1. ‘We shall not cease from exploration, and the end of that exploring will be to arrive where we started and know the place for the first time’ T.S. Eliot

2. Definition of workplace learning ‘the product of participation in social practice through - engagement in workplace activities, and - access to support and guidance’. Billett

3. Limitations of learning through everyday practice (Billett) learning that is inappropriate (i.e. bad, unhelpful, wrong) lack of access to activities and guidance not understanding the goals for workplace performance reluctance of experts to provide guidance absence of expert guidance limits in developing understanding in the workplace reluctance of workers to participate

4. Are we clear about the educational purposes of these experiences? (Billett) learning about an occupation building capacities to be effective professional practitioners learning about some variations of that occupational practice extending knowledge learnt in university settings orientations to the places where the occupation is practiced meeting requirements of occupational or professional licensing ongoing (i.e. professional ) development Particular kinds of experiences address specific kinds of purposes

5. Key findings about integrating practice experiences… (Billett) Experiences alone insufficient: need building on Importance of preparing students for experiences Importance of support during experiences Importance of helping them to connect experiences Students’ ‘readiness’ is key factor shaping their learning Challenge of providing experience for students who are ‘time jealous’ How students make sense of the ‘experienced curriculum’ Incremental exposure to practice-based experience and progression

6. Key principles (Billett) All workplace learning can be seen as an invitation to the learner to learn Learners generally have much more autonomy and input into where, when and whether learning takes place That invitation/ dialogue requires the input of the teacher and the learner… Environment crucially important, and is part of the ‘invitation’

7. WHAT IS THE NATURE OF WORKPLACE KNOWLEDGE?

8. What have you learnt to be a doctor? Small Group Exercise: On the flipchart sheets, capture what sort of ‘knowledge’ you have learnt in order to be a doctor – e.g. ‘knowledge of people’

9. Knowledge of.. PeopleSituationsPracticeConceptualProcessControl Michael Eraut Ability to read the situation one finds oneself in Patient diagnosis, management, assessment … Theories & principles held Knowing how to do things / go about things Managing oneself & one’s own behaviour Knowing others

10. How much of this was learnt in a classroom? Most learning occurs in the workplace Historically all learning was done in the workplace Learning is indistiguishable from practice So how, as educators, do we maximise?

11. “I see things in terms of my own work. When I chisel at a wheel, if I go slow, the chisel slides and does not stay put; if I hurry, it jams and doesn’t move properly. When it is neither too slow or too fast, I can feel it in my hand and respond to it from my heart. My mouth cannot describe it in words, but there is something there. I cannot teach it to my son, and my son cannot learn it from me. So, I have gone on for seventy years, growing old chiselling wheels. The men of old died in possession of what they could not transmit. So, it follows that what you are reading are their dregs.” Account by chinese philosopher Zhuangzi (369-286 BC) Wheelwright talking to a powerful general

12. Theory (Eraut) Performance Practical Theories in use Tacit knowledge Knowing how (the how) Facts Technical Espoused theories Formal or codified knowledge Knowing that (the what, the facts, the who)

13. EXPERIENTIAL LEARNING THEORY - KOLB

14. “Learning is the process whereby knowledge is created through the transformation of experience” (Kolb, 1984)

15. Experiential learning cycle Do (practice) Review (reflect) Theorise (interpret) Apply (plan)

16. Experiential Learning Experience (practice) is linked with abstract concepts (theory) through the process of reflection and planning Learning from experience involves analysis and synthesis Conscious reflection does not happen automatically but is built in Create the space for reflection and planning

18. Learning from experience

19. REFLECTION

20. Reflection is key to learning

21. Reflection.. What happened? How does this relate to you? What have you learnt? What will you do differently in the future?

22. ….or…. …What? …So what? …Now what?

23. DIALOGUE IS KEY TO REFLECTION

24. ‘practitioners require guidance to see beyond themselves, to see their own self- distortions and limited horizons, and how those forces embedded within practice have limited their ability to know and achieve desirable work,’ (Johns and Freshwater 1998 p 63).

