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Knowing and acting in the clinical workplace: trainees’ perspectives on modelling and feedback

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Abstract

In this article we discuss clinical workplace learning using a dual approach: a theoretical one and an empirical one. Drawing on the philosophical work of Aristotle, Polanyi and Schön we posit that the ‘knowing and acting’ underpinning day-to-day medical practice is personal and embraces by nature a tacit dimension. Consequently, imparting and acquiring this knowledge type necessitates personal interaction between trainer and trainee. The tacit dimension particularly influences modelling and feedback. In our empirical exploration we explore these educational routes in two disparate disciplines: surgery and paediatrics. We use a longitudinal design with in-depth interviewing. Our conclusion on modelling is: modelling is a dynamic and fragmented process reflecting discipline bound characteristics and working styles. On feedback it is: ‘feedback’ serves as vehicle for three distinctive forms of commenting on performance, each holding a specific power of expression for learning. We propose to view clinical workplace learning as: an interactive master-apprenticeship model encompassing modelling and feedback as natural educational routes. We conceptualise modelling and feedback as ‘function’ of interaction (developing grounded theory). Modelling function and feedback function may serve to study these routes as didactical components of ongoing interaction between trainer and trainee rather than an educator-driven series of unrelated events.

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References

  • Ackrill, J. L. (1981). Aristotle the philosopher. Oxford: Oxford University Press.

    Google Scholar 

  • Archer, J. A. (2010). State of the science in health professional education: Effective feedback. Medical Education, 44, 101–108.

    Article  Google Scholar 

  • Bandura, A. (1986). Social foundations of thought and action. Englewood Cliffs, NJ: Prentice-Hall.

    Google Scholar 

  • Billett, S. (2004). Workplace participaory practices: Conceptualising workplaces as learning environments. Journal of Workplace Learning, 16, 312–324.

    Article  Google Scholar 

  • Bing-You, R. G., Paterson, J., & Levine, M. A. (1997). Feedback falling on deaf ears: Residents’ receptivity to feedback tempered by sender credibility. Medical Teacher, 19, 40–44.

    Article  Google Scholar 

  • Bleakley, A. (2005). Stories as data, data as stories: Making sense of narrative inquiry in clinical education. Medical Education, 39, 534–540.

    Article  Google Scholar 

  • Bleakley, A. (2006). Broadening conceptions of learning in medical education: The message from team-working. Medical Education, 40, 150–157.

    Article  Google Scholar 

  • Brownhill, R. J. (1983). Education and the nature of knowledge. London: Croom Helm.

    Google Scholar 

  • Bucher, R., & Stelling, J. G. (1977). Becoming professional. Beverly Hills: Sage Publications.

    Google Scholar 

  • Cote, L., & Leclere, H. (2000). How clinical teachers perceive the doctor-patient relationship and themselves as role models. Academic Medicine, 75, 1117–1124.

    Article  Google Scholar 

  • Coulson, M. A. (1972). Role: A redundant concept in sociology? Some educational considerations. In J. A. Jackson (Ed.), Role (pp. 107–128). Cambridge: Cambridge University Press.

    Google Scholar 

  • Cruess, S. R., Cruess, R. L., & Steinert, Y. (2008). Role modelling-making the most of a powerful teaching strategy. Britisch Medical Journal, 336, 718–721.

    Article  Google Scholar 

  • Eisner, E. W. (1985). The art of educational evaluation. London: The Falmer Press.

    Google Scholar 

  • Ende, J. (1983). Feedback in clinical medical education. Journal of the American Medical Association, 250, 777–781.

    Article  Google Scholar 

  • Eraut, M. (1994). Developing professional knowledge and competence. London: The Falmer Press.

    Google Scholar 

  • Eraut, M. (2000). Non-formal learning and tacit knowledge in professional work. British Journal of Educational Psychology, 70, 113–136.

    Article  Google Scholar 

  • Eraut, M. (2004). Informal learning in the workplace. Studies in Continuing Education, 26, 247–273.

    Article  Google Scholar 

  • Eraut, M. (2007). Learning from other people in the workplace. Oxford Review of Education, 33, 403–422.

    Article  Google Scholar 

  • Goffmann, E. (1969). Where the action is. London: The penguin Press.

