The realities of workplace learning
Whilst the pendulum has clearly shifted so that health professions education is underpinned by the academic rigour provided by university education, one of the key characteristics of the health professions is that much of the learning takes place in clinical environments. Learning in the workplace is one of the central planks of education and training because it enables learners to learn on the job, by doing the job they are training for. In particular it enables learners to:
- become familiar with healthcare contexts, systems and processes
- work with and learn from patients, families and other workers
- develop professional knowledge, e.g. how clinical conditions affect different patients
- develop professional skills, e.g. communicating with patients, procedural/practical skills
- engage in professional socialisation and identity formation, e.g. behaving and acting like a healthcare professional and learning how the other professions work
- continue their professional development.
It is hard to imagine becoming a pharmacist, physiotherapist, doctor or dentist without engaging in the above activities and workplace learning is highly valued (and usually enjoyed) by learners. However, it is not without its challenges.
Griffiths and Guile describe the dual agenda for learners.
‘Learning in work-based contexts involves learners having to come to terms with a dual agenda. They not only have to learn how to draw upon their formal learning and use it to interrogate workplace practices; they also have to learn how to participate within workplace activities and cultures’ (Griffiths and Guile, 1999, p 170).
Learners in particular often report concerns about:
- lacking a clear role or responsibilities
- knowing what is expected of them
- competing demands on time (studying for exams versus taking part in workplace activity or having to ‘do the job’ rather than learning ‘on the job’)
- limited opportunities to be observed and receive feedback on performance
- being unclear about the immediate relevance of workplace learning elements.
• How could you address the above concerns?
• What strategies do you currently use to support workplace learning?
Many of our learners are very knowledgeable individuals, having demonstrated this knowledge in formal assessments and examinations. One of the difficulties for learners, however, is learning how to draw on that knowledge purposefully in order to understand the patients and situations they meet in busy clinical environments. This is one type of challenge. The other, which we explore later, is the need to understand the ways in which teams operate in each particular context they encounter and find ways to fit in and work effectively.
Clinical teachers are readily able to identify the challenges to workplace learning. Typically they will list issues such as:
- available time/resources
- high turnover of patients, patient flow
- changing expectations (of learners, patients/carers, employers, universities, professional bodies)
- competing demands and priorities (caring, treating or teaching)
- opportunistic nature of clinical work compared to curriculum requirements
- knowing what to teach, when to teach and how to teach it
- increased paperwork and assessment load
- issues around consent
- concerns about risks involved through allowing learners to practice.
• Review the list above and note those you share and those you would add.
• Which one(s) cause you greatest difficulty as a teacher-trainer?
Clinical teachers also have another challenge: trying to fit teaching methods designed for the classroom to the workplace. In the next section we will explore some theoretical perspectives on workplace learning and consider the ways in which they can help us in developing approaches to the support and facilitation of workplace learning.