September 30th 2016 @ Temple Street Hospital, Dublin
“Working and Learning – the clinical apprenticeship model revisited”
A half day INMED symposium for consultant, junior doctor and GP clinical teachers
We were delighted to see such a broad range of clinical disciplines at the recent INMED symposium which augurs well for the future of INMED as an organisation dedicated to supporting health professional educators regardless of their professional backgrounds.
The wonderful Pim Teunissen who presented on the day has allowed us to share his presentation and some of the key messages from the symposium are as follows:
Here are some bullet points From my notes:
- It is time to stop regarding workplaces as neutral spaces in terms of health professional development. We now know that workplaces represent contexts that play a large part in defining and shaping us.
- Key features of workplace that influence development include
* organisational structure, norms, policies, contracts
* interpersonal relations and tensions within teams, between teams and between different professional groups.
* The willingness of supervisors, managers, leaders etc to make time and opportunity available to learners, trainees and students for learning/developing in clinical settings.
* The dominance of service delivery over teaching and research. Such dominance is necessary and normal in a patient centred health service, but should not be regarded as an absolute barrier to making the best of the opportunities available.
- Peer learning in pairs or bigger groups should be considered for all clinical placements because learners further down the hierarchical tree get a lot of mutual support from other learners; they often learn more from them than the do from senior educators and the also tend to learn collaboratively and thus more effectively. We need to consider peer learning is an important strategy for enhancing workplace learning.
- The organisation of teams and institutions ought to be focused on placing the patient at the centre of service and of education. If clinical education is focused on how we might enhance and support excellent patient carer then it is likely to align well with service and also be ethically and professionally appropriate.
- Much of clinical education occurs in busy workplaces and thus on the run. Learning on the run gets in the way of reflective learning. We therefore need to think about making opportunities for reflection on our own or in the presence of others over coffee, lunch and in the breaks between events. we noted that in Ireland coffee breaks are regarded as off-duty time; I.e. time to talk about personal or other stuff, not work. We need to think about how we can make use of such time to do educational work in a manner that does not seem like work! We mentioned that non service events such as journal clubs often provide a useful pretext for more reflective or innovative discussions that otherwise would seem out of place at a coffee break.
- From a learner’s perspective encountering many different teachers with variable perspectives and experience is valuable as exposure to different role models and perspectives is very important informing future professional selves.
- It is important in workplaces to recognise that many trainees and students learn by doing, I.e. Experiential, whilst many others learn by reflecting on standing back from events to appreciate that Gestalt or meaning of the events. We need to make space for both categories of learner.
- Pim Emphasised the importance of being flexible and adaptive. Teachers need to be adapted to students different needs and capabilities. Organisations need to be adaptive so as to navigate service delivery whilst facilitating excellent clinical education.
- Clinical education occurs in public spaces in the context of uni-disciplinary and multidisciplinary teams. There is therefore an opportunity to develop collective as well as individual competence. Collective competences is an essential attribute for graduates who will inevitably need to work in collaboration with others.
- Much of what trainees and students learn in clinical settings is implicit or tacit. They learn ways of talking, being and acting without being conscious of learning or changing.
- Clinical teachers should try to make their thinking explicit for learners by talking out loud about their critical thinking, their judgements and estimations.
- The implementation of curriculum in clinical workplaces is challenging. The word innovation can lead to thoughts like “ what do I lose if I have to do this?” Or “ how much additional work will this mean for me?”. There is also a tension between the management of the health service, (in Ireland the HSE) and the practitioner, I.e. Us. Thus, implementation often runs contrary to individual teachers sense of turf or territory leading to defensive and often rejecting responses.
- It is important to ascertain whether our learners are coming to learn or are coming for one of us to teach them – there’s quite a difference in terms of their expectations.