their implications for effective workplace learning.
1 Learning is part of everyday social practice.
Implication: we need to make learning opportunities more explicit to ourselves and to our learners. We also need to make explicit specific workplace cultures and practices to help learners ‘make sense’ of what they see, hear, sense and do.
Example: you are the nurse in charge of five operating theatres where many different healthcare students come on placement. In collaboration with the theatre team and a group of final year students, you produce a ‘Theatre Etiquette’ guide and video which explains the ‘dos and don’ts’, roles of the members of the team and expectations of the different types of student (ODPs, nurses, midwives, medical students, etc.) and things they should look out for while observing procedures.
2 Teams are ‘communities of practice’ (Lave and Wenger, 2003) identified and defined by their shared expertise, e.g. in managing patients or teaching learners.
Implication: we need to involve the whole team in supporting learner/learner learning.
Example: you run a busy inner-city dental outreach clinic and have been teaching dental students for some time. The university now offers a dental nursing and therapist programme and has asked you to take these students as well. With your multi-disciplinary team (dentists, practice managers, therapists, nurses, hygienists) you develop an interprofessional education programme through which the learners can achieve their own learning outcomes, by learning from different members of the team and from one another.
3 Novices become experts through participation in these communities of practice.
Implication: we need to consider the ways in which we can meaningfully involve our learners in workplace activity.
Examples: student-led clinics, ward rounds, drug rounds; purposeful, structured observation of practical procedures or examinations.
4 Workplaces don’t always readily invite learners in and don’t always offer equal opportunities to all learners (Billett, 2002).
Implication: we need to consider how we create the right conditions for learning to take place in our workplace and to ensure certain individual or groups of learners are not inadvertently disadvantaged. This has to be balanced whilst ensuring appropriate, safe patient care.
Example: centralisation of obstetric services in your local area has led to the closure of a number of smaller, local midwife-led units with all hospital-based deliveries now taking place in the expanded city-based unit. One university in the city trains doctors and nurses whereas the other trains nurses, midwives and physiotherapists; the local LETB has also placed an increased number of O&G doctors in training in the new unit. You call a meeting of the programme leads for these programmes and representatives of hospital and community based services to discuss how you can best work together to ensure all learners can meet their outcomes within the new service arrangements.
5 Horizontal learning is as important as vertical learning in the workplace (Griffiths and Guile, 1999).
Implication: we need to help learners take what they know already and use it to make sense of what they see, hear, sense and do.
Example: a second-year pharmacy student has worked in the university simulated pharmacy using the electronic prescribing system. She now joins you in practice. Although your system is different, many of the basic features are the same. You ask her to explain what she knows, observe what you do and then you watch her and give feedback while she practices. She realises that although it seemed very different and she wasn’t confident, by you taking the time to find out what she knows and put it into practice, she quickly built confidence and competence.
6 ‘Talk’ is a central part of practice – learners need to ‘learn to talk their way into expertise’ rather than just learn from the talk of an expert (Lave and Wenger, 2003).
Implication: we need to find strategies to help our learners talk themselves into the expertise, by using techniques such as ‘thinking aloud’ and case-based discussion.
Example: after obtaining consent from a patient you know well, you ask your physiotherapy student to examine the patient’s spine and to talk his thoughts aloud about what he is feeling and thinking. Afterwards you meet with the student for a case-based discussion about another patient with the same condition with whom he worked the previous week, what the treatment plans are and why these differ between patients.