Using activity theory to transform medical work and learning

Abstract

This article introduces key concepts of activity theory and expansive learning. Expansive learning builds on the foundational ideas of the cultural-historical activity theory (CHAT). It is a research approach designed for studying the complexities and contradictions in authentic workplace environments. Change Laboratory is a formative intervention method developed for studying workplaces in transition and for stimulating collaborative efforts to design improved patterns of activity. We present concrete examples of formative interventions in healthcare, where good patient care was compromised by the fragmentation of care and disturbances in collaboration between the healthcare experts. This implies that physicians are challenged to develop collaborative and transformative expertise. We present three spearheads into a zone of proximal development, representing opportunities for change of medical expertise: (1) reconceptualizing expertise as object-oriented and contradiction-driven activity systems, (2) pursuing expertise as negotiated knotworking, and (3) building expertise as expansive learning. While medical expertise needs to expand, medical education must also look for ways to evolve and meet the challenges of the surrounding society. We call for adopting an interventionist approach for developing medical education and intensifying collaboration with the practitioners in healthcare units, their patients and target communities.

The wolf you feed: Challenging intraprofessional workplace‐based education norms

“…There are several different theories and orientations on the social aspect of learning residing under the socio-cultural learning theory umbrella including, for example situated learning, 44 Cultural Historical Activity Theory 45 and Practices of Communities. 46,47 These socio-cultural learning theories emphasise the social and interactional nature of health professionals' education.…”

Cultural Historical Activity Theory for Studying Practice-Based Learning and Change in Medical Education

“…Participants then devise the future model which resolves the contradictions identified in the process, including a plan for examining and implementing the new model. 4,37 Activity Systems Analysis The analytical process by which researchers can conceptualize and describe the activity of interest in terms of the CHAT framework (see Table 2). 9 Advances in Medical Education and Practice 2021:12 https://doi.org/10.2147/AMEP.S313250…”

“…In this way, practitioners are provided with agency to transform their own area of practice for the better. 4,37 The Change Laboratory has been shown to be of use in medical education contexts. In Denmark, researchers utilized the Change Laboratory to develop innovative change in a pediatric department and develop new ways of learning and practice.…”

“…1,2 Cultural historical activity theory (CHAT) is a social theory for studying social practice, and is attracting increasing interest in medical education for studying dynamic systems in change. [3][4][5] CHAT was originally devised for studying children at play, but it has been subsequently developed by philosophers interested in learning through practice, especially in complex systems, as this article will explain. CHAT considers the fundamental unit of life to be activity, which is collective and requires communication and interaction between practitioners.…”

“…CHAT is therefore useful for studying how practice and learning may be changed in the future in dynamic systems. 4,9,10 This article aims to provide a practical and accessible introduction to understanding CHAT and utilizing the theory as a framework in medical education research methodology. It will explain how CHAT aligns with medical education learning theories, describe how practice and learning can be understood as activity systems, and explain how systems-based tensions can be brought to light using CHAT.…”