Learning practice? Exploring the links between transitions and medical performance

Kilminster, Sue; Zukas, Miriam; Quinton, Naomi; Roberts, Trudie

doi:10.1108/14777261011088656

Cited by 44 publications

(49 citation statements)

References 38 publications

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“…For policy-makers and regulatory agencies, concern often centres upon ensuring quality and reliability of professional decision-making throughout transition periods (e.g. Kilminster et al 2010). Educators, on the other hand, tend to focus upon…”

Section: Structured Abstractmentioning

confidence: 99%

Understanding transitions in professional practice and learning

Fenwick

2013

Journal of Workplace Learning

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Structured abstractThe purpose of this article is to critically examine, within the context of professional practice and learning, diverse theoretical approaches that are currently prominent in researching transitions and to propose future directions for research. Much research to date on professional transitions has focused on predicting them and then preparing individual practitioners to navigate transitions as sites of struggle. The article begins by describing work contexts integral with professional transitions: regulation, governance and accountability; new work structures; and knowledge development. The discussion then examines transitions research in developmental psychology, lifecourse sociology, and career studies. These perspectives are compared critically in terms of questions and approaches, contributions to understanding professional transitions, and limitations. The implications for educators are a series of critical questions about research and education directed to support transitions in professional learning and work. Future directions and questions for research in professional transitions are suggested in the final section, along with implications for supporting professional learning in these transitions. The article is not intended to be comprehensive, but to identify issues for the reader's consideration in thinking about various forms of transition being experienced by professions and professionals. The discussion theory-based, exploratory, and indicative rather than definitive.Professions arguably are experiencing a heightened state of transition these days as they respond to major changes in policies and policy ideals, regulatory regimes, restructured work arrangements, new technologies and shifting public demands (Evetts 2009). Individual practitioners within the collective professions, too, are called to manage difficult transitions throughout their careers beginning with the shift from initial professional education to the workplace. Professionals frequently must cope with transitions to new levels of responsibility, implementation of new protocols for practice, and migration to new work sites and cultures.Who is interested in understanding these professional transitions, and why? The answer varies depending on one's discipline and investments. In the field of psychology, for instance, concern has centred on the personal struggle, dissonance, and challenges to selfconcept that transitions are assumed to pose. Research in these areas informs counseling practices intended to help people develop personal coping strategies. In organization and management studies, transition has sparked an industry of 'change management' interested in improving planning strategies and managing workers' transitions (e.g. Bridges 2004). For policy-makers and regulatory agencies, concern often centres upon ensuring quality and reliability of professional decision-making throughout transition periods (e.g. Kilminster et al. 2010). Educators, on the other hand, tend to focus upon

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Section: Structured Abstractmentioning

confidence: 99%

Understanding transitions in professional practice and learning

Fenwick

2013

Journal of Workplace Learning

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“…The purpose of the original study from which this paper is drawn, Learning responsibility? Exploring doctors' transitions to new levels of medical performance, was to develop better understandings of these transitions and more details have been reported elsewhere (Kilminster et al, 2010(Kilminster et al, , 2011Zukas and Kilminster, 2012). Essentially we used a learning perspective to understand doctors' transitions.…”

Section: Methodsmentioning

confidence: 99%

Responsibility matters: putting illness back into the picture

Kilminster

Zukas

2013

Journal of Workplace Learning

Self Cite

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Purpose -The purpose of this paper is to explore specific instances of junior doctors' responsibility.Learning is often understood to be a prerequisite for managing responsibility and risk but this paper aims to argue that this is insufficient because learning is integral to the management of responsibility and risk. Design/methodology/approach -This is a "collective" case study of doctors designed to focus on the interrelationships between individual professionals and complex work settings. The authors focussed on two key points of transition: the transition to beginning clinical practice which is the move from medical student to foundation training (F1) and the transition from generalist to specialist clinical practice. Findings -Responsibility in clinical settings is immediate, concrete, demands response and (in) action has an effect. Responsibility is learnt and is not always apparent; it shifts depending on time of day/night and who else is present. Responsibility does not necessarily increase incrementally and can decrease; it can be perceived differently by different actors. Responsibility is experienced as personal although it is distributed. Originality/value -This detailed examination of practice has enabled the authors to foreground the particularities, urgency and fluidity of everyday clinical practice. It recasts their understandings of responsibility -and managing risk -as involving learning in practice. This is a critical insight because it suggests that the theoretical basis for the current approach to managing risk and responsibility is insufficient. This has significant implications for policy, employment, education and practice of new doctors and for the management of responsibility and risk.

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“…Park, Woodrow, Reznick, Beales, and MacRae (2007) have identified patient care and education, as well as self-(imposed) and collegial relationships, as major responsibilities in the daily work of surgical resident doctors and faculty members, thus emphasizing their complex structure and collective character. From the perspective of junior physicians' performance at various levels of responsibility, Kilminster, Zukas, Quinton, and Roberts (2010) have argued that junior physicians' transitions through healthcare can be referred to as critical intense learning periods (CILPs), in which the role of the workplace and those with whom they work have a decisive impact. In our study, we found that relational tensions between the physicians' professional responsible doings illustrate the connections between learning and support of others' learning and that they can be seen as important features of CILPs.…”

Section: Discussionmentioning

confidence: 99%

The Dynamics of Physicians’ Learning and Support of Others’ Learning

Thörne

Hult

Gäre

et al. 2014

P&P

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Learning has been defined as a condition for improving the quality of healthcare practice. The focus of this paper is on physicians' learning and their support of others' learning in the context of Swedish healthcare. Data were generated through individual and focus group interviews and analyzed from a sociomaterial practice theory perspective. During their workday, physicians dynamically alternated between their own learning and their support of others' learning in individual patient processes. Learning and learning support were interconnected with the versatile mobility of physicians across different contexts and their participation in multiple communities of collaboration and through tensions between responsibilities in healthcare. The findings illustrate how learning enactments are framed by the existing "practice architectures." We argue that productive reflection on dimensions of learning enactments in practice can enhance physicians' professional learning and improve professional practice.

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Learning practice? Exploring the links between transitions and medical performance

Cited by 44 publications

References 38 publications

Understanding transitions in professional practice and learning

Understanding transitions in professional practice and learning

Responsibility matters: putting illness back into the picture

The Dynamics of Physicians’ Learning and Support of Others’ Learning

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