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Facilitating learning in the workplace.pdf - Faculty Development

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<strong>Facilitat<strong>in</strong>g</strong> <strong>learn<strong>in</strong>g</strong> <strong>in</strong> <strong>the</strong> <strong>workplace</strong>Workplace-based <strong>learn<strong>in</strong>g</strong> has long been an <strong>in</strong>tegral aspect of all stages of medical educationand tra<strong>in</strong><strong>in</strong>g. Traditionally <strong>in</strong> medic<strong>in</strong>e, <strong>workplace</strong>-based <strong>learn<strong>in</strong>g</strong> took <strong>the</strong> form of a series ofprolonged apprenticeships, with long work<strong>in</strong>g hours and long hospital stays creat<strong>in</strong>g plenty ofopportunities to learn by ‘osmosis’. These traditional models of apprenticeship are challengedby recent and ongo<strong>in</strong>g reform of both tra<strong>in</strong><strong>in</strong>g and healthcare. The new tra<strong>in</strong><strong>in</strong>g curricula,alongside work<strong>in</strong>g time directives, centralisation of specialist services and shorter hospitalstays, mean we need to look to new models of apprenticeship that ensure our students andtra<strong>in</strong>ees have opportunities to learn ‘on <strong>the</strong> job’ while ‘do<strong>in</strong>g <strong>the</strong> job’.In this module we will explore some <strong>the</strong>oretical perspectives on <strong>workplace</strong>-based <strong>learn<strong>in</strong>g</strong> andconsider how <strong>the</strong>y can help us support <strong>the</strong> <strong>workplace</strong>-based <strong>learn<strong>in</strong>g</strong> of our students andtra<strong>in</strong>ees. It <strong>in</strong>cludes some practical suggestions on how to enhance <strong>learn<strong>in</strong>g</strong> while work<strong>in</strong>g.By <strong>the</strong> end of this module you should have a clearer sense of <strong>the</strong> opportunities for <strong>learn<strong>in</strong>g</strong>that present <strong>the</strong>mselves <strong>in</strong> everyday work<strong>in</strong>g practice. You should be more able to identify <strong>the</strong>ways <strong>in</strong> which you can create an environment where <strong>learn<strong>in</strong>g</strong> can take place and have a widerrange of strategies to support this <strong>learn<strong>in</strong>g</strong>.Before you startBefore you start <strong>the</strong> module we recommend that you spend a few m<strong>in</strong>utes th<strong>in</strong>k<strong>in</strong>g about <strong>the</strong>follow<strong>in</strong>g po<strong>in</strong>ts and not<strong>in</strong>g down some of your thoughts. If you are registered on <strong>the</strong> site, youcan do this <strong>in</strong> <strong>the</strong> ‘reflections area’. Click on <strong>the</strong> ‘my area’ l<strong>in</strong>k at <strong>the</strong> top of <strong>the</strong> page to accessyour personal pages. Please note that you must be logged <strong>in</strong> to do this. Please also note thatyou will need to contribute to <strong>the</strong> ‘reflections area’ dur<strong>in</strong>g <strong>the</strong> course of <strong>the</strong> module <strong>in</strong> order tocomplete and pr<strong>in</strong>t out your certificate.1


Th<strong>in</strong>k<strong>in</strong>g po<strong>in</strong>ts• Th<strong>in</strong>k about your current and recent <strong>workplace</strong>(s) and consider your opportunities for <strong>learn<strong>in</strong>g</strong>.• What are <strong>the</strong> ways <strong>in</strong> which you and/or your students/tra<strong>in</strong>ees learn through work-relatedactivity?• What seems to challenge opportunities for you and/or your students/tra<strong>in</strong>ees to learn throughwork-related activity?• What does <strong>workplace</strong>-based <strong>learn<strong>in</strong>g</strong> seem to offer that ‘classroom-based’ <strong>learn<strong>in</strong>g</strong> does not?Challenges and opportunitiesCl<strong>in</strong>ical teachers are readily able to identify <strong>the</strong> challenges to <strong>workplace</strong>-based <strong>learn<strong>in</strong>g</strong>.Typically <strong>the</strong>y will list issues such as:• available time/resources• chang<strong>in</strong>g expectations (of students, patients, employers, medical schools, colleges)• compet<strong>in</strong>g demands and compet<strong>in</strong>g priorities (treat<strong>in</strong>g or teach<strong>in</strong>g)• opportunistic nature of cl<strong>in</strong>ical work• know<strong>in</strong>g what to teach, when to teach and how to teach it• <strong>in</strong>creased tra<strong>in</strong><strong>in</strong>g paperwork and assessment load• issues around consent• concerns about risks <strong>in</strong>volved <strong>in</strong> student/tra<strong>in</strong>ee practice.Th<strong>in</strong>k<strong>in</strong>g po<strong>in</strong>ts• Review <strong>the</strong> list above and note those you share and those you would add.• Which one(s) cause you greatest difficulty as a teacher-tra<strong>in</strong>er?Students and tra<strong>in</strong>ees also face similar challenges. Students <strong>in</strong> particular often report concernsabout:• lack<strong>in</strong>g a clear role or responsibilities• know<strong>in</strong>g what is expected of <strong>the</strong>m• compet<strong>in</strong>g demands on time (study<strong>in</strong>g for exams versus tak<strong>in</strong>g part <strong>in</strong> <strong>workplace</strong> activity orhav<strong>in</strong>g to ‘do <strong>the</strong> job’ ra<strong>the</strong>r than <strong>learn<strong>in</strong>g</strong> ‘on <strong>the</strong> job’)• limited opportunities to be observed and receive feedback on performance• be<strong>in</strong>g unclear about <strong>the</strong> immediate relevance of <strong>workplace</strong>-based <strong>learn<strong>in</strong>g</strong> elements.2


