Dr Clare Morris medicaleducationmatters@gmail.com Spring Symposium Dr Clare Morris medicaleducationmatters@gmail.com

Abstract This workshop provides an opportunity to consider the features of a 'community of practice' and its relevance for GP Educators. We will look at the extent to which GP Training can be seen as times spent in a community of practice and the implications for the ways in which learning and development are supported by whole team Furthermore, we will consider how the whole team can develop their practice through work activity.

Communities of practice? Apprenticeship revisited?

The first step, however, will be to sketch a birds-eye view of the competing trends in our present conceptualisations of learning. To be able to embrace the whole issue at a glance one has to reach the most fundamental, primary levels of our thinking and bring to the open the tacit assumptions and beliefs that guide us. This means digging out the metaphors that underlie both our spontaneous and everyday conceptions and scientific theorising. (Sfard 1998:4) A starting place The views we hold about learning will shape our work as educators (and educational researchers)

Digging out the metaphors Learning-as-acquisition Learning-as-participation

Two metaphors for learning (after Sfard 1998) Learning-as-acquisition Learning-as-participation Learning through teaching Teacher-learner relations Vertical learning Acquisition of knowledge and skill as goal of learning Learning through working Team relations Vertical & horizontal Full participation in work of community as goal of learning

Cognitive models tend to Emphasise learning from teaching Focus on individual learning Be concerned with vertical development Emphasise knowledge/skill acquisition as goal of learning Guiding metaphor? Learning-as-acquisition

On competence in medical education “Competence reflects our individualistic healthcare system and education culture. It selects for our attention individual learners and the knowledge, abilities and values they possess in their heads, hands and hearts. What then, does it deflect our attention from? What blind spots does it produce? (…) competent individual professionals can – and do, with some regularity – combine to create an incompetent team.” Lingard (2013) p. 54 From: Lingard, L (2012) Rethinking Competence in the Context of Team Work. In Hodges, B and Lingard L. (Eds) The Question of Competence. New York: Cornell University Press.

Socio-cultural models tend to emphasise learning through working focus on the collective (community/team) be concerned with vertical & horizontal development emphasise full participation as goal of learning Guiding metaphor? Learning-as-participation

Collective competence “Three key premises underpinning the collectivist discourse of competence in medical education: Competence is achieved through participation in authentic situations Competence is distributed across a network of persons and artifacts Competence is a constantly evolving set of multiple, interconnected behaviours enacted in time and space.” Ref: Lingard (2013) p. 55

Communities of Practice learning is part of everyday social practice - learning resources are embedded in everyday practice – need to make explicit ‘newcomers’ become ‘old timers’ by engaging in practice, and as a result change that practice communities of practice can be identified and defined by common expertise. learning happens through legitimate peripheral participation Language is a central part of practice, learning from talk and learning to talk

Legitimate peripheral participation a way to speak about the relations between newcomers and old-timers, and about activities, identities, artefacts and communities of knowledge and practice. It concerns the process by which newcomers become part of a community of practice. A person’s intentions to learn are engaged and the meaning of learning is configured through the process of becoming a full participant in a socio-cultural practice Lave and Wenger (1991) p. 29.

GP Training Time spent in a community of practice?

A view of WBL ‘Learning in work-based contexts involves students 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 page 170 Griffiths,T.,Guile,D. ( 1999) Pedagogy in work-based contexts in Mortimore,P.(Ed) Understanding Pedagogy,Chapman.

Planning for on-the-job learning What am I doing today? What can the trainee do? Without me? With other members of the team? With other trainees? What will be the value-added I offer the trainee today?

Strategies Observation Bedside teaching Case based discussion Sign-posting Briefing and de-briefing Review and reflect Trainer think-aloud technique Others?

Developing expertise (after Collins, 2006) Method Approach Modeling Active observation of trainer, using advanced organisers Coaching Trainer observes and facilitates trainee undertaking the task Scaffolding Trainer provides support during task, gradually removing this support over time, to move towards independence Articulation Trainer and/or trainee think aloud and/or verbalisation Reflection Trainer encourages to compare their performance with that of others /or own previously Exploration Trainer invites trainee to pose and solve their own problems /situations

Developing the practice A shared endeavour?

Structured opportunities? ‘workplaces structure and routinely provide learning experiences as part of everyday work activities and through guidance from other workers. Participation in workplace tasks assists new learning and reinforces what has been learnt through further practice.’ Ref: Billett, S. (2001) Learning in the workplace. Strategies for effective practice. Australia: Allan and Unwin. Page 15.

Another view of WBL How workplaces afford opportunities for learning, and how individuals elect to engage in activities and with the support and guidance provided by the workplace, is central to understanding workplaces as learning environments.(…) In particular, the workplace’s readiness to afford opportunities for individuals to engage in work activities and direct and indirect support is a key determinant of the quality of learning. These affordances are salient to the outcomes of both structured workplace learning arrangements, such as mentoring, as well as learning accessed through everyday participation at work. Billett, S. (2001)

Billett’s contributions Need to consider the invitation qualities of each workplace Workplace affordances are not always benignly distributed Need to consider individual agency