Informal and Incidental Learning in the Clinical Learning Environment: Learning Through Complexity and Uncertainty During COVID-19

Abstract

In the time of the COVID-19 pandemic, where clinical environments are plagued by both uncertainty and complexity, the importance of the informal and social aspects of learning among health care teams cannot be exaggerated. While there have been attempts to better understand the nuances of informal learning in the clinical environment through descriptions of the tacit or hidden curriculum, incidental learning in medical education has only been partially captured in the research. Understood through concepts borrowed from the Cynefin conceptual framework for sensemaking, the early stages of the pandemic immersed clinical teams in complex and chaotic situations where there was no immediately apparent relationship between cause and effect. Health care teams had to act quickly amidst the chaos: they had to first act, make sense of, and respond with intentionality. Informal and incidental learning (IIL) emerged as a byproduct of acting with the tools and knowledge available in the moment. To integrate the informal, sometimes haphazard nature of emergence among health care teams, educators require an understanding of IIL. This understanding can help medical educators prepare health professions learners for the cognitive dissonance that accompanies uncertainty in clinical practice. The authors introduce IIL as an explanatory framework to describe how teams navigate complexity in the clinical learning environment and to better inform curricular development for health professions training that prepares learners for uncertainty. While further research in IIL is needed to illuminate tacit knowledge that makes learning explicit for all audiences in the health professions, there are opportunities to cultivate learners’ skills in formal curricula through various learning interventions to prime them for IIL when they enter complex clinical learning environments.

Making decisions “in the dark”: Learning through uncertainty in clinical practice during Covid‐19

“…As an example of this approach, at our medical school, we have successfully integrated CBL cases that prompt students to navigate various types of uncertainty (e.g., stochastic, diagnostic, prognostic) in the preclinical curriculum. Immersing students in design sprints builds skills in design thinking and action learning, which support the implementation and testing of novel solutions 8,40 . Participating in routine patient safety initiatives, such as failure modes and effects analyses, can help students assess the intended and unintended consequences of their actions 41 .…”

“…7 It often occurs when doing something for which the primary purpose is not learning, such as solving a problem in the CLE. 8 In essence, IIL describes how clinicians learn every day as they face circumstances calling for new ways to problem solve and make decisions. [9][10][11][12][13] While the study of IIL in the CLE has not been explored in health professions education, other similar theoretical frameworks have been described.…”

“…For example, adopting practices of a hidden curriculum that may include specific workflows, procedures, and team roles for a designated clinical context 7 . It often occurs when doing something for which the primary purpose is not learning, such as solving a problem in the CLE 8 . In essence, IIL describes how clinicians learn every day as they face circumstances calling for new ways to problem solve and make decisions 9–13 …”

Rethinking Workplace Learning and Development Catalyzed by Complexity

“…This echoes the earlier point in this article that Pendleton-Jullian seeks cognitive equity that allows for collaboration, dialogue, boundary-crossing, and the opening of neural networks that help us generate new ideas. We need to adopt an idea from a medical educator and colleague, Dr. Dimitri Papanagnou, who—together with other faculty—has introduced an uncertainty curriculum for preparing medical doctors in training for the inevitable uncertainty of clinical environments (Papanagnou et al, 2022).…”

Bridging Human Resource Development and Health Professions Education Through Action Learning

“…Despite the challenges mentioned, there are opportunities for the use of action learning in healthcare: first, action learning has long been used for the leadership development of healthcare professionals, including nurses, doctors, managers, and physician associates in diverse contexts using various delivery modes in-person (Cho et al, 2012; Joyce, 2022; McCray et al, 2018), online (Lindsay, 2022), and hybrid (Kilbane et al, 2022). Second, evidence of using action learning in healthcare to combat the Covid-19 pandemic is timely and crucial: Action learning and action research can provide strategies to mitigate issues posed by the pandemic (De Georgeo et al, 2021); and action learning can also help understand complexity in healthcare during the pandemic (Papanagnou et al, 2022). With this background of action learning in healthcare in mind, the following section presents three unique cases to illustrate how action learning can be used in HPE in diverse clinical contexts.…”