Th<strong>in</strong>k<strong>in</strong>g po<strong>in</strong>ts• How could you address <strong>the</strong> above student/tra<strong>in</strong>ee concerns?• What strategies do you currently use to support <strong>workplace</strong>-based <strong>learn<strong>in</strong>g</strong>?If <strong>workplace</strong>-based <strong>learn<strong>in</strong>g</strong> creates so many challenges for both tra<strong>in</strong>ers and tra<strong>in</strong>ees, why dowe persist <strong>in</strong> plac<strong>in</strong>g this type of activity so centrally <strong>in</strong> undergraduate and postgraduatecurriculum? Some key reasons <strong>in</strong>clude:• familiarisation with healthcare contexts• development of professional knowledge, e.g. case knowledge and cl<strong>in</strong>ical reason<strong>in</strong>g• development of professional skills, e.g. history tak<strong>in</strong>g, physical exam<strong>in</strong>ation, proceduralskills, etc.• development of professional socialisation, e.g. behav<strong>in</strong>g and act<strong>in</strong>g like a doctor/healthcareprofessional• cont<strong>in</strong>u<strong>in</strong>g professional development.Workplace-based <strong>learn<strong>in</strong>g</strong> is clearly highly valued, but is not without its challenges. Forstudents <strong>the</strong>re is <strong>the</strong> dual agenda described by Griffiths and Guile <strong>in</strong> 1999.‘Learn<strong>in</strong>g <strong>in</strong> work-based contexts <strong>in</strong>volves students hav<strong>in</strong>g to come to terms with a dualagenda. They not only have to learn how to draw upon <strong>the</strong>ir formal <strong>learn<strong>in</strong>g</strong> and use it to<strong>in</strong>terrogate <strong>workplace</strong> practices; <strong>the</strong>y also have to learn how to participate with<strong>in</strong> <strong>workplace</strong>activities and cultures’ ( Griffiths and Guile, 1999, p 170).Our students and tra<strong>in</strong>ees are clearly very knowledgeable <strong>in</strong>dividuals, hav<strong>in</strong>g demonstratedthis knowledge <strong>in</strong> formal assessments and exam<strong>in</strong>ations, be it at medical school or via Collegeexams. One of <strong>the</strong> difficulties for students and tra<strong>in</strong>ees, however, is <strong>learn<strong>in</strong>g</strong> how to draw onthat knowledge purposefully <strong>in</strong> order to understand <strong>the</strong> patients and situations <strong>the</strong>y meet <strong>in</strong><strong>the</strong> cl<strong>in</strong>ical environment. This is one type of challenge. The o<strong>the</strong>r, which we will explore fur<strong>the</strong>rlater <strong>in</strong> this module, is <strong>the</strong> need to understand <strong>the</strong> ways <strong>in</strong> which teams operate <strong>in</strong> eachparticular context <strong>the</strong>y encounter and f<strong>in</strong>d ways to fit <strong>in</strong> and work effectively.For cl<strong>in</strong>ical teachers <strong>the</strong>re is one fur<strong>the</strong>r challenge: try<strong>in</strong>g to fit teach<strong>in</strong>g methods designed for<strong>the</strong> classroom to <strong>the</strong> <strong>workplace</strong>. In <strong>the</strong> next section we will explore some <strong>the</strong>oreticalperspectives on <strong>workplace</strong>-based <strong>learn<strong>in</strong>g</strong> and consider <strong>the</strong> ways <strong>in</strong> which <strong>the</strong>y can help us <strong>in</strong>develop<strong>in</strong>g approaches to <strong>the</strong> support and facilitation of <strong>workplace</strong>-based <strong>learn<strong>in</strong>g</strong>.3


Theoretical perspectives on <strong>workplace</strong>-based <strong>learn<strong>in</strong>g</strong>Traditional models of education have tended to focus on formal teach<strong>in</strong>g, with <strong>the</strong> focus be<strong>in</strong>gon <strong>the</strong> ‘transmission’ of knowledge from teacher to learner.Transmission models are characterised by:• <strong>the</strong>ir emphasis on ‘teach<strong>in</strong>g’ (not <strong>learn<strong>in</strong>g</strong>)• <strong>the</strong>ir focus on <strong>the</strong> <strong>in</strong>dividual teacher–learner relationship• an emphasis on ‘know<strong>in</strong>g’ ra<strong>the</strong>r than ‘do<strong>in</strong>g’ or ‘behav<strong>in</strong>g’.While such models have relevance <strong>in</strong> <strong>the</strong> classroom, <strong>the</strong>y have significant limitations iftransferred to <strong>the</strong> <strong>workplace</strong>, with all its dynamic complexity. No doubt every cl<strong>in</strong>ician hassuffered <strong>the</strong> frustrations of late-runn<strong>in</strong>g cl<strong>in</strong>ics or <strong>the</strong>atre lists because <strong>the</strong>y have attempted to‘teach and treat’ at <strong>the</strong> same time. And equally, every student or tra<strong>in</strong>ee has probably had <strong>the</strong>experience of sitt<strong>in</strong>g passively <strong>in</strong> <strong>the</strong> corner of a room, observ<strong>in</strong>g <strong>the</strong>ir supervisor get on with<strong>the</strong> work.Th<strong>in</strong>k<strong>in</strong>g po<strong>in</strong>ts• What o<strong>the</strong>r examples can you come up with that illustrate how difficult it is to ‘teach’ <strong>in</strong> <strong>the</strong><strong>workplace</strong>?• Can you identify ways <strong>in</strong> which your students/tra<strong>in</strong>ees learn without you hav<strong>in</strong>g to formally ‘teach’<strong>the</strong>m?In <strong>the</strong> 1990s <strong>the</strong>re was a noticeable shift <strong>in</strong> <strong>learn<strong>in</strong>g</strong> <strong>the</strong>ory, with conceptions of experiential<strong>learn<strong>in</strong>g</strong> becom<strong>in</strong>g <strong>in</strong>creas<strong>in</strong>gly popular, based on Kolb’s now familiar <strong>learn<strong>in</strong>g</strong> cycle of‘concrete experience’, ‘reflective observation’, ‘abstract conceptualisation’ and ‘activeexperimentation’. This move prompted cl<strong>in</strong>ical teachers to consider how students and tra<strong>in</strong>eesmight learn through tak<strong>in</strong>g part <strong>in</strong> <strong>workplace</strong>-based activity.4


