Newly qualified doctors’ perceptions of informal learning from nurses: implications for interprofessional education and practice

Abstract

Newly qualified doctors spend much of their time with nurses, but little research has considered informal learning during that formative contact. This article reports findings from a multiple case study that explored what newly qualified doctors felt they learned from nurses in the workplace. Analysis of interviews conducted with UK doctors in their first year of practice identified four overarching themes: attitudes towards working with nurses, learning about roles, professional hierarchies and learning skills. Informal learning was found to contribute to the newly qualified doctors' knowledge of their own and others' roles. A dynamic hierarchy was identified: one in which a "pragmatic hierarchy" recognising nurses' expertise was superseded by a "normative structural hierarchy" that reinforced the notion of medical dominance. Alongside the implicit learning of roles, nurses contributed to the explicit learning of skills and captured doctors' errors, with implications for patient safety. The findings are discussed in relation to professional socialisation. Issues of power between the professions are also considered. It is concluded that increasing both medical and nursing professions' awareness of informal workplace learning may improve the efficiency of education in restricted working hours. A culture in which informal learning is embedded may also have benefits for patient safety.

The case of veterinary interprofessional practice: From one health to a world of its own

“…34 The case study observations and considerations of newly qualified doctors and experienced nurses portrayed a complex structure where awareness of nurses' expertise was evident, but superseded by the culture of continuing medical dominance. 36 A recent study by Barrow et al 2 used an Activity Theory framework, similar to that used here, to consider conceptual differences between doctors and nurses in hospitals. The authors suggested that co-configured, joined-up work was evident in their study, and the traditional hierarchy was overruled at times by attention to competence.…”

The Process and Implication of Inter-Professional Education: A Systematic Review

“…Few IPE programs included any form of formal academic accreditation. Further, most IPE programs were delivered as elective learning experiences to participants, where some of the school accepted the credit hours but some were not (Burford et al, 2013;Joseph et al, 2012;Zanoti & Canova, 2015).…”

“…Programs were more commonly delivered to students in the final year as a classroom or sometimes as a practice-based activity. Also, the synthesis of the reviews indicated that while the duration of IPE program varied, ranging from 1-to-2 days' sessions to programs delivered over a period of the year; most programs lasted between 1-3 months (Burford et al, 2013). …”

“…For example, the curriculum might teach students about group dynamics and communication skills using role plays (Greidanus et al, 2013;Thuente, 2014;West, 2015). Clinical placements could provide experiences in joint decision-making and negotiation skills by having a group of students work together to handle particular patients (Burford et al, 2013;Joseph et al, 2012).…”

“…Among the students, IPE is a useful strategy to help change the attitudes, develop their interest in patient care and improve their medical and clinical knowledge (Shunguya, Hinthong, Jimba & Yosuoka, 2014). Many studies have reported that IPE led to positive changes in the students' knowledge or skills of interprofessional (IP) collaboration related to their enhanced understanding of the roles and responsibilities of other professional groups (Burford et al, 2013;Wilbur & Kelly, 2015), improved knowledge of the nature of IP collaboration (Thuente, 2014;Zanoti & Canova, 2015) and development of communications skills (Defenbaugh & Chikotas, 2015;Lancken & Levenhagen, 2014).…”