    Google Scholar 

  • Goldman, G. M. (1990). The tacit dimension of clinical judgment. Yale Journal of Biology and Medicine, 63, 47–61.

    Google Scholar 

  • Hattie, J., & Timperley, H. (2007). The power of feedback. Review of Educational Research, 77, 81–112.

    Article  Google Scholar 

  • Irby, D. M. (1986). Clinical teaching and the clinical teacher. Journal of Medical Education, 61, 35–45.

    Google Scholar 

  • Irby, D. M., Cooke, M., & O’Brien, B. C. (2010). Calls for reform of medical education by the Carnegie foundation for the advancement of teaching: 1910 and 2010. Academic Medicine, 85, 220–227.

    Article  Google Scholar 

  • Kenny, N. P. (1997). Does good science make good medicine? Incorporating evidence into practice is complicated by the fact that clinical practice is as much art as science. Canadian Medical Association Journal, 157, 33–36.

    Google Scholar 

  • Kenny, N. P., Mann, K. V., & MacLeod, H. (2003). Role modelling in physicians’ professional formation: Reconsidering an essential but untapped educational strategy. Academic Medicine, 78, 1203–1210.

    Article  Google Scholar 

  • Kilminster, S. M., & Jolly, B. C. (2000). Effective supervision in clinical practice settings: A literature review. Medical Education, 34, 827–840.

    Article  Google Scholar 

  • Kluger, A. N., & DeNisi, A. (1996). The effects of feedback interventions on performance: A historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychological Bulletin, 119, 254–284.

    Article  Google Scholar 

  • Kvale, S. (1996). InterViews: An introduction to qualitative research interviewing. Thousand Oaks: Sage Publications.

    Google Scholar 

  • Malterud, K. (1995). The legitimacy of clinical knowledge: Towards a medical epistemology embracing the art of medicine. Theoretical Medicine, 16, 183–198.

    Article  Google Scholar 

  • Malterud, K. (2001). Qualitative research: Standards, challenges, and guidelines. Lancet, 358, 483–488.

    Article  Google Scholar 

  • Mamede, S., & Schmidt, H. G. (2004). The structure of reflective practice in medicine. Medical Education, 38, 1308.

    Article  Google Scholar 

  • Mann, K. V. (2011). Theoretical perspectives in medical education: Past experience and future possibilities. Medical Education, 45, 60–68.

    Article  Google Scholar 

  • Maudsley, G., & Strivens, J. (2000). Promoting professional knowledge, experiential learning and critical thinking for medical students. Medical Education, 34, 544.

    Google Scholar 

  • McDonald, C. J. (1996). Medical heuristics: The silent adjudicators of clinical practice. Annals of Internal Medicine, 124, 56–62.

    Article  Google Scholar 

  • McWhinney, I. R. (1989). An acquaintance with particulars…. Family Medicine, 21, 298.

    Google Scholar 

  • Molander, B. (1992). Tacit knowledge and silenced knowledge: Fundamental problems and controversies. In B. Goranzon & S. M. Florin (Eds.), Skill and education: Reflection and experience (pp. 9–31). New York: Springer.

    Chapter  Google Scholar 

  • Nyiri, J. C., & Smith, B. (1988). Practical knowledge: Outlines of a theory of traditions and skills. London: Croom Helm.

    Google Scholar 

  • Oakeshott, M. (1967). Learning and teaching. In R. S. Peters (Ed.), The concept of education. London: Routledge and Kegan Paul.

    Google Scholar 

  • Orasanu, J., & Connoly, T. (1993). The reinvention of decision making. In G. A. Klein & J. Orasanu (Eds.), Decision making in action: Models and methods (pp. 3–20). Norwood, NJ: Ablex.

    Google Scholar 

  • Paice, E., Heard, S., & Moss, F. (2002). How important are role models in making good doctors? British Medical Journal, 325, 707–710.

    Article  Google Scholar 

  • Pintrich, P. R., & Schunk, D. H. (1996). Other social cognitive processes. In P. R. Pintrich & D. H. Schunk (Eds.), Motivation in education (pp. 153–197). Englewood Cliffs: Prentice-Hall.

    Google Scholar 

  • Polanyi, M. (1962). Personal knowledge: Towards a post-critical philosophy. Chicago: The University of Chicago Press.