Kolb's <strong>learn<strong>in</strong>g</strong> cycleKolb’s cycle provides a framework to consider what needs to happen beyond <strong>the</strong> actual ‘do<strong>in</strong>gsometh<strong>in</strong>g’ for <strong>learn<strong>in</strong>g</strong> to take place. While <strong>the</strong>re is much to commend this model, <strong>the</strong>greatest danger is that it implies that somehow <strong>the</strong> provision of appropriate ‘experience’ issufficient to ensure <strong>learn<strong>in</strong>g</strong> takes place. This model underplays <strong>the</strong> complexity of <strong>learn<strong>in</strong>g</strong> <strong>in</strong>and through experience, and <strong>the</strong> role played by <strong>the</strong> cl<strong>in</strong>ical teach<strong>in</strong>g <strong>in</strong> support<strong>in</strong>g this type of<strong>learn<strong>in</strong>g</strong>.Th<strong>in</strong>k<strong>in</strong>g po<strong>in</strong>ts• What types of <strong>learn<strong>in</strong>g</strong> experience do you offer to students and tra<strong>in</strong>ees?• What opportunities do you provide for <strong>the</strong>m to th<strong>in</strong>k and talk about <strong>the</strong> experiences <strong>the</strong>y havehad?• How do you help <strong>the</strong>m develop <strong>the</strong>ir knowledge/skills/attitudes <strong>in</strong> read<strong>in</strong>ess for <strong>the</strong> next <strong>learn<strong>in</strong>g</strong>experience offered?Social models of <strong>workplace</strong> <strong>learn<strong>in</strong>g</strong>In more recent years, attention has turned to a relatively under-explored school of educational <strong>the</strong>ories(<strong>in</strong> medical education) which can loosely be described as ‘socio-cultural’ <strong>the</strong>ories.What makes <strong>the</strong>se models different from those described so far is that <strong>the</strong>y essentially see <strong>the</strong> dist<strong>in</strong>ctionbetween <strong>learn<strong>in</strong>g</strong> and work<strong>in</strong>g (or practice) as be<strong>in</strong>g artificial. They start from <strong>the</strong> premise that <strong>learn<strong>in</strong>g</strong> ispart and parcel of our everyday experience and practice. When we ga<strong>the</strong>r round <strong>the</strong> bedside with ourcolleagues, to talk to our patients and to discuss <strong>the</strong>ir progress or management, we are engaged <strong>in</strong> botha work<strong>in</strong>g activity and a <strong>learn<strong>in</strong>g</strong> activity. Our understand<strong>in</strong>g of one o<strong>the</strong>r, our patients and <strong>the</strong>ir illnesses5


is <strong>in</strong>fluenced by <strong>the</strong> conversations around <strong>the</strong> bed and by <strong>the</strong> notes made, and this becomes part of <strong>the</strong><strong>learn<strong>in</strong>g</strong> <strong>in</strong> <strong>the</strong> <strong>workplace</strong>. When we encounter a complex patient or a complex situation, we draw on <strong>the</strong>‘<strong>learn<strong>in</strong>g</strong> resources’ around us (our peers, our seniors, o<strong>the</strong>r members of <strong>the</strong> healthcare team) toconsider how to move forward. We might consult o<strong>the</strong>r types of resource (for example NICE guidel<strong>in</strong>es,<strong>the</strong> BNF or <strong>in</strong>ternet search eng<strong>in</strong>es), but seldom do we immediately rush off to be ‘taught’. As we developour cl<strong>in</strong>ical practice, we are <strong>learn<strong>in</strong>g</strong> at <strong>the</strong> same time. One of <strong>the</strong> challenges for cl<strong>in</strong>ical teachers<strong>the</strong>refore, is to make this <strong>learn<strong>in</strong>g</strong> more explicit to tra<strong>in</strong>ees, to help <strong>the</strong>m recognise that <strong>the</strong>y are <strong>learn<strong>in</strong>g</strong>‘how to do <strong>the</strong> job’ by ‘do<strong>in</strong>g <strong>the</strong> job’.The extent to which we learn through our work activity is <strong>in</strong>fluenced by our ability to recognise <strong>the</strong><strong>learn<strong>in</strong>g</strong> to be had, by <strong>the</strong> ways <strong>in</strong> which we <strong>in</strong>vite our learners to be part of <strong>the</strong> work activity and by <strong>the</strong>decisions <strong>the</strong>y make about whe<strong>the</strong>r or not to accept (and value) such <strong>in</strong>vitations.Th<strong>in</strong>k<strong>in</strong>g po<strong>in</strong>t• Th<strong>in</strong>k about your last couple of weeks at work.• What have you learnt ‘on <strong>the</strong> job’, how did you learn it and who else was <strong>in</strong>volved <strong>in</strong> thiswork<strong>in</strong>g–<strong>learn<strong>in</strong>g</strong> process?Some key concepts and <strong>the</strong>ir implicationsIf we look at <strong>the</strong> writ<strong>in</strong>g of socio-cultural <strong>the</strong>orists like Wenger (1997), Lave and Wenger (2003), Billett(2002) and those who have argued for greater attention to <strong>the</strong>se models of <strong>learn<strong>in</strong>g</strong> (such as Bleakley,2002 and 2005; and Swanwick, 2005) it is possible to draw out some key ideas and <strong>the</strong>ir implications forthose who support <strong>workplace</strong>-based <strong>learn<strong>in</strong>g</strong>.1 Learn<strong>in</strong>g is part of everyday social practice.Implication: we need to make <strong>learn<strong>in</strong>g</strong> opportunities more explicit to ourselves and to our learners. Wealso need to make explicit specific <strong>workplace</strong> cultures and practices to help students and tra<strong>in</strong>ees ‘makesense’ of what <strong>the</strong>y see, hear, sense and do.2 Teams are ‘communities of practice’ (Lave and Wenger, 2003) identified and def<strong>in</strong>ed by <strong>the</strong>irshared expertise, e.g. <strong>in</strong> manag<strong>in</strong>g patients or teach<strong>in</strong>g students.Implication: we need to <strong>in</strong>volve <strong>the</strong> whole team <strong>in</strong> support<strong>in</strong>g student/tra<strong>in</strong>ee <strong>learn<strong>in</strong>g</strong>.3 Novices become experts through participation <strong>in</strong> <strong>the</strong>se communities of practice.Implication: we need to consider <strong>the</strong> ways <strong>in</strong> which we can mean<strong>in</strong>gfully <strong>in</strong>volve our studentsand tra<strong>in</strong>ees <strong>in</strong> <strong>workplace</strong> activity.6


