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      Workplace learning from a socio-cultural perspective: creating developmental space during the general practice clerkship


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          Workplace learning in undergraduate medical education has predominantly been studied from a cognitive perspective, despite its complex contextual characteristics, which influence medical students’ learning experiences in such a way that explanation in terms of knowledge, skills, attitudes and single determinants of instructiveness is unlikely to suffice. There is also a paucity of research which, from a perspective other than the cognitive or descriptive one, investigates student learning in general practice settings, which are often characterised as powerful learning environments. In this study we took a socio-cultural perspective to clarify how students learn during a general practice clerkship and to construct a conceptual framework that captures this type of learning. Our analysis of group interviews with 44 fifth-year undergraduate medical students about their learning experiences in general practice showed that students needed developmental space to be able to learn and develop their professional identity. This space results from the intertwinement of workplace context, personal and professional interactions and emotions such as feeling respected and self-confident. These forces framed students’ participation in patient consultations, conversations with supervisors about consultations and students’ observation of supervisors, thereby determining the opportunities afforded to students to mind their learning. These findings resonate with other conceptual frameworks and learning theories. In order to refine our interpretation, we recommend that further research from a socio-cultural perspective should also explore other aspects of workplace learning in medical education.

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          Informal learning in the workplace

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            Experience-based learning: a model linking the processes and outcomes of medical students' workplace learning.

            To develop a model linking the processes and outcomes of workplace learning. We synthesised a model from grounded theory analysis of group discussions before and after experimental strengthening of medical students' workplace learning. The research was conducted within a problem-based clinical curriculum with little early workplace experience, involving 24 junior and 12 senior medical students. To reach their ultimate goal of helping patients, medical students must develop 2 qualities. One is practical competence; the other is a state of mind that includes confidence, motivation and a sense of professional identity. These 2 qualities reinforce one another. The core process of clinical workplace learning involves 'participation in practice', which evolves along a spectrum from passive observation to performance. Practitioners help students participate by being both supportive and challenging. The presentation of clear learning objectives and continuous periods of attachment that are as personal to the student(s) and practitioner(s) as possible promote workplace learning. The core condition for clinical workplace learning is 'supported participation', the various outcomes of which are mutually reinforcing and also reinforce students' ability to participate in further practice. This synthesis has 2 important implications for contemporary medical education: any reduction in medical students' participation in clinical practice that results from the patient safety agenda and expanded numbers of medical students is likely to have an adverse effect on learning, and the construct of 'self-directed learning', which our respondents too often found synonymous with 'lack of support', should be applied with very great caution to medical students' learning in clinical workplaces.
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              Conceptual frameworks to illuminate and magnify.

              In a recent study of the quality of reporting experimental studies in medical education, barely half the articles examined contained an explicit statement of the conceptual framework used. Conceptual frameworks represent ways of thinking about a problem or a study, or ways of representing how complex things work. They can come from theories, models or best practices. Conceptual frameworks illuminate and magnify one's work. Different frameworks will emphasise different variables and outcomes, and their inter-relatedness. Educators and researchers constantly use conceptual frameworks to guide their work, even if they themselves are not consciously aware of the frameworks. Three examples are provided on how conceptual frameworks can be used to cast development and research projects in medical education. The examples are accompanied by commentaries and a total of 13 key points about the nature and use of conceptual frameworks. Ultimately, scholars are responsible for making explicit the assumptions and principles contained in the conceptual framework(s) they use in their development and research projects.

                Author and article information

                +31-43-3885721 , +31-43-3885779 , j.vanderzwet@educ.unimaas.nl
                Adv Health Sci Educ Theory Pract
                Advances in Health Sciences Education
                Springer Netherlands (Dordrecht )
                28 December 2010
                28 December 2010
                August 2011
                : 16
                : 3
                : 359-373
                [1 ]Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
                [2 ]Department of General Practice, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
                [3 ]The Netherlands Health Care Inspectorate, ‘s Hertogenbosch, The Netherlands
                [4 ]Institute for Medical Education, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
                [5 ]Department of Obstetrics and Gynaecology, VUmc Medical Centre, Amsterdam, The Netherlands
                © The Author(s) 2010
                : 15 October 2010
                : 13 December 2010
                Custom metadata
                © Springer Science+Business Media B.V. 2011

                undergraduate medical education,clerkship,general practice,workplace learning,socio-cultural perspective,learning perspectives,qualitative research


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