Widening how we see the impact of culture on learning, practice and identity development in clinical environments

Sheehan, Dale; Wilkinson, Tim

doi:10.1111/medu.14630

Cited by 14 publications

(12 citation statements)

References 31 publications

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“…Thus, the use of boundary objects may become a goal in itself that takes energy away from ‘true’ learning, suggesting a deconstructive struggle (Stoffels et al, 2021 ; Teunissen & Westerman, 2011 ). A possible explanation is that the local practice culture has not been completely acknowledged in the design of boundary objects (Sheehan & Wilkinson, 2021 ). Therefore, theory and practice stakeholders should collaborate to design objects to help students connect the two.…”

Section: Discussionmentioning

confidence: 99%

Learning in and across communities of practice: health professions education students’ learning from boundary crossing

Stoffels

Burgt

Bronkhorst

et al. 2022

Adv in Health Sci Educ

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Learning to adapt to new contexts is crucial in health professions education (HPE). Boundaries between and within contexts challenge continuity in students’ learning processes. Little is known about how HPE students can make these “boundary experiences” productive for learning. We investigated how and what nursing students learn from boundary experiences while they are simultaneously growing into a community of practice (CoP). Using a boundary-crossing lens, experiences of discontinuity were identified in pre-placement and post-placement interviews and diary fragments with 14 nursing students during their placement in an academic hospital. We found that students experience discontinuity as a result of different approaches to nursing care and to learning, both between (academic and clinical) settings and within a setting. When students feel safe enough, they can convert boundary experiences into meaningful learning situations, such as critical discussions with staff. Successfully overcoming boundary experiences improves students’ understanding of healthcare and professional development and helps them to develop a personal approach to learning. Students critically address boundary experiences when they are motivated to learn and when they perceive a violation of ethical standards but not when they are concerned that it will affect their assessment. Objects designed to bridge theory and practice can generate additional barriers. This study adds to the HPE literature by demonstrating the learning potential of boundaries and to the broader literature by showing how responses to boundary experiences are intertwined with the process of growing into a CoP. The findings can be used to design future boundary objects.

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Section: Discussionmentioning

confidence: 99%

Learning in and across communities of practice: health professions education students’ learning from boundary crossing

Stoffels

Burgt

Bronkhorst

et al. 2022

Adv in Health Sci Educ

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“…The COVID-19 pandemic has been posited to have impacted on the professional identity formation of medical students as they grapple with a changed learning experience and future ( 126 ). The recognition of the powerful influence of context, environment and culture as a shaper of possibilities for professional identity formation is maturing in the medical literature ( 127 ) in ways that veterinary researchers have yet to meaningfully engage with.…”

Section: Professional Identity In the Veterinary And Medical Professionsmentioning

confidence: 99%

Veterinary professional identity: Conceptual analysis and location in a practice theory framework

Scholz

Trede

2023

Front. Vet. Sci.

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Professional, social, and cultural issues and phenomena of veterinary practice are now established areas of commentary and interest in research, education, professional publications and even in the mainstream media. Despite the availability of theoretically informed literature in diverse relevant domains and disciplines including professional practice, workplace learning, and medical sociology and anthropology, commentary and research on veterinary practice issues and phenomena remains dominated by clinician-educators and clinician-policymakers. Reflecting the clinical disciplinary traditions, there is a resulting over-representation of individualistic, positivist perspectives and under-theorized research studies. In this paper we provide an interdisciplinary theoretical framework for veterinary practice and veterinary professional identity grounded in a practice theory perspective. We begin by arguing for the need for such a framework by scoping veterinary practice in its contemporary social context. We go on to provide a sociocultural framing of veterinary practice, underlining the mutual constitution of individuals and the social world through participation in practices and taking into consideration important concepts including knowledge, institutions, ethics, and embodiment. We assert the importance of professional identity as a core phenomenon of veterinary practice, constituted by making meaning of professional practice experiences, especially through narrative and dialogue. This practice theory framework for veterinary practice and veterinary professional identity development provides rich opportunities for understanding, researching, and enacting diverse activities and phenomena, especially learning, development and change within and beyond formal educational settings.

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“…22 From the third level of positioning analysis in Narrative ways. [74][75][76] Moreover, the norms and values held by the community may be legitimately constructed by the stakeholders and considered by the novice trainees as they become medical doctors. 77 Often this act, if not enacted wisely, is problematic particularly when there are no shared understandings about the goals and standards of assessment.…”

Section: Wider Social Implicationsmentioning

confidence: 99%

Striving to thrive or striving to survive: Professional identity constructions of medical trainees in clinical assessment activities

et al. 2023

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ContextAssessment plays a key role in competence development and the shaping of future professionals. Despite its presumed positive impacts on learning, unintended consequences of assessment have drawn increasing attention in the literature. Considering professional identities and how these can be dynamically constructed through social interactions, as in assessment contexts, our study sought to understand how assessment influences the construction of professional identities in medical trainees.MethodsWithin social constructionism, we adopted a discursive, narrative approach to investigate the different positions trainees narrate for themselves and their assessors in clinical assessment contexts and the impact of these positions on their constructed identities. We purposively recruited 28 medical trainees (23 students and five postgraduate trainees), who took part in entry, follow‐up and exit interviews of this study and submitted longitudinal audio/written diaries across nine‐months of their training programs. Thematic framework and positioning analyses (focusing on how characters are linguistically positioned in narratives) were applied using an interdisciplinary teamwork approach.ResultsWe identified two key narrative plotlines, striving to thrive and striving to survive, across trainees' assessment narratives from 60 interviews and 133 diaries. Elements of growth, development, and improvement were identified as trainees narrated striving to thrive in assessment. Neglect, oppression and perfunctory narratives were elaborated as trainees narrated striving to survive from assessment. Nine main character tropes adopted by trainees with six key assessor character tropes were identified. Bringing these together we present our analysis of two exemplary narratives with elaboration of their wider social implications.ConclusionAdopting a discursive approach enabled us to better understand not only what identities are constructed by trainees in assessment contexts but also how they are constructed in relation to broader medical education discourses. The findings are informative for educators to reflect on, rectify and reconstruct assessment practices for better facilitating trainee identity construction.

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Widening how we see the impact of culture on learning, practice and identity development in clinical environments

Cited by 14 publications

References 31 publications

Learning in and across communities of practice: health professions education students’ learning from boundary crossing

Learning in and across communities of practice: health professions education students’ learning from boundary crossing

Veterinary professional identity: Conceptual analysis and location in a practice theory framework

Striving to thrive or striving to survive: Professional identity constructions of medical trainees in clinical assessment activities

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