4 Workplaces don’t always readily <strong>in</strong>vite learners <strong>in</strong> and don’t always offer equal opportunitiesto all learners (Billett, 2002).Implication: we need to consider how we create <strong>the</strong> right conditions for <strong>learn<strong>in</strong>g</strong> to take place<strong>in</strong> our <strong>workplace</strong> and to ensure certa<strong>in</strong> students or groups of students/tra<strong>in</strong>ees are not<strong>in</strong>advertently disadvantaged.5 Horizontal <strong>learn<strong>in</strong>g</strong> is as important as vertical <strong>learn<strong>in</strong>g</strong> <strong>in</strong> <strong>the</strong> <strong>workplace</strong> (Griffiths and Guile,1999).Implication: we need to help tra<strong>in</strong>ees take what <strong>the</strong>y know already and use it to make senseof what <strong>the</strong>y see, hear, sense and do.6 ‘Talk’ is a central part of practice – learners need to ‘learn to talk <strong>the</strong>ir way <strong>in</strong>to expertise’ra<strong>the</strong>r than just learn from <strong>the</strong> talk of an expert (Lave and Wenger, 2003).Implication: we need to f<strong>in</strong>d strategies to help our students and tra<strong>in</strong>ees talk <strong>the</strong>mselves <strong>in</strong>to<strong>the</strong> expertise, by us<strong>in</strong>g techniques such as ‘th<strong>in</strong>k<strong>in</strong>g aloud’ and case-based discussion.Mak<strong>in</strong>g <strong>the</strong> most of <strong>workplace</strong>-based <strong>learn<strong>in</strong>g</strong>In <strong>the</strong>se next sections we will explore fur<strong>the</strong>r <strong>the</strong> implications aris<strong>in</strong>g from <strong>the</strong>se ideas andconsider how <strong>the</strong>y can help you develop your approaches to support<strong>in</strong>g <strong>workplace</strong>-based<strong>learn<strong>in</strong>g</strong>.Creat<strong>in</strong>g <strong>the</strong> right conditions for <strong>workplace</strong>-based <strong>learn<strong>in</strong>g</strong>Students and tra<strong>in</strong>ees who are made to feel welcome are more likely to actively engage <strong>in</strong> <strong>the</strong>full range of <strong>learn<strong>in</strong>g</strong> opportunities provided and to seek to play an active role <strong>in</strong> <strong>the</strong> team.Billet (2002) suggests that <strong>the</strong> ‘<strong>in</strong>vitational qualities of <strong>the</strong> <strong>workplace</strong>’ can be seen as <strong>the</strong> ways<strong>in</strong> which <strong>the</strong> <strong>workplace</strong> provides and supports <strong>learn<strong>in</strong>g</strong> from work activity. Billett argues that<strong>the</strong>se <strong>in</strong>vitational qualities or ‘affordances’ are far from benign, as <strong>the</strong>y shape all opportunitiesto engage and are unequally distributed. Affordances can be shaped, for example, by studentor tra<strong>in</strong>ee prior experience, stage <strong>in</strong> tra<strong>in</strong><strong>in</strong>g, gender, ethnicity, socio-economic backgroundand apparent differences <strong>in</strong> motivation, enthusiasm or <strong>in</strong>terest. For example, male students onobstetric and gynaecology attachments may be afforded fewer opportunities to participate than<strong>the</strong>ir female colleagues, affect<strong>in</strong>g exam<strong>in</strong>ation performance and career choices made (seeHigham and Steer, 2004).Consider your own <strong>workplace</strong> and how ‘newcomers’ are made to feel welcome. Do you alwaysknow <strong>the</strong>ir preferred form of address and do you use it? Do <strong>the</strong>y have somewhere to store<strong>the</strong>ir personal effects? Are <strong>the</strong>y <strong>in</strong>vited to jo<strong>in</strong> you for coffee or lunch? Are <strong>the</strong>y givenopportunities to get to know all members of <strong>the</strong> team – medical, nurs<strong>in</strong>g, healthcare and7


support staff – and to appreciate <strong>the</strong> role <strong>the</strong>y play <strong>in</strong> patient management and care? Are youconfident that your <strong>workplace</strong> affordances are equally distributed? Do you need to encouragemore women <strong>in</strong>to your profession? Do you need to f<strong>in</strong>d ways to engage less confident or vocalstudents or tra<strong>in</strong>ees?Th<strong>in</strong>k<strong>in</strong>g po<strong>in</strong>ts• How can you make your <strong>workplace</strong> more ‘<strong>in</strong>vitational’ from a <strong>learn<strong>in</strong>g</strong> perspective?• Are certa<strong>in</strong> groups or types of student/tra<strong>in</strong>ee potentially disadvantaged?• What strategies can you use to ensure equal opportunities to participate and learn from <strong>workplace</strong>activity?Involv<strong>in</strong>g <strong>the</strong> whole team <strong>in</strong> your <strong>workplace</strong>-based <strong>learn<strong>in</strong>g</strong>Medical students and tra<strong>in</strong>ees readily identify colleagues, team members and <strong>in</strong>deed patientsand <strong>the</strong>ir carers who have enabled <strong>the</strong>m to ‘fit <strong>in</strong>’ to new sett<strong>in</strong>gs and who have made positivecontributions to <strong>the</strong>ir <strong>learn<strong>in</strong>g</strong>. In many cases <strong>the</strong>se <strong>in</strong>dividuals are not those with a formallyrecognised teach<strong>in</strong>g role. For example, consider how powerful patient feedback (be it direct or<strong>in</strong>direct) can be on re<strong>in</strong>forc<strong>in</strong>g your practice or seek<strong>in</strong>g new ways to do th<strong>in</strong>gs. Consider <strong>the</strong>ways <strong>in</strong> which students and tra<strong>in</strong>ees learn from each o<strong>the</strong>r (‘I f<strong>in</strong>d it helpful to hold it thisway’) and share experiences (‘saw a great case <strong>in</strong> <strong>the</strong>atre yesterday’). Consider <strong>the</strong> ways <strong>in</strong>which junior medical staff guide less experienced colleagues <strong>in</strong> ways of exam<strong>in</strong><strong>in</strong>g patients,<strong>in</strong>terpret<strong>in</strong>g charts or test results and prioritis<strong>in</strong>g workloads. Consider <strong>the</strong> role played bynurs<strong>in</strong>g colleagues <strong>in</strong> help<strong>in</strong>g ‘newcomers’ get to grips with ward procedures and protocols or<strong>in</strong> identify<strong>in</strong>g ways to effectively work with particular team members. Acknowledge <strong>the</strong> roleplayed by all members of your community and value it explicitly. Encourage your colleagues tobe <strong>in</strong>volved <strong>in</strong> <strong>the</strong> multi-source feedback to tra<strong>in</strong>ees. Invite <strong>the</strong>m to be <strong>in</strong>volved <strong>in</strong> medicaleducation and tra<strong>in</strong><strong>in</strong>g. Identify <strong>the</strong> ways <strong>in</strong> which <strong>the</strong>y can support <strong>learn<strong>in</strong>g</strong> and make <strong>the</strong>mexplicit to students and tra<strong>in</strong>ees.See <strong>the</strong> Workplace-based assessment and Giv<strong>in</strong>g effective feedback modules <strong>in</strong> this series forfur<strong>the</strong>r ideas and <strong>in</strong>formation.Th<strong>in</strong>k<strong>in</strong>g po<strong>in</strong>ts• Consider who could potentially be <strong>in</strong>volved <strong>in</strong> support<strong>in</strong>g student or tra<strong>in</strong>ee <strong>learn<strong>in</strong>g</strong> <strong>in</strong> your<strong>workplace</strong>.• Who could be more <strong>in</strong>volved and how?• What contributions can be made by people o<strong>the</strong>r than yourself?8