25. QUESTIONING AND FEEDBACK ARE KEY TO DIALOGUE

26. Questioning ‘The quality of a question is judged not by its complexity, but by the complexity of thinking it provokes’ Joseph O Connor

28. Social Constructivism

29. Knowledge is constructed socially, then taken in individually

30. Vygotsky

32. Good open questions?.... How did this patient come to be here today? What do we know about this patient? What do we need to know in order to provide them with the best care? (with thanks to Richard Thomson)

33. QUESTIONING AND FEEDBACK ARE KEY TO DIALOGUE

34. Feedback

35. Principles of feedback in the clinical setting (Ramani, S. & Krakov, S.K. (2012)) Establish a respectful learning environment.. Communicate goals and objectives for feedback.. Base feedback on direct observation.. Make feedback timely and a regular occurrence.. Begin the session with the learner’s self-assessment.. Reinforce and correct observed behaviours.. Use specific, neutral language to focus on performance.. Confirm the learner’s understanding and facilitate acceptance.. Conclude with an action plan.. Reflect on your feedback skills.. Create staff-development opportunities.. Make feedback part of institutional culture.

36. A dynamic interaction…. Learner Environment Experience / content Construction of ‘knowledge’ Teacher

37. Learning styles - 3 key messages…. The evidence is poor – maybe works best as a lens Learners should learn in all modalities Beware of teaching only in your own preferred style

41. Three factors influence whether a learner will seek feedback; The intentions and characteristics of the feedback provider. The relationship between the feedback seeker and provider. The motives of the learner (Molloy and Boud 2013)

42. Learning from observation “Clearly the instruction “observe!” is absurd. Observation is always selective. It needs a chosen object, a definite task, an interest, a point of view, a problem.” (Karl Popper)

43. Learning from observation Be specific about; Target of observation e.g. the patient, the clinician or the context in which they live or work Focus of observation e.g. the patient’s condition, level of impairment; skills or attitudes of professionals Nature of observation e.g. descriptive – eg behaviour? Analytical – their interpretation of what they observe

44. Learning is indistinguishable from participation…....therefore learning is happening all the time…

45. curriculum as intended curriculum as learnt curriculum as delivered ‘Hidden curriculum’ curriculum as assessed

46. What ‘hidden curriculum’ messages do you transmit through your behaviour in workplace teaching? What are the implications for our teaching?

47. Learning all the time…. The importance of role modelling….

48. Practical tips (Cruess, Cruess and Steinert) Be aware of being a role model The need to treat students, patients and staff with respect and care – always put the patient first The need to manage the conflicting demands of teaching and service delivery ‘effectively’ Show a positive attitude for what you do Facilitate reflection on clinical experiences and what has been modelled – ‘think out loud’ Encourage dialogue with colleagues Work to improve the institutional culture Be clear about the purpose of observation Demonstrate clinical competence Educators as guardians of high quality clinical care

49. Educators as guardians of quality care You will see them…. They will see you…. They will tell you….

50. “ We must acknowledge that the most important, indeed the only, thing we have to offer our students is ourselves. Everything else they can read in a book.” D. Tosteson

51. Situated learning theory Apprenticeship Communities of practice Legitimate peripheral participation

52. ‘learners inevitably participate in communities of practitioners and that the mastery of knowledge and skill requires newcomers to move toward full participation in the socio-cultural practices of the community’ (Lave & Wenger, 1991

53. Novice to expert Dreyfus & Dreyfus 1986 Novice – completely rules focussed; no awareness of context Advanced beginner – some awareness of context Competence – prioritises information to avoid overload Proficiency – more emotional involvement. Expert: works and knows what to do intuitively without applying conscious decisions Often can’t explain what they do. Behaviour governed by their experiences, not rules.

54. A final thought…. ‘ultimately workplace learning boils down to people showing a genuine interest in each other, their development as practitioners, and their patients’ (Teunissen)

55. references Boud, D. & Molloy, E. (2013) Seeking a different angle on feedback in clinical education: the learner as seeker, judge and user of performance information Medical Education 47: 224–231 Cruess, S.R., Cruess, R.L., & Steinert, Y. (2008) Role modelling—making the most of a powerful teaching strategy British Medical Journal ;336:718-21 Dreyfus, S. (2004). The five stage model of adult skill acquisition. Bulletin of Science, Technology and Society, (24) p177-181 Eraut, M. (2004) Informal learning in the workplace. Studies in Continuing Education 26 (2) 247-273