    Google Scholar 

  • Ryle, G. (1949). The concept of mind. Chicago: The University of Chicago Press.

    Google Scholar 

  • Sanders, A. F. (1988). Michael Polanyi’s post-critical epistomology. Amsterdam: Editions Rodopi.

    Google Scholar 

  • Sargeant, J. (2006). Multi-source feedback for physician learning and change. Dissertation, University of Maastricht, The Netherlands.

  • Schön, D. A. (1983). The reflective practitioner. How professionals think in action. London: Temple Smith.

    Google Scholar 

  • Schön, D. A. (1987a). Educating the reflective practitioner: Towards a new design for teaching and learning in the professions. San Francisco: Jossey-Bass Publishers.

    Google Scholar 

  • Schön, D. A. (1987b). From technical rationality to reflection-in-action. In J. Dowie & A. Elstein (Eds.), Professional judgement: A reader in clinical decision making (pp. 60–77). Cambridge: Cambridge University Press.

    Google Scholar 

  • Schuwirth, L. W. T., & Van der Vleuten, C. P. M. (2004). Changing education, changing assessment, changing research? Medical Education, 38, 805–812.

    Article  Google Scholar 

  • Shuval, J. T., & Adler, I. (1980). The role of models in professional socialization. Social Science and Medicine, 14A, 5–14.

    Google Scholar 

  • Silverman, D. (2001). Interpreting qualitative data (2nd ed.). London: SAGE Publications Ltd.

    Google Scholar 

  • Skeff, K. M., & Mutha, S. (1998). Role models-guiding the future of medicine. New England Journal of Medicine, 339, 2015–2017.

    Article  Google Scholar 

  • Stegeman, J. H. (2008). Gezel bij moderne meesters (Pupils of modern masters). Dissertation, University of Amsterdam, The Netherlands.

  • Sternberg, R. J., & Horvath, J. A. (1999). Tacit knowledge in professional practice: Researcher and practitioner perspectives. Mahwah, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Svenaeus, F. (2003). Hermeneutics of medicine in the wake of Gadamer: The issue of phronesis. Theoretical Medicine and Bioethics, 24, 407–431.

    Article  Google Scholar 

  • Sweeney, K. (2006). Personal knowledge: Doctors are much more than simple conduits for clinical evidence. British Medical Journal, 332, 129–130.

    Article  Google Scholar 

  • Teunissen, P. W., ed. (2009).Unravelling learning by doing. A study of workplace learning in postgraduate medical education. Dissertation, Free University of Amsterdam, The Netherlands.

  • Teunissen, P. W., Stapel, D. A., Van der Vleuten, C., et al. (2009). Who wants feedback? An investigation of the variables influencing residents’ feedback-seeking behavior in relation to night shifts. Academic Medicine, 84, 910–917.

    Article  Google Scholar 

  • Williams, C. (2010). Understanding the essential elements of work-based learning and its relevance to everyday clinical practice. Journal of Nursing Management, 18, 624–632.

    Article  Google Scholar 

  • Wright, S. M., Kern, D. E., Kolodner, K., Howard, D. M., & Brancati, F. L. (1998). Attributes of excellent attending-physician role models. New England Journal of Medicine, 339, 1986–1993.

    Article  Google Scholar 

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Acknowledgments

The authors wish to thank Peter de Laat and Niek Klazinga for their valuable comments in an earlier phase of this project. They thank Clare Price. Her knowledgeable and creative comments have greatly contributed to the English text.

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None.

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Not required for this study type in the Netherlands.

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Authors and Affiliations

  1. Department of Medical Ethics and Philosophy, Erasmus Medical Center, Erasmus University Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands

    J. H. Stegeman

  2. Health Council of The Netherlands, The Hague, The Netherlands

    E. J. Schoten

  3. Department of Surgery, Leiden University Medical Center, Leiden University, Leiden, The Netherlands

    O. T. Terpstra

Authors
  1. J. H. Stegeman
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  2. E. J. Schoten
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  3. O. T. Terpstra
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Correspondence to J. H. Stegeman.

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Stegeman, J.H., Schoten, E.J. & Terpstra, O.T. Knowing and acting in the clinical workplace: trainees’ perspectives on modelling and feedback. Adv in Health Sci Educ 18, 597–615 (2013). https://doi.org/10.1007/s10459-012-9398-4

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