Mak<strong>in</strong>g <strong>workplace</strong>-based <strong>learn<strong>in</strong>g</strong> opportunities explicitWhile <strong>the</strong> <strong>workplace</strong> is a great place to learn, <strong>the</strong> primary focus is on work<strong>in</strong>g, andopportunities to learn may go unrecognised. How often have you been frustrated by astudent’s reluctance to attend a ward round or cl<strong>in</strong>ic or <strong>the</strong>atre list because <strong>the</strong>y prefer to goand study <strong>in</strong> <strong>the</strong> library for a forthcom<strong>in</strong>g exam? How often have you been frustrated by astudent’s reluctance to come <strong>in</strong>to cl<strong>in</strong>ic or <strong>the</strong>atre more than once, because <strong>the</strong>y have ‘seen italready’. In both <strong>the</strong>se situations it may well be that <strong>the</strong> student's reluctance is because <strong>the</strong>ycan’t ‘see’ <strong>the</strong> <strong>learn<strong>in</strong>g</strong> opportunities that are part and parcel of <strong>the</strong> experience and nobody hasmade <strong>the</strong>m explicit. There are a number of ways <strong>in</strong> which you can help students and tra<strong>in</strong>eesrecognise <strong>the</strong> <strong>learn<strong>in</strong>g</strong> value of everyday work<strong>in</strong>g activity.Label <strong>the</strong> <strong>learn<strong>in</strong>g</strong> opportunity e.g. ‘We have a <strong>the</strong>atre list this afternoon and we need to consentpatients this morn<strong>in</strong>g. It would be a great opportunity for you to learn more about how to expla<strong>in</strong>procedures and ga<strong>in</strong><strong>in</strong>g patient consent.’Establish prior experience and negotiate a <strong>learn<strong>in</strong>g</strong> goal e.g. ‘So, you have experience ofconsent<strong>in</strong>g patients for rout<strong>in</strong>e procedures, so why don’t we work toge<strong>the</strong>r this morn<strong>in</strong>g to consentpatients about to undergo more complex procedures, with <strong>the</strong> aim be<strong>in</strong>g that you will do two withoutmy need<strong>in</strong>g to <strong>in</strong>tervene by <strong>the</strong> end of <strong>the</strong> morn<strong>in</strong>g?’Prime <strong>the</strong>m for <strong>learn<strong>in</strong>g</strong> through observ<strong>in</strong>g e.g. ‘In cl<strong>in</strong>ic this morn<strong>in</strong>g we are likely to see patientswho are booked <strong>in</strong> for caesarean section or who will raise <strong>the</strong> question of elective section. While youobserve I want you to notice <strong>the</strong> reasons given for request<strong>in</strong>g section and consider <strong>the</strong> ways <strong>in</strong> which<strong>the</strong>y might <strong>in</strong>fluence your decision mak<strong>in</strong>g if it was your decision to make.’Use assessment for <strong>learn<strong>in</strong>g</strong> purposes e.g. <strong>the</strong> new <strong>workplace</strong>-based assessment tools providerepeated opportunities to identify opportunities for development that can be addressed through<strong>workplace</strong>-based activity. For example, directly observ<strong>in</strong>g procedural skills and observ<strong>in</strong>g a brief cl<strong>in</strong>icalexam<strong>in</strong>ation provides you with first-hand <strong>in</strong>formation about tra<strong>in</strong>ee strengths and weaknesses. Use thisas a way to identify ways to enhance performance, be it through more opportunities to do someth<strong>in</strong>g,purposeful observation of peers do<strong>in</strong>g someth<strong>in</strong>g or shadow<strong>in</strong>g members of <strong>the</strong> team who areparticularly skilled <strong>in</strong> someth<strong>in</strong>g of relevance. ‘One of <strong>the</strong> aspects you found difficult this morn<strong>in</strong>g wastak<strong>in</strong>g <strong>the</strong> history from a slightly confused patient. Why don’t you f<strong>in</strong>d out if you can sit <strong>in</strong> on <strong>the</strong> nextmemory cl<strong>in</strong>ic and watch how <strong>the</strong> team do <strong>the</strong>ir <strong>in</strong>itial consultations with patients?’ or ‘I noticed youwere struggl<strong>in</strong>g with putt<strong>in</strong>g <strong>in</strong> that l<strong>in</strong>e, why don’t you arrange to work with one of <strong>the</strong> anaes<strong>the</strong>tistsfor <strong>the</strong> day and get some extra experience <strong>in</strong> <strong>the</strong>atre?’See <strong>the</strong> Workplace-based assessment module <strong>in</strong> this series for fur<strong>the</strong>r ideas and <strong>in</strong>formation.9


