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Contextual dynamics in clinical workplaces: learning from doctor–doctor consultations
Author(s) -
Pimmer Christoph,
Pachler Norbert,
Genewein Urs
Publication year - 2013
Publication title -
medical education
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.776
H-Index - 138
eISSN - 1365-2923
pISSN - 0308-0110
DOI - 10.1111/medu.12130
Subject(s) - competence (human resources) , situational ethics , situated learning , situated , psychology , context (archaeology) , situated cognition , medical education , cognition , dynamics (music) , medicine , pedagogy , social psychology , computer science , paleontology , artificial intelligence , neuroscience , biology
Medical Education 2013: 47 : 463–475 CONTEXT Some studies have explored the role of learning context in clerkships and in clinical teams. Very little is known, however, about the relationship between context and competence development in more loosely framed, day‐to‐day practices such as doctor–doctor consultations, although such interactions are frequent and typical in clinical work. METHODS To address this gap in the literature, a study was conducted using semi‐structured interviews in four different hospitals and participant observation at one site. Inductive content analysis was used to develop a framework. Special reference was made to the principles of situated cognition. RESULTS The framework illustrates how different situational, personal and organisational factors interact in every learning situation. The interplay manifests in three different roles that doctors assume in highly dynamic ways: doctors learn as ‘actors’ (being responsible), as ‘participants’ (being involved) and as ‘students’ (being taught); contextual influences also impact on the quality of learning within these roles. CONCLUSIONS The findings add to the current literature on clinical workplace learning and to the conceptualisation of context in the field of education. The practical contribution of the research lies in disentangling the complex dynamics of learning in clinical environments and in helping doctors and medical educators to increase their responsiveness to contextual factors.