Th<strong>in</strong>k<strong>in</strong>g po<strong>in</strong>ts• What opportunities for <strong>learn<strong>in</strong>g</strong> does your <strong>workplace</strong> offer on a day-to-day basis?• How can you make <strong>the</strong>m more explicit to students and tra<strong>in</strong>ees?Creat<strong>in</strong>g and support<strong>in</strong>g opportunities to learn through work participationWe know that <strong>learn<strong>in</strong>g</strong> is most effective when students/tra<strong>in</strong>ees are given opportunities toengage actively <strong>in</strong> real <strong>workplace</strong> activity. These opportunities are obviously bounded bycompet<strong>in</strong>g demands, concerns and priorities, which will <strong>in</strong>clude <strong>the</strong> complexity of <strong>the</strong> activity,<strong>the</strong> potential risks <strong>in</strong>volved, <strong>the</strong> competence and confidence of <strong>the</strong> student/tra<strong>in</strong>ee, <strong>the</strong> timeavailable and <strong>the</strong> will<strong>in</strong>gness (and consent) of patients to be <strong>in</strong>volved <strong>in</strong> tra<strong>in</strong><strong>in</strong>g activity.There will be times when, with adequate preparation and ‘safety nett<strong>in</strong>g’, you will delegatetasks to students/tra<strong>in</strong>ees <strong>in</strong> <strong>the</strong>ir entirety. However, <strong>the</strong>re are many o<strong>the</strong>r opportunities <strong>in</strong>which you can work with students and tra<strong>in</strong>ees <strong>in</strong> parallel, to delegate aspects of work toenhance <strong>the</strong>ir <strong>learn<strong>in</strong>g</strong> or to provide participatory opportunities that will <strong>in</strong>crease <strong>the</strong>irconfidence and read<strong>in</strong>ess to undertake aspects of work activity.One of <strong>the</strong> ways <strong>in</strong> which you can prepare and safety net is by ensur<strong>in</strong>g you start with <strong>learn<strong>in</strong>g</strong>needs analysis. A brief yet really focused conversation with a tra<strong>in</strong>ee can <strong>in</strong>form your decisionmak<strong>in</strong>g about what to delegate and <strong>the</strong> support strategies you need to put <strong>in</strong> place. This willusually <strong>in</strong>clude f<strong>in</strong>d<strong>in</strong>g out what <strong>the</strong>y ‘know’, what <strong>the</strong>y have ‘done’ before that is of relevance,any concerns or anxieties <strong>the</strong>y have about what is proposed and how you can offer back-upsupport (or rescue) if th<strong>in</strong>gs don’t go accord<strong>in</strong>g to plan.See <strong>the</strong> Assess<strong>in</strong>g educational needs and Sett<strong>in</strong>g educational objectives modules <strong>in</strong> this seriesfor fur<strong>the</strong>r ideas and <strong>in</strong>formation.For example, a tra<strong>in</strong>ee might not yet be ready to perform a complete surgical procedure. Theymay, however, be ready to take <strong>the</strong> history, perform <strong>the</strong> exam<strong>in</strong>ation, consent <strong>the</strong> patient,prep <strong>the</strong> patient and perform one part of <strong>the</strong> procedure, monitor <strong>in</strong> recovery and write up <strong>the</strong>charts. This gives <strong>the</strong>m a sense of tak<strong>in</strong>g responsibility for <strong>the</strong> patient’s management and timeto focus <strong>the</strong>ir attention fully on <strong>the</strong> aspects <strong>the</strong>y are not yet do<strong>in</strong>g, but might do next time.See ‘Integrat<strong>in</strong>g teach<strong>in</strong>g and <strong>learn<strong>in</strong>g</strong> <strong>in</strong> cl<strong>in</strong>ical practice’ and ‘Teach<strong>in</strong>g and <strong>learn<strong>in</strong>g</strong> throughactive observation’ <strong>in</strong> Explore around this topic.This is ano<strong>the</strong>r situation where you can use assessments for <strong>learn<strong>in</strong>g</strong> purposes. By look<strong>in</strong>g at<strong>the</strong> tra<strong>in</strong>ee’s profile, you can spot patterns of competence and obvious gaps <strong>in</strong> ei<strong>the</strong>rexperience or competence. By focus<strong>in</strong>g on <strong>the</strong>se, you can ensure that you guide <strong>the</strong> tra<strong>in</strong>ee to<strong>the</strong> types of experience that are best aligned with <strong>the</strong>ir development needs.10


Help<strong>in</strong>g student to ‘talk’ <strong>the</strong>ir way <strong>in</strong>to <strong>workplace</strong>-based <strong>learn<strong>in</strong>g</strong>One of <strong>the</strong> challenges of <strong>learn<strong>in</strong>g</strong> <strong>in</strong> <strong>the</strong> <strong>workplace</strong> is that much of <strong>the</strong> complexity of practicegoes unseen. Many aspects of medical practice take place <strong>in</strong> <strong>the</strong> m<strong>in</strong>ds of practitioners, whoengage <strong>in</strong> an <strong>in</strong>ternal dialogue based around differential diagnosis, cl<strong>in</strong>ical reason<strong>in</strong>g,management plann<strong>in</strong>g and explor<strong>in</strong>g prognosis. A key challenge for <strong>the</strong> cl<strong>in</strong>ical teacher is tof<strong>in</strong>d ways to make this th<strong>in</strong>k<strong>in</strong>g accessible to <strong>the</strong> tra<strong>in</strong>ee and to f<strong>in</strong>d ways to access <strong>the</strong>tra<strong>in</strong>ee’s ‘th<strong>in</strong>k<strong>in</strong>g’ as a way of ensur<strong>in</strong>g <strong>the</strong>y are ‘on track’.Some of <strong>the</strong> ways <strong>in</strong> which you can do this <strong>in</strong>clude <strong>the</strong> follow<strong>in</strong>g.‘Th<strong>in</strong>k<strong>in</strong>g aloud’ – provid<strong>in</strong>g a narrative as we teach a skill or procedure is commonplace <strong>in</strong>cl<strong>in</strong>ical teach<strong>in</strong>g. Provid<strong>in</strong>g a narrative along <strong>the</strong> l<strong>in</strong>es of ‘What I am consider<strong>in</strong>g with thispatient because…’ or ‘What I am struggl<strong>in</strong>g with here is…’ or ‘I am weigh<strong>in</strong>g up <strong>the</strong> options of Xversus Y because…’ are equally powerful.Purposeful observation – by prim<strong>in</strong>g a tra<strong>in</strong>ee to observe purposefully, we are mak<strong>in</strong>gexplicit <strong>the</strong> ways <strong>in</strong> which we look at patients or situations. For example, ra<strong>the</strong>r than ask<strong>in</strong>g atra<strong>in</strong>ee to just observe a consultation with a distressed patient, you might ask <strong>the</strong>m to noteaspects of <strong>the</strong> patient’s verbal or non-verbal behaviour that <strong>in</strong>dicate distress. Alternatively, youmight ask <strong>the</strong>m to note down specific strategies you use to calm <strong>the</strong> patient and to addressfears or anxieties.See ‘Teach<strong>in</strong>g and <strong>learn<strong>in</strong>g</strong> through active observation’ <strong>in</strong> Explore around this topic.‘Talk <strong>the</strong> talk’ – many cl<strong>in</strong>ical teachers have ‘set ways’ <strong>the</strong>y like tra<strong>in</strong>ees to present patients.These set ways often reflect <strong>the</strong> ways <strong>in</strong> which practitioners organise <strong>the</strong>ir thoughts aboutpatients, as a way of ensur<strong>in</strong>g a systematic approach to diagnosis, etc. By be<strong>in</strong>g clear withtra<strong>in</strong>ees that this talk<strong>in</strong>g prompts a way of th<strong>in</strong>k<strong>in</strong>g, you are labell<strong>in</strong>g it as a teach<strong>in</strong>g strategyra<strong>the</strong>r than a personal ‘quirk’. These ways of talk<strong>in</strong>g about patients are often <strong>the</strong> ways <strong>in</strong> whichparticular ‘cultural practices’ are made evident. For example, <strong>the</strong> way a patient is presented <strong>in</strong>surgery is different from medic<strong>in</strong>e, which is different from psychiatry, etc. By be<strong>in</strong>g explicitabout this, tra<strong>in</strong>ees aga<strong>in</strong> ga<strong>in</strong> <strong>in</strong>sight <strong>in</strong>to <strong>the</strong> ways <strong>in</strong> which medic<strong>in</strong>e is practised <strong>in</strong> thatcontext.Use case-based discussion – this is ano<strong>the</strong>r example of <strong>the</strong> ways <strong>in</strong> which <strong>workplace</strong>-basedassessment tools can be powerful <strong>workplace</strong>-based <strong>learn<strong>in</strong>g</strong> tools. Case-based discussion isdesigned to explore <strong>the</strong> th<strong>in</strong>k<strong>in</strong>g beh<strong>in</strong>d practice, for example to consider why <strong>the</strong> tra<strong>in</strong>eemade a particular diagnostic or management decision. It provides an opportunity for <strong>the</strong>tra<strong>in</strong>ee to make <strong>the</strong>ir th<strong>in</strong>k<strong>in</strong>g explicit and to develop <strong>the</strong>ir ideas. Cl<strong>in</strong>ical teachers can make<strong>the</strong> most of <strong>the</strong>se opportunities by chang<strong>in</strong>g <strong>the</strong> types of question that check out <strong>the</strong>knowledge base (e.g. what are <strong>the</strong> diagnostic <strong>in</strong>dicators for…) to those that require <strong>the</strong> tra<strong>in</strong>eeto provide a rationale for decisions made or not made. For example, ‘You made <strong>the</strong> decision toadmit this patient, can you tell me more about <strong>the</strong> factors that you took <strong>in</strong>to account… how11


might you justify send<strong>in</strong>g this same patient home… who else <strong>in</strong> <strong>the</strong> team did you <strong>in</strong>volve/couldyou <strong>in</strong>volve <strong>in</strong> that decision-mak<strong>in</strong>g process’, etc.See also <strong>the</strong> Workplace-based assessment module <strong>in</strong> this series.Foster<strong>in</strong>g 'horizontal' <strong>learn<strong>in</strong>g</strong>Medical students and tra<strong>in</strong>ees move rapidly from one <strong>workplace</strong> to ano<strong>the</strong>r and are expectedto somehow identify and absorb <strong>the</strong> nuanced differences between one sett<strong>in</strong>g or team andano<strong>the</strong>r, and adapt <strong>the</strong>ir own behaviour to fit accord<strong>in</strong>gly. For example, all doctors rout<strong>in</strong>elytake a history from <strong>the</strong>ir patients – but consider <strong>the</strong> differences between those taken <strong>in</strong> acutehospital sett<strong>in</strong>gs from those <strong>in</strong> general practice. And all doctors establish professionalrelationships with patients – aga<strong>in</strong> th<strong>in</strong>k about <strong>the</strong> differences <strong>in</strong> relationship between doctorsand patients <strong>in</strong> palliative care from those <strong>in</strong> paediatrics, obstetrics or psychiatry.How do you help newcomers ‘see’ such differences and f<strong>in</strong>d ways of work<strong>in</strong>g with you, yourteam and your patients, that are appropriate and congruent? One way is to provide clear‘jo<strong>in</strong><strong>in</strong>g’ <strong>in</strong>structions that outl<strong>in</strong>e preferred styles of dress, ways of address<strong>in</strong>g colleagues andpatients, format for writ<strong>in</strong>g <strong>in</strong> notes or construct<strong>in</strong>g letters, for example. Ano<strong>the</strong>r is to <strong>in</strong>vitenewcomers to actively seek and articulate differences between observed practice <strong>in</strong> your<strong>workplace</strong> and those experienced elsewhere, and to discuss <strong>the</strong>se where it would appear to behelpful. This is ano<strong>the</strong>r situation where purposeful observation can be very powerful.See ‘Teach<strong>in</strong>g and <strong>learn<strong>in</strong>g</strong> through active observation’ <strong>in</strong> Explore around this topic.Ano<strong>the</strong>r important aspect of horizontal <strong>learn<strong>in</strong>g</strong> is around help<strong>in</strong>g student/tra<strong>in</strong>ees to draw on<strong>the</strong>ir formal <strong>learn<strong>in</strong>g</strong> (ga<strong>in</strong>ed <strong>in</strong> <strong>the</strong> classroom) to understand what <strong>the</strong>y see <strong>in</strong> practice. One of<strong>the</strong> ways we can do this really effectively is through question<strong>in</strong>g, ra<strong>the</strong>r than tell<strong>in</strong>g. You mightstart with some Socratic questions, designed to explore what <strong>the</strong>y know already, <strong>in</strong> order tomake sense of what <strong>the</strong>y see. For example, when <strong>the</strong>y meet a patient for whom <strong>the</strong>y areunable to come up with a differential diagnosis, you might start by ask<strong>in</strong>g <strong>the</strong>m to identifyobserved signs and symptoms, <strong>the</strong>n go on to explore what might be <strong>the</strong> cause and elaboratewhy <strong>the</strong>y th<strong>in</strong>k it is or isn’t likely to be that. This might lead to ano<strong>the</strong>r set of unansweredquestions, which you might address through some heuristic-type questions, designed to help<strong>the</strong> tra<strong>in</strong>ee identify <strong>the</strong> ways <strong>in</strong> which <strong>the</strong>y might develop <strong>the</strong>ir understand<strong>in</strong>g or come up with<strong>the</strong> diagnosis. ‘Where might you go to f<strong>in</strong>d out more about this condition? What <strong>in</strong>vestigationsmight be relevant at this po<strong>in</strong>t <strong>in</strong> order to rule out X or Y?’For more ideas, see <strong>the</strong> Supervision and Small group teach<strong>in</strong>g modules <strong>in</strong> this series.12


To sum upWorkplace-based <strong>learn<strong>in</strong>g</strong> might be under threat yet it has never been more important. Bydraw<strong>in</strong>g on <strong>the</strong> sound traditions of apprenticeship and mak<strong>in</strong>g <strong>the</strong> most of <strong>the</strong> opportunities tolearn that arise <strong>in</strong> our day-to-day practice, we can ensure that tra<strong>in</strong>ees learn how to do <strong>the</strong> jobby do<strong>in</strong>g <strong>the</strong> job. You can do this by:• mak<strong>in</strong>g sure your <strong>workplace</strong> is <strong>in</strong>vitational for all students and tra<strong>in</strong>ees• <strong>in</strong>volv<strong>in</strong>g all members of your team (<strong>in</strong>clud<strong>in</strong>g patients) <strong>in</strong> <strong>the</strong> tra<strong>in</strong><strong>in</strong>g process• mak<strong>in</strong>g opportunities for <strong>learn<strong>in</strong>g</strong> explicit• creat<strong>in</strong>g and support<strong>in</strong>g opportunities for <strong>learn<strong>in</strong>g</strong>• provid<strong>in</strong>g opportunities for participation <strong>in</strong> <strong>workplace</strong>-based activity• help<strong>in</strong>g tra<strong>in</strong>ees to learn from your talk and by <strong>learn<strong>in</strong>g</strong> ‘to talk’• foster<strong>in</strong>g horizontal <strong>learn<strong>in</strong>g</strong>.CongratulationsYou have now reached <strong>the</strong> end of <strong>the</strong> module. Provided you have entered someth<strong>in</strong>g <strong>in</strong>to yourlog you can now pr<strong>in</strong>t your certificate. To generate your certificate please go to ‘my area’ andclick on ‘complete’ <strong>in</strong> <strong>the</strong> course status column. Please note, you will not be able to pr<strong>in</strong>t yourcertificate unless you have entered someth<strong>in</strong>g <strong>in</strong> your ‘reflections area’.Please now take a moment to evaluate <strong>the</strong> course and enter your comments below.13


Fur<strong>the</strong>r <strong>in</strong>formationThis module was written by Clare Morris, Associate Dean, Bedfordshire and HertfordshirePostgraduate Medical School, Programme Lead MA <strong>in</strong> Medical Education, University ofBedfordshire, and Educational Lead, East of England Tra<strong>in</strong>er <strong>Development</strong> Programme.Teachers’ tookitLesson plann<strong>in</strong>g checklistReferencesBillett S (2002) Toward a <strong>workplace</strong> pedagogy: guidance, participation and engagement. AdultEducation Quarterly. 53: 27–43.Billet S (2004) Workplace participatory practices: conceptualis<strong>in</strong>g <strong>workplace</strong>s as <strong>learn<strong>in</strong>g</strong>environments. Journal of Workplace Learn<strong>in</strong>g. 16: 312–24.Bleakley A (2002) Pre-registration House Officers and ward-based <strong>learn<strong>in</strong>g</strong>: a newapprenticeship model. Medical Education. 36: 9–15.Bleakley A (2006) Broaden<strong>in</strong>g conceptions of <strong>learn<strong>in</strong>g</strong> <strong>in</strong> medical education: <strong>the</strong> message fromteam-work<strong>in</strong>g. Medical Education. 40: 150–7.Griffiths T and Guile D (1999) Pedagogy <strong>in</strong> workbased contexts. In: Mortimore P.Understand<strong>in</strong>g Pedagogy and it’s Impact on Learn<strong>in</strong>g. Sage, London.Higham J and Steer P (2004) Gender gap <strong>in</strong> undergraduate experience and performance <strong>in</strong>obstetrics and gynaecology: analysis of cl<strong>in</strong>ical experience logs. British Medical Journal. 328:142–3.Kolb D (1984) Experiential Learn<strong>in</strong>g. Prentice Hall, Englewood Cliffs, NJ.Lave J and Wenger E (2003) Situated Learn<strong>in</strong>g: legitimate peripheral participation. CambridgeUniversity Press, Cambridge.Seagraves L, Osborne M, Neal P, Dockrell R, Hartshorn C and Boyd A (1996) Learn<strong>in</strong>g <strong>in</strong>Smaller Companies (LISC), F<strong>in</strong>al Report. University of Stirl<strong>in</strong>g Educational Policy and<strong>Development</strong>.Swanwick T (2005) Informal Learn<strong>in</strong>g <strong>in</strong> Postgraduate Medical Education: from cognitivism to‘culturism’. Medical Education. 39: 859–65.14


Wenger E (1998) Communities of Practice: <strong>learn<strong>in</strong>g</strong>, mean<strong>in</strong>g and Identity. CambridgeUniversity Press, Cambridge.Fur<strong>the</strong>r read<strong>in</strong>gEvans K, Hodk<strong>in</strong>son P, Ra<strong>in</strong>bird H and Unw<strong>in</strong> L (2006) Improv<strong>in</strong>g Workplace Learn<strong>in</strong>g.Routledge, London.Gordon J (2003) ABC of <strong>learn<strong>in</strong>g</strong> and teach<strong>in</strong>g <strong>in</strong> medic<strong>in</strong>e: one-to-one teach<strong>in</strong>g and feedback.British Medical Journal. 326: 543–5.Irby D and Wilkerson L (2008) Teach<strong>in</strong>g when time is limited. British Medical Journal. 336:384–7.Lake F and Hamdorf J (2004) Teach<strong>in</strong>g on <strong>the</strong> run tip no. 5: teach<strong>in</strong>g a skill. Medical Journal ofAustralia. 181: 327–8.Lake F and Ryan G (2004) Teach<strong>in</strong>g on <strong>the</strong> run tip no 4: teach<strong>in</strong>g with patients. MedicalJournal of Australia. 181: 158–9.Lake F and Vickery A (2006) Teach<strong>in</strong>g on <strong>the</strong> run tip no 14: teach<strong>in</strong>g <strong>in</strong> ambulatory care.Medical Journal of Australia. 185: 166–7.Spencer J (2003) ABC of <strong>learn<strong>in</strong>g</strong> and teach<strong>in</strong>g <strong>in</strong> medic<strong>in</strong>e: <strong>learn<strong>in</strong>g</strong> and teach<strong>in</strong>g <strong>in</strong> <strong>the</strong>cl<strong>in</strong>ical environment. British Medical Journal. 326: 591–4.15


Learn<strong>in</strong>g activitiesSelect one or more of <strong>the</strong> activities below to develop your skills <strong>in</strong> support<strong>in</strong>g <strong>workplace</strong>-based<strong>learn<strong>in</strong>g</strong>.If you are registered on <strong>the</strong> site, you can write up your reflections <strong>in</strong> <strong>the</strong> ‘reflections area’ .Click on <strong>the</strong> ‘my area’ l<strong>in</strong>k at <strong>the</strong> top of <strong>the</strong> page to access your personal pages. Please notethat you must be logged <strong>in</strong> to do this.1 Get <strong>in</strong>volved <strong>in</strong> peer observation of cl<strong>in</strong>ical teach<strong>in</strong>gAsk a colleague if <strong>the</strong>y will observe you and give feedback, but seek opportunities to do <strong>the</strong>same for <strong>the</strong>m. It is a really powerful way to learn more about your teach<strong>in</strong>g and to get goodideas for ways to develop your approach.2 Ask students and tra<strong>in</strong>ees for explicit feedback on <strong>the</strong> <strong>learn<strong>in</strong>g</strong> opportunitiesprovided• What makes <strong>the</strong> attachment or post one that is good for <strong>learn<strong>in</strong>g</strong>?• What seems to get <strong>in</strong> <strong>the</strong> way of <strong>the</strong>ir <strong>learn<strong>in</strong>g</strong>?• What would <strong>the</strong>y like more of?• What would <strong>the</strong>y like less of?• Whose approach to teach<strong>in</strong>g do <strong>the</strong>y like